The California State Senate passed the single payer bill. This is hopefully the start of the process of exploring what that actually means and how it can actually be done in a state with resources and technical sophistication.
Under the Senate bill, the “Healthy California” program would take over payment for almost all medical spending in the state. It would absorb funding currently going to federal and state programs, and relieve employers, their workers and buyers in the individual market of premiums, deductibles and co-pays….
They need multiple waivers from the federal government to refashion Medicaid (known in California as Medi-Cal), Medicare and other federally funded health programs and redirect federal dollars into their own systems….(emphasis mine)
Show me the waivers.
If there aren’t waivers, this plan is vaporware.
California would need federal funding streams from Medicaid, Medicare, Medicare Advantage, the ACA or AHCA, Veterans Administration, and the IRS via the cash value of the tax advantage of employer sponsored insurance coverage. I can see a legal pathway towards a Medicaid waiver. I can see a legal pathway towards an ACA waiver. I can squint hard to see an AHCA waiver.
I don’t know how California convinces a friendly administration that state wide single payer is worthy of a Center for Medicare and Medicaid Innovation (CMMI). An unfriendly administration won’t grant a Medicare CMMI waiver.
Transferring all of the VA’s funds and responsibilities to a state is a radical redevelopment of the obligations of the VA and its service delivery system/.
The IRS/Treasury ceding the cash value of a tax deduction to a state is an incredible renegotiation of power and leverage between the state and the federal government. California’s federal tax code would be fundamentally different than the tax code in the rest of the country.
I am going to let the political scientists and the constitutional lawyers really examine the altered relationship that would occur within the US governing framework if California received all of these waivers. I just know that at least half of the money that the feasibility analysis assumes that California will get from federal sources needs waivers that require Congressional majorities in both chambers, a Presidential signature and at least five votes on the Supreme Court.
California would need some incredible waivers to finance single payer in a single state.
Show me the waivers.