BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 921|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
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|327-4478 | |
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THIRD READING
Bill No: SB 921
Author: Kuehl (D)
Amended: 6/3/03
Vote: 21
SENATE INSURANCE COMMITTEE : 5-3, 4/30/03
AYES: Speier, Escutia, Figueroa, Perata, Soto
NOES: Johnson, Morrow, Oller
SENATE HEALTH & HUMAN SERV. COMMITTEE : 8-3, 5/7/03
AYES: Ortiz, Alarcon, Chesbro, Figueroa, Florez, Kuehl,
Romero, Vincent
NOES: Aanestad, Ashburn, Battin
SENATE APPROPRIATIONS COMMITTEE : 8-5, 5/29/03
AYES: Alpert, Bowen, Burton, Escutia, Karnette, Machado,
Murray, Speier
NOES: Battin, Aanestad, Ashburn, Johnson, Poochigian
SUBJECT : Single payer health care coverage
SOURCE : Author
DIGEST : This bill states the intent of the Legislature
to implement a single payer universal health care delivery
system in California.
ANALYSIS : Existing law does not provide a system of
universal health care coverage for California residents.
Existing law provides for the creation of various programs
to provide health care services to persons who have limited
CONTINUED
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incomes and meet various eligibility requirements. These
programs include the Healthy Families Program administered
by the Managed Risk Medical Insurance Board, and the
Medi-Cal program administered by the State Department of
Health Services. Existing law provides for the regulation
of health care service plans by the Department of Managed
Health Care and health insurers by the Department of
Insurance.
The issue of universal health insurance has been around
since 1945 when Governor Earl Warren's proposal was
introduced as AB 800 (Wollenberg), which died in the policy
committee after a motion to withdraw from committee failed.
Related legislation
SB 2123 (Lee and Watson), introduced in 1998, would have
established a short, modified framework for a California
single payer system, but the bill failed in the Health and
Human Services Committee. SB 480 (Solis - Chapter,
Statutes of 1999) required the secretary of the California
Health and Human Services Agency to report to the
Legislature concerning options for achieving universal
health care coverage and to establish a process to develop
those options. SB 1414 (Speier), introduced in 2002,
would have created Healthy California to provide universal
coverage by expanding and consolidating public health
programs and requiring employers to provide health
insurance using a "pay or play" approach, but failed in
Senate Appropriations. SB 2 (Burton and Speier), 2003,
would create an approach to universal health coverage by
mandating all employers provide health insurance using a
"pay or play" approach. AB 30 (Richman) 2003, would expand
Healthy Families to include working adults without
children. AB 1527 (Frommer) 2003, would mandate employers
with more than 50 employees to provide health insurance
using a "pay or play" approach. AB 1528 (Cohn) 2003, would
mandate all employers to provide health insurance using a
"pay or play" approach, require individuals without
employer provided health insurance to obtain health
insurance, and would create the California Essential Health
Benefits Program.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
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Local: No
Note: Because of the length of the analysis, the list of
SUPPORT/ OPPOSITION will come after the arguments in
support/opposition.
ARGUMENTS IN SUPPORT : The author states there are no
uniform regulations and statutes governing the health care
system leading to a highly fragmented health insurance and
delivery system that is administratively complex and
annually diverts billions of dollars in health care
spending from direct health care services to administrative
costs. The author adds that it provides care based on
income and insurance status rather than medical need, with
intricate interactions with public and private health
insurance programs, providers, and regulatory agencies that
are confusing and time-consuming for consumers and
providers alike.
The author believes existing law provides no mechanism for
stabilizing the growth in health care spending that is
quickly outpacing growth in GDP, and that absent budgeting
capabilities, growth in health care spending is rapidly
surpassing the ability to afford current levels of benefits
or to add new benefits related to technological
improvements. International comparisons demonstrate the
ability of single payer health care systems stabilize the
growth in health care spending.
The author points out that health care providers spend
increasing amounts of time navigating the porous network of
public and private health insurance programs. For example,
UCSF Children's Hospital works with nearly 80 different
health insurance policies and public programs each with its
own benefits package, formulary schedule, and rate of
co-payments and deductibles. One peninsula group practice
serving 70,000 patients works with 6,000 different health
insurance plans.
The author states between 20-30 percent of the health care
dollar is spent on administration (excluding profit). A
quantitative analysis performed by the Lewin Group that a
single payer system, California could reduce administrative
costs to 1.8 percent of health care spending, allowing the
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system to divert $14 billion dollars annually to direct
health care services.
The author states the United States leads the world in
health care spending at about $5,000 per person per year on
average - more than twice the average in other
industrialized countries, and that despite our high level
of spending, the U.S. ranks 37th in population-based health
outcome measurements according to the World Health
Organization, well below the rankings of all other
industrialized nations. This is true because a large
portion of the $5,000 is not going to health services and
because nearly 20 percent of the population has no health
insurance.
The author states the bill has as its purpose, establishing
universal health insurance for all California residents,
stabilizing growth in health care spending, including costs
to employers, and improving health outcomes and consumer
and provider satisfaction.
ARGUMENTS IN OPPOSITION : The Association of California
Life and Health Insurance Companies (ACLHIC) disagrees with
the two major premises of the bill: that government systems
are more efficient than private business, and that a single
payer system would cost less than the current private
system. ACLHIC points out that patients in Canada or
England face lengthy waiting times for services and their
medical outcomes are very poor compared to the United
States, and California particular. ACLHIC states that not
only are survival rates from cancer and other
life-threatening diseases abysmal in comparison, but the
services Californians take for granted are so rationed that
what should be routine treatment becomes life-threatening.
The California Association of Health Plans (CAHP) states
proponents of single payer reforms believe that wiping out
competing health plans will generate enormous savings from
lowered administrative costs and the elimination of profit,
and that the savings will be so substantial than 7 million
uninsured Californians can be immediately afforded
health-care coverage with not a penny of additional
financing. CAHP states that the bulk of the administrative
costs will not eliminated under a single-payer system.
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Claims payment, utilization review, disease and care
management programs, the development of drug formularies,
and customer service functions make up a lion's share of
what is commonly called "administration," and that none of
these functions are wasteful or inefficient and none can be
ignored under a single-payer system.
SUPPORT : (Verified 6/2/03)
9 to 5, Bay Area Chapter, National Association of Working
Women
A Window Between Worlds
ACCESS, Empowering People with Disabilities
Activist Arts
ACT UP East Bay
AFSCME, AFL-CIO
AFSCME Retirees, Chapter 36
Alameda County Advisory Commission on Aging
Alameda County Board of Supervisors
All American Home Center, medium sized business
Almaden Hills United Methodist Church, San Jose, California
Amalgamated Transit Union, Local 192
American Association of University Women, California
American Civil Liberties Union (ACLU), Southern California
American Civil Liberties Union (ACLU), South Bay Chapter
American Medical Student Association
American Medical Women's Association, Inc.
American Nurses Association, California
Americans for Democratic Action
Americans for Democratic Action, Southern California
Asian and Pacific Islander American Health Forum (APIAHF)
Asthma Education and Resource Council
Berkeley Retired Teachers Association
Beth Shir Sholom
Breaking Barriers
Breast Cancer Action
Burma Forum, Los Angeles
Butte County Health Care Coalition
California Advocates for Nursing Home Reform
California Association of Midwives
California Church Impact
California Coalition for Youth
California Commission on Aging
California Commission on the Status of Women
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California Council of Community Mental Health Agencies
California Democratic Council
California Democratic Party, Disability Caucus
California Dental Hygienist's Association
California Disability Alliance
California Federation of Teachers
California Foundation for Independent Living Centers
California Immigrant Welfare Collaborative
California Independent Public Employees Legislative Council
California Insurance Commissioner, John Garamendi
California Nurses Association
California Optometric Association
California Part Time Faculty Association
California Physical Therapy Association
California Physicians Alliance
California Public Health Association - North
California Retired Teachers Association, East Bay
California School Employees Association (CSEA)
California Senior Legislature
California Society for Clinical Social Work
California Teachers Association (CTA)
California Women's Law Center
Carlton Designs
Castro Valley Democratic Club
Center for Independence of the Disabled, Inc
Center for Independent Living, Fresno
Central Coast Center for Independent Living
Child Care Law Center
The Citizenship Project
City and County of San Francisco
City of Berkeley
City of Santa Cruz
City of Santa Monica
City of West Hollywood
Claremont House Resident's Council
Coalition for a Living Wage
Coalition for Community Health
Coalition for Quality Health Care
Coast-to-Coast Community Campaigns
Committee for Social Justice, Santa Barbara
Community Action Board, Santa Cruz County, Inc.
Community Clinic Association of Los Angeles County
Community Homeless Alliance Ministry (CHAM)
Community Leadership Development Council
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Community Rehabilitation Services, Inc.
Congress of California Seniors
Congress of California Seniors, Region 3
Consumer Federation of California (CFC)
Consumers Union
Contra Costa County Advisory Council on Aging
Contra Costa County Senior Nutrition Program Advisory
Council
Council on Wireless Technology Impacts
Counseling and Consulting Association
County of Sacramento, Department of Health and Human
Services
Dayle McIntosh Center
Death Penalty Focus, Santa Cruz Chapter
Democratic Action Club of Chico
Democratic Party of the San Fernando Valley
Democratic Socialists of America, East Bay
Democratic Women of Santa Barbara County
Democrats for Change
Demos Democratic Club of Hayward
Disability Resource Agency for Independent Living (DRAIL)
Drug Policy Alliance
Dunham & Associates (small business)
East Bakersfield Community Health Center
East Bay Peace Action
East Bay Women for Peace
El Cerrito Democratic Club
Elections Committee of the County of Orange (ECCO)
English Learning Advisory Committee
The Episcopal Church of Saint John-the-Baptist
The Evergreen Democratic Club of San Jose
Faculty Association of California Community Colleges, Inc
(FACCC)
Family Counseling Center
The Federation of Retired Union Members (FORUM), Santa
Clara and San Benito County
Four Winds Inc.
Fresno County Democratic Central Committee
Fresno Stonewall Democrats
Friends Committee on Legislation, California
Funeral Consumers Alliance of Monterey Bay, Inc.
Gardena Valley Democratic Club
Garment Worker Center
Globallinx Network, Inc.
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Gray Panthers, California
Gray Panthers, Berkeley
Gray Panthers, Central Contra Costa County
Gray Panthers, Long Beach
Gray Panthers, Marin
Gray Panthers, Sacramento
Gray Panthers, San Francisco
Gray Panthers, South Bay
Gray Panthers, Southern Alameda County
Green Party of Alameda County
Green Party of Butte County
Green Party of San Mateo County
Green Party of Santa Barbara County
Green Party of Santa Clara County
Green Party of Santa Cruz County
Hadassah Southern California Nurses Council of San Diego
County
Health Access - California
Health Care Council of Orange County
Health Care for All - California
Health Care for All - California, Central California
Health Care for All - California, Marin
Health Care for All - California, Los Angeles
Health Care for All - California, Sacramento Valley
Health Care for All - California, San Francisco
Health Care for All - California, San Francisco Mid
Peninsula
Health Care for All - California, Santa Barbara
Health Care for All - California, Santa Cruz
Health Care for All - California, Santa Clara County
Health Care for All - California, Sonoma County
Health Care for All - California, South Bay/Long Beach
Health Care for All - California, Orange County
Health Care for All - California, Tulare/Kings County
Hermanson's Employment Services (small business)
Humanist Society of Santa Barbara
Homeless Health Care, Los Angeles
Ideas in Motion (small business)
Independent Living Resource Center
Independent Living Resource Center, San Francisco
Insure the Uninsured Project (ITUP)
The Interfaith Council on Religions, Race, Economic and
Social Justice
The International Friendship Society
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Jennings/Des Anges (small business)
Jericho
Judge Joseph G. Kennedy Democratic Club, San Francisco
Kayline (small manufacturing company)
Kennedy Club of San Joaquin Valley
The Lambda Letters Project
Latino Issues Forum
Law Offices of Stewart, Green and McGowan
Law Offices of Macdonald and Associates
League of Women Voters, California
League of Women Voters, Santa Barbara
League of Women Voters, Whittier
Lise Matthews and Associates
Lifelong Medical Care
Long Beach Greens
Los Angeles Alliance for a New Economy
Los Angeles Breast Cancer Alliance
Los Angeles Coalition to End Hunger and Homelessness
Los Angeles County Board of Supervisors
Los Angeles County HIV Drug and Alcohol Task Force
Los Angeles Free Clinic
Los Angeles Gay and Lesbian Center
Los Angeles Metropolitan Alliance and AGENDA
Low Income Self Help Center - San Jose
Marin County Pharmaceutical Association
Marin Democratic Club
Marin Family Action
Marin Interfaith Council
Marin Interfaith Youth Outreach
Marin United Taxpayers Association
Matthews De Turck, Architecture (small business)
Mental Health Association, California
Mental Health Association, Los Angeles County
Metropolitan Community Church, Los Angeles
Mexican American Legal Defense and Educational Fund
(MALDEF)
Middle East Children's Alliance
Minerva Consulting (small business)
Musicians Union, Local 6
Monterey Peninsula Monthly Meeting of Friends
NAMI, California
NAMI, Yuba-Sutter
NAMI, San Gabriel Valley
The Nation Group
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National Association for the Advancement of Colored People
(NAACP), Pasadena Branch
National Association of Social Workers - California
National Association of Social Workers, Santa Barbara
County Unit
National Council of Jewish Women, California
National Council of Jewish Women, Los Angeles
National Council of Jewish Women, Sacramento
National Organization for Women (NOW), California
National Organization for Women (NOW), Oakland/East Bay
National Organization for Women (NOW), San Jose/South Bay
National Women's Political Caucus, Alameda North
National Women's Political Caucus, San Fernando Valley
Neighbor to Neighbor, San Francisco
Old Lesbians Organizing for Change
Older Women's League - California
Older Women's League - Inland Empire
Older Women's League - Ohlone/East Bay Chapter
Older Women's League - Sacramento Capitol Chapter
Older Women's League - San Francisco
Older Women's League - Santa Clara County
Operation Access
Orange County Friends Meeting
p-conn-tie Hot Ties (small business)
Pacific Pride Foundation
Pacific Unitarian Church
Palo Alto Friends Meeting (Quakers)
Palos Verdes Peninsula Democratic Club
Peace Action of San Mateo
Peninsula Democratic Coalition
Peninsula Peace and Justice Center
People for a National Health Program
Peoples Democratic Club
Performing and Media Arts
Pharmacists Planning Service, Inc.
Physicians for Social Responsibility, San Francisco Bay
Area
The PICO California Project
Planned Parenthood Affiliates of California (PPAC)
Planning for Elders in the Central City (PECC)
Pride At Work
Professional Pharmaceutical Advocates
Progressive Jewish Alliance
Quincy Foundation for Medical Research Charitable Trust
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Rainbow Coalition
Resources for Independent Living
Richmond Commission on Aging
Richmond Greens
Ritter House
Rolling Start, Independent Living Center
Saint John's Health Center
San Benito County Health and Human Services Agency
San Francisco AIDS Foundation
San Francisco Department and Commission on the Status of
Women
San Gabriel Valley Pharmacists Association
San Mateo Community College Federation of Teachers
Santa Barbara County Democratic Central Committee
Santa Barbara Monthly Meeting of Friends, Society of
Friends
Santa Barbara Religious Society of Friends
Santa Barbara Women's Political Committee
Santa Clara County Health Care Committee
Santa Cruz Action Network
Santa Cruz County Coalition for a Living Wage
Screen Actors Guild
Seal Press
Senior Advocacy Council, Pasadena
Senior Access Adult Day Health and Alzheimer's Care
Seniors Council of Santa Cruz and San Benito Counties
Service Employees International Union (SEIU), California
State Council
SEIU, Local 616
SEIU, Local 415
SEIU, Local 535
SEIU, Local 949
The Shefa Fund
The Sherman Oaks Democratic Club
The South Hayward Parish
Good Shepherd Lutheran Church
Mt. Eden Presbyterian Church
St. Clement Catholic Church
Starr King Unitarian Universalist Church
United Church of Hayward
Wesley United Methodist Church
Westminster Hills Presbyterian Church
Social Wokers for Social and Economic Justice
Southern California Library for Social Studies and Research
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Southern California Public Health Association
St. Anthony Foundation
St. John the Baptist Episcopal Church
St. John's Senior Center
St. Mary's Center
Statewide California Coalition for Battered Women
Stinson Beach Medical Center
Through the Looking Glass, National Resource Center for
Patients with Disabilities
Town and Country Democratic Club
Trinity United Methodist Church of Berkeley
Unitarian Society of Santa Barbara, Social Justice
Committee
Unitarian Universalist Church of Ventura
United Electrical, Radio and Machine Workers of America, UE
District 10
United Nurses Association of California/Union of Health
Care Professionals
United Steelworkers of America
United Union of Roofers, Waterproofers and Allied Trades,
Local No. 81
U.S.A/Cuba InfoMed
Valley Democrats United
Valley Financial
Van Dyke and Associates, Land Use Planning
Venice Family Clinic
Vote Health
Warehouse Union Local 6, ILWU
West Contra Costa Healthcare District
West County Toxics Coalition
West Hollywood Democratic Club
West Hollywood Disability Advisory Board
Westside Family Health Center
Women Democrats of Placer County
Women's Cancer Resource Center
The Women's Foundation
Women's International League for Peace and Freedom,
Berkeley/East Bay
Women's International League for Peace and Freedom,
Monterey County
Women's International League for Peace and Freedom,
Peninsula Branch
Women's International League for Peace and Freedom, Santa
Cruz
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The Workman's Circle/Arbeter Ring, Southern California
District
Worksafe!
OPPOSITION : (Verified 6/2/03)
Association of California Life and Health Insurance
Companies
Blue Cross of California
California Association of Health Plans
California Association of Health Underwriters
California Beer and Beverage Distributors
California Health Care Association
Chamber of Commerce, Cerritos
Chamber of Commerce, Chico
Chamber of Commerce, Encinitas
Chamber of Commerce, Irvine
Chamber of Commerce, Sante Fe Springs
Coalition of California Insurance Professionals
Coors Brewing Company
Health Net
Logret Import and Export Company
Orange County Business Council
DLW:nl 6/2/03 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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