Single-Payer Legislation Making Inroads in States

Published May 31, 2016

With government-run health care stalled at the federal level, legislators in several states are attempting to pass health care legislation of their own, including single-payer approaches in California, Missouri, and Vermont.


Recycled California Bill

The California Senate passed Senate Bill 810 in January. It would create a single-payer State Healthcare System for which all residents would be eligible.

While funding is tight across most of the country, California is facing particularly onerous budget woes. The California bill, sponsored by Sen. Mark Leno (D-San Francisco), includes a provision for $1 million to create a commission to study how to fund the single-payer system. Leno says the state could use existing state and federal dollars plus a payroll tax.

According to John Graham, director of health care studies at the Pacific Research Institute, a California-based think tank, SB-810 is recycled from a bill offered during the 2005-2006 legislative session, which Gov. Schwarzenegger vetoed.

“SB-810 would impose a government monopoly over every Californian’s access to medical services,” Graham said. “In analyzing the previous bill, I concluded that the number of physicians practicing in California would drop from 94,000 to 71,000; that Californians would suffer lengthy waiting times for treatment, time worth about $1 billion annually; and that about $9 billion of ‘free” health care would be wasted by people who don’t need it.”

The California House will likely consider the bill early this summer.

Sweeping Legislation in Missouri


Missouri legislators have introduced bills including House Bill 1480, the Missouri Universal Health Insurance Act, and Senate Bill 722, which would establish a State Universal Health Assurance Program (UHAP).

House Bill 1480 was read in January but is not currently on the calendar or scheduled for a hearing. Part of that bill prohibits private health insurers from selling health insurance competing with the proposed state-run program, banning anything that “duplicates the benefits provided … in the act.”

UHAP would be a publicly financed, statewide program covering “necessary health, mental, and dental care.” It would be administered by a 23-member board of governors and financed through a new Missouri Health Care Trust fund. To finance the trust fund every Missouri citizen would be required to pay a health premium based on the individual’s income level.

According to Sen. Joan Bray (D- St. Louis) who sponsored SB 722, “SB 722 has been referred to the Small Business Insurance and Industry committee, though whether it will be heard in committee, let alone on the floor, remains to be seen. The bill I have sponsored will be difficult to pass because of opposition from the insurance industry.”


Replacing Private Insurance

Vermont’s House Bill 491, according to sponsor Susan Davis (Progressive-Washington), would create a single-payer healthcare system covering all Vermonters.

“The basis is public financing rather than private insurance,” Davis said. “Because other single-payer bills lacked details on implementation, I wanted to move that part of the healthcare discussion forward.”

Even in a state like Vermont, Davis acknowledges HB 491 will be difficult to pass.

“I think it is possible that the Democrats will draft a committee bill incorporating pieces and parts from the six health care bills that are on the table. So, if that happens, I am hopeful that they will include most of HB 491,” said Davis.


Single-Payer Stumbles

According to Graham, even smaller-scale single-payer systems have performed poorly where they’ve been tried, and state legislators would be wise to consider this record before making their own proposals.

“In California today, Medi-Cal, the government’s single-payer program, is in serious crisis. Although spending is out of control, 11 percent of cardiologists in Los Angeles will not even see Medi-Cal patients,” Graham said. “Imposing such a system universally is a violation of peoples’ rights to make their own decisions about medical care.”

Sarah McIntosh ([email protected]) teaches constitutional law and American politics at Wichita State University in Kansas.


Internet Info:

California SB 810:

Missouri HB 1480:

Missouri SB 722:

Vermont HB 491: