FAQ: California Healthcare Roadblock Removal Act

Fellow Californians, if you are serious about having any kind of healthcare improvements or expansion, then the California Healthcare Roadblock Removal Act is a must-pass ballot initiative. Read on for an FAQ and steps to help. If you are ignoring this and still say you want universal healthcare or single payer, etc. *in California* then you are not an ally. It really is night vs day.

How you can help:
1) Call your state legislators and tell them to put the “California Healthcare Roadblock Removal Act” on the ballot. The Democrats control 2/3rds of the legislature and just adopted single payer as a party plank. If they really are for single payer, then they will get behind this initiative. This should be a no-brainer.

2) Help us collect signatures. While we are trying to nudge the legislature to make this step moot, we are going to go forward until they change their minds. You will need to be registered California voter (if you’re not, please register to vote). Please go to our page and send us a message saying you want to help.

3) Contribute $5 or more to help with operations, materials, and paid signature gatherers.


Enact Universal Healthcare for CA is a California 501(c)(4) non-profit run by Californians. We’re not a state agency, and we don’t have deep pockets. We’re simply working-class folks who want to help our neighbors.

Obligatory IRS safe-harbor statement: Contributions or gifts to Enact Universal Healthcare for CA are not tax deductible.

4) If you’re with another organization, talk to them about the ballot initiative and have them support us.


Q: Where can I find the text of the Calfornia Healthcare Roadblock Removal Act ballot initiative?

A: https://oag.ca.gov/system/files/initiatives/pdfs/17-0019%20%28Healthcare%20Roadblock%20Removal%29.pdf

Q: The measure’s findings and declarations allude to the fiscal rules in the California Constitution that you see as an obstacle to instituting single-payer healthcare.

A: We’re not the only people who see the Gann Limit (Proposition 4) and Propositions 98 & 111 as obstacles that will require voter approved exemptions for healthcare:

David Dayen at The Intercept with an acknowledgement from Senator Lara:

Assembly Speaker Anthony Rendon:

The Legislative Analyst’s Office report on SB 562:

“Article XIII B (often referred to as the “Gann Limit”) constrains overall state spending growth based on population growth and inflation. Due to subsequent changes made by the voters, the Gann Limit has not fundamentally constrained state spending since the 1980s. However, the very large tax revenues that this bill would require (almost twice current General Fund revenue) would clearly exceed the Gann Limit. Therefore, to successfully implement the bill, the voters would need to amend the state constitution to either repeal the Gann Limit or exempt the taxes to fund the Program from the Gann Limit.

“Article XVI, Section 8 (Proposition 98 of 1988) generally requires the state to make payments for K-14 education equal to about 50% of annual General Fund revenues. (The actual funding formulas for Proposition 98 are complex and vary from year to year based on economic conditions and state budgeting.) In the context of Proposition 98, the term “General Fund” revenue refers to state tax revenues, not simply revenues that are deposited in the state’s General Fund. Any taxes raised to support this bill would be considered the proceeds of taxes and would be subject to the requirements of Proposition 98. Since it would be infeasible to dedicate one-half of the new revenues for this program to education (or to raise twice the amount needed for the bill), the voters would need to exempt the tax revenues generated to fund this bill from the requirements of Proposition 98.”

The 2017 LAO report on Propositions 98 & 111:

The 2017 LAO report on Proposition 4, the Gann Limit:

Now, people can spin that any way they like, but if these constitutional issues are not addressed through a ballot initiative, any meaningful healthcare expansion will be sued into oblivion. The Legislature by itself cannot change the California Constitution.

Q: But how does the measure address those constitutional provisions, and what do you expect to happen?

A: The “California Healthcare Roadblock Removal Act” addresses the constitutional provisions by creating a healthcare trust fund and explicitly placing it outside the General Fund, and exempting any revenues deposited in or withdrawn from the healthcare trust fund. The Legislature will now be able to do its job and deliberate, hold hearings, and propose funding mechanisms that all Californians can weigh in on, improve, and feel a part of the legislative process, rather than having no say, no time for debate, or a ballot initiative they can’t change.

And I need to point out, the California voters have approved these same exemptions before.
Proposition 98 “Tobacco Tax and Health Protection Act of 1988”
Proposition 10 “California Children and Families First Act of 1998”
Proposition 56 “California Healthcare, Research and Prevention Tobacco Tax Act of 2016”
All of those propositions are healthcare related.

Q: It appears the heart of the proposal is the establishment of this Healthy California Trust Fund, but I’m not sure I see if there’s any tax or other mechanism to direct money into the fund. How exactly would money be raised to be put to use to establish universal healthcare?

A: So, I think it needs to be explicitly said, this is the “California Healthcare Roadblock Removal Act” and not an establishment of any kind of healthcare system. As I mentioned in the answer to the previous question, it will be up to our esteemed Legislature to fund the necessary studies, write the necessary legislation, propose revenue sources, etc. Basically, they will need to do the job they were elected to do. Vermont’s legislature is currently doing this, why can’t California’s? (http://digital.vpr.net/post/bill-providing-primary-care-all-vermonters-viewed-first-step-single-payer#stream/0) This initiative gives them the tools they are asking for.

Much of what you’re asking here is actually related to SB 562, and has been answered by the UMass-Amherst fiscal study of SB 562 (https://www.peri.umass.edu/publication/item/996-economic-analysis-of-the-healthy-california-single-payer-health-care-proposal-sb-562). If the Legislature wants another opinion, they have all the power to fund another study right now. But I digress.

Q: The purpose of the measure is to “direct, and place reasonable burden on, the Legislature” to act. How does this measure do this?

A: Well, that’s part of one of the purposes. In full:

(a) To establish a healthcare trust fund independent of the General Fund.

(b) To direct, and place reasonable burden on, the Legislature to enact healthcare policy and funding mechanisms through normal legislative deliberation.

Leaving out all of that just dilutes the point.

As far as part (b), this happens naturally at a few points in the process.

1) After we collect 25% of the necessary signatures (about 150,000), the Legislature is mandated to hold hearings on the initiative (http://codes.findlaw.com/ca/elections-code/elec-sect-9034.html). The legislators get to decide at this point whether their claims that they are for single payer actually hold water. They could very well save us time and immediately place this initiative on the ballot themselves.

2) After we collect 600,000 signatures, it will be placed on the ballot. Now, those are likely 600,000 very annoyed constituents who are wondering why the Legislature couldn’t have just placed this on the ballot themselves. We are confident we can get more signatures than necessary.

3) Election Day. The latest California-specific survey on single payer showed 70% in support, and even with attempting to bad-mouth single payer with all the counterclaims unchallenged, that dropped to a solid 58% support (http://www.tulchinresearch.com/wp-content/uploads/2017/06/Healthy-California-Act-Survey-public-memo-5-17-final.pdf). Keep in mind that survey was done in May. Single payer support has been increasing since then, and we are confident that this initiative will pass. Now, if the Legislature hasn’t acted already on passing a complete bill for universal single payer healthcare including its funding in anticipation of the initiative, they will have a choice: Either they can keep throwing their hands up in the air, saying “it’s too hard!” and lose their next election, or they can take this as a mandate and pass the legislation that the California people demand.