On January 31, the campaign for single-payer health care in California suffered its latest defeat. Progressive Democrats in the Assembly were unable to line up enough support for AB 1400, which would’ve launched a state takeover of private health insurance, Medicare, and Medi-Cal. So Assemblyman Ash Kalra, D-San Jose, the bill’s main sponsor, let it expire without a vote.
The bill’s failure has sparked feuds among Democrats and warnings of political retribution from the state’s nurses’ union. Progressives contemplating single-payer in other states should pay close attention. Promising single-payer and then failing to deliver may be politically riskier than sidestepping the issue altogether.
California Democrats have long had their sights set on single-payer, going back to the failed ballot initiative Proposition 186 in 1994.
In 2017, progressives in the state Senate introduced SB 562, of which AB 1400 was a virtual carbon copy. Among the staunchest supporters of both measures was the 100,000-strong California Nurses Association.
Democratic Assembly Speaker Anthony Rendon eventually killed SB 562. That bill was projected to cost California $400 billion annually, double the entire state budget. The measure included no funding mechanism; Rendon concluded that it was “woefully incomplete.”
That didn’t matter to the Nurses Association. The union’s executive director took to Twitter to post a picture of a knife with Rendon’s name on it stabbing a California grizzly bear in the back. Rendon even reported receiving death threats.
Lawmakers gave single-payer another go last year, when San Jose state Assemblyman Ash Kalra and his fellow Democrats introduced AB 1400. Voting on the reintroduced bill was delayed until January of this year so lawmakers could work on a funding mechanism for the proposal.
The funding plan they dreamt up would’ve required amending the state constitution. Their proposed Assembly Constitutional Amendment 11 would’ve allowed the legislature to hike taxes to fund single-payer by a simple majority, rather than the two-thirds majority required under current law.
Ratifying a constitutional amendment takes the approval of two-thirds of both houses of the legislature and a majority of voters at the ballot box.
The tax hikes that Kalra and company envisioned amounted to roughly $163 billion in new taxes each year—more than California’s total tax revenue in any year prior to 2020. The total price tag for the bill was estimated as high as $391 billion.
The unprecedented cost made even the staunchest advocates give state-run health insurance a second thought. Governor Gavin Newsom, who won the California Nurses Association’s support on the campaign trail in 2018 and in a 2021 recall election promising to implement single-payer, refused to support AB 1400. And despite Democrats having control of 56 of the 80 seats in the state Assembly, Kalra decided he couldn’t amass the 41 votes needed to pass the bill.
Instead, he chose to not bring the legislation up for a vote at all. The California Nurses Association isn’t pleased. In a statement, the union said they were “outraged that Kalra chose to just give up on patients across the state.” The group chastised him for “providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California.”
Even Kalra’s Democratic colleagues have turned on him. Speaker Rendon seems to have learned his lesson from his last go-round with the Nurses Association. He said he was “deeply disappointed that the author did not bring [the] bill up for a vote.”
Other Democrats, particularly those in the Progressive Caucus who have said that they will not endorse any Democratic candidate this fall who did not support AB 1400, excoriated Kalra for not forcing lawmakers to make their stance on single-payer public. Activists are already discussing mounting primary challenges against Kalra—not to mention any other lawmaker who won’t support a state takeover of health care.
If the Nurses Association and Democratic lawmakers in California can turn on the prime sponsor of their single-payer bill, who’s to say it couldn’t happen to progressive lawmakers in other states?
From New York to Oregon, lawmakers in more than a dozen states are pursuing their own form of single-payer health care. They’d be wise to notice what just happened in California—and what’s happened in other states that have tried to move ahead with single-payer.
In 2014, Vermont Gov. Peter Shumlin declined to move forward with a plan he set in motion in 2011 that would’ve launched a state takeover of health insurance. And in 2016, Colorado voters rejected Amendment 69, which would’ve launched a state-level single-payer system, by a margin of 79% to 21%.
Government-run health care is disastrous for patients, doctors, taxpayers—and now lawmakers. California’s progressives say they are not giving up—and that single-payer will be back. But perhaps California’s single-payer firestorm will finally wake progressives up from their single-payer delusions.