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Soft Single Payer Proposal — Jan. 2019

Yesterday, we submitted this proposal for “Soft” Single Payer to the leaders of the Assembly. The proposal addresses many of the intractable concerns with “Hard” Single Payer, such as a state constitutional amendment needed to exempt healthcare from revenue restrictions, federal waivers, and challenges with ERISA (self-funded) employer health plans. There is also the psychology behind large increases to the state’s budget, and people’s perception of taxes and how insurance works. After years of research and reaching out to legal experts, we believe this is the most feasible and legally viable proposal that will get us as close as possible to single payer universal healthcare in California.

Our proposal will instead have the state charter and own a nonprofit insurance corporation that would insure people based on their incomes in the gap between Medicaid and Medicare. By being a standalone insurance company, it can also enter into contracts for Medicaid managed plans, Medicare Advantage plans, list on the Covered California exchange, and be offered through employers. Through a “Grand Bargain” between the state and providers, we can eliminate copays, coinsurance, out-of-pocket, and deductibles, and any patient can sign up with and be referred to any practice within California. In exchange for mandating 100% acceptance of this insurance, the state will cover medical & nursing school, school loans, or match retirement funds as long as doctors & nurses practice in the state for 10 years and accept assignments to underserved communities. Since Californians will now have a truly affordable insurance plan they can use anywhere in the state, an individual mandate will actually make sense and benefit everyone.

If you would like this proposal to be considered, please call the Assembly Budget Committee at (916) 319-2099. Thank you for your support.

Soft Single Payer Proposal

  • I. State-owned non-profit insurance corporation
  • A. No Waivers Needed — Insures residents in the gap between Medicaid & Medicare
  • B. Not subject to Props 13, 4, or 98 (Articles 13, 13b, & 16) — Very little funding needed
  • C. Does not touch ERISA plans
  • D. Union plans are not affected
  • E. Can be up & running quickly
  • II. Funding
  • A. Main source of funds is insurance premiums
  • 1. Premiums are adjusted based on insured’s income
  • a) Employers can contribute as with normal insurance plans
  • B. State provides or subsidizes reinsurance policies for unexpected high-cost and catastrophic claims
  • C. State guarantees or subsidizes low-interest loans for startup and capital needs
  • III. Implementation
  • A. State appoints board members who then run the nonprofit
  • B. Covers Medical, Dental, Vision, Mental Health, & Pharma
  • C. No copays, coinsurance, out-of-pocket, or deductibles
  • D. “The Grand Bargain”
  • 1. The State provides to Doctors & Nurses
  • a. Free medical/nursing school for qualified applicants
  • b. Loan forgiveness for those who’ve already completed school and residency
  • c. Matching contribution to retirement fund for those who don’t need a&b
  • 2. Must practice in California for 10 years and accept placement to underserved communities
  • 3. All California doctors, clinics, & hospitals mandated to accept this insurance
  • a. “In-network” = negotiated contracts
  • 1) Provider contracts with other insurance companies must be disclosed
  • b. “Out-of-network” = No contract or Refusal to negotiate = Medicare + 15%
  • 4. Individual mandate
  • IV. Side Benefits
  • A. Can accept contracts with Medicaid
  • B. Can be a Medicare Advantage supplemental plan
  • C. Can operate on the Covered California exchange
  • D. Any “profits” will be used to lower premiums, pay off debts, keep a reserve, and any other expenditures used as necessary to lower costs and ensure long-term solvency
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