Questions and Answers

Single Payer refers to a government-managed health insurance financing system, where the state becomes the insurer, and pays for medical services. The state insurance is the “single payer”. In a true single-payer system, all funds are collected and services paid by the “single payer.”

The primary reason why 22 research studies have determined that a single-payer will cost the government less money is because the bureaucratic administrative waste caused by multiple private insurance companies and wealth extraction derived from denial of care is eliminated from the current multi-payer system.

Yes, somewhat. Medicare is an insurance system operated by the Federal government, which pays for medical services. However, there is an associated system called “Medicare Advantage,” which is a privatization of the original “Traditional Medicare” system which uses public Medicare money to fund private insurance middlemen and private network HMOs, which makes it more of a multi-payer system.

They are the same thing. “Medicare for All” was coined as a more understandable name for “Single-Payer,” because most everyone knows about Medicare, and have some idea about how it works, for the consumer.

CalCare is the name of the Medicare-for-All bills in the California legislature. Health insurance in the USA is organized, mainly, at the state level. Federal funding of health insurance, for example, in the form of Medicare and Medicaid (e.g. “Medi-Cal” in CA), would be centralized and augmented by a CalCare single-payer system. Currently, there are efforts to win both Medicare-for-All reform at the Federal and CA statewide-level.

No. “Unified Financing” is a new term being pushed by the insurance industry to describe a system where the state will give money to an insurance company or HMO to insure a customer. The “unified financing” refers to the state as the “financier” of healthcare, while payment for services is performed and managed by private insurance companies.

Assembly Bill 2200 – Guaranteed Health Care for All – is known as “CalCare” for brevity and is the policy framework for this single-payer reform effort as it has been re-introduced across annual legislative sessions with varying legislative bill numbers.

From the Center for American Progress: “…the data—both from other nations with universal coverage and from historic expansions of coverage within the United States—show that this is not the case. Patients in peer nations generally have similar or shorter wait times than patients in the United States for a variety of services, refuting the argument that universal coverage would necessarily result in longer wait times in the future.”

Due to healthcare disparities inherent in the current for-profit-centric healthcare system, long wait times are not only problem. but even access to basic healthcare services is challenging in many communities. CalCare’s program design includes a provider reimbursement structure to incentivize care where it is needed. It also allows for a special projects budget that would create reliable funding streams for hospitals and other providers in rural and medically underserved areas that could be used to increase the capacity of providers. For example, special projects funds could be used to expand health care provider facilities, increase staffing, or extend operating hours. Additionally, there would be capital expenditures available to prioritize funding for the construction or renovation of health care facilities in rural or medically underserved areas.

CalCare will offer healthcare superior to most existing healthcare plans (e.g. most do not include dental/vision/hearing/long-term care/gender-affirming care and all have restricted provider options). All public funding currently helping to finance current private insurance plans will go into the CalCare Trust Fund instead of the coffers of for-profit insurance companies. You will automatically become enrolled in CalCare and have no more restrictions on service providers being limited to that insurer’s private network. In addition, you will no longer have to bear the burden of premiums, co-pays, and high deductibles.

Initially framed by proponents as being “complimentary to CalCare,” SB 770 was actually a bill concocted to delay and potentially derail CalCare single-payer reform. It is a multi-payer initiative to allow legislators to avoid enacting true single-payer reform. (See the question, “Is Unified Financing Single Payer?” above). For more information about SB770, see Critical Analysis of SB770

CalCare will be funded with a combination of existing federal funds (including Medcaid and Medicare) and an increase in payroll taxes. However, you will no longer be paying perpetually rising insurance premiums, co=pays and deductibles nor astronomical drug prices. In sum, both for employers and the consumer, there will be tremendous net savings in out-of-pocket costs.

Read here for more details about CalCare financing.

CalCare will save billions in administrative costs. With great leverage, CalCare will directly negotiate prescription drug prices and provider payments on a statewide basis – CalCare will be able to lower prices for drugs and health care services, resulting in substantial savings overall.

The total health care spending in California is roughly $400 billion annually, approximately 71% of which is via public monies. Today, multiple for-profit insurance entities control public funds and profit via claims denials, resulting in administrative waste. 22 studies including a high-level meta-analysis of single-payer systems (Cai et al., 2020), have determined a more efficient single-payer system to be lower than the cost of the current multi-payer system.

AB 2200 includes cost-controls and would minimize new spending by consolidating existing funds and redirecting funds spent on administrative waste toward providing more equitable health care to all Californians.

CalCare controls health care costs in several different ways. First, a simplified payment system constitutes the largest area of reduced spending, as there is strong evidence that billing and insurance-related administration account for higher system-wide costs. AB 2200 would also establish reasonable payment methodologies for health care providers that align with actual costs of care rather than profit. Additionally, leveraging its negotiating power as the single- payer for health care in California, CalCare would be able to obtain reasonable prices for prescription drugs and other provider payments through direct negotiations with drug manufacturers, hospitals, doctors, and other providers.

In order to ensure that hospitals and larger institutional providers do not have unsustainable rates of growth, CalCare would negotiate adequate global budgets to cover all operating expenses while making strategic investments to promote high quality, equitable health care. Tailored to each hospital or institutional provider, global budgets ensure that providers get the appropriate funding for the services that their patients need and that reimbursements are being used towards care.

CalCare will create an Office of Health Equity that will have access to healthcare data, which can be analyzed to identify possible disparities. A disparity is generally considered a difference in healthcare services or outcomes from the norm. For more information, read the API Healthcare Disparities article.

Employee health care is the second-largest and fastest-growing expense for businesses. Despite healthy economic periods, rising health care costs represent a major burden for American business owners. The weight of health coverage and costs threatens the competitiveness of small businesses, while being a major annual cost for large businesses with many employees. With a single-payer health care system, businesses’ healthcare costs will be zero because health care will not be tied to employment, freeing up small, medium and large businesses to invest the savings in their business and employees.

Seniors on “Traditional Medicare” will receive superior health coverage at less out-of-pocket cost. Medicare Funds enter the CalCare Trust and seniors receive dental/vision/hearing/long-term care without having to purchase supplemental private insurance for those services, as they are covered under CalCare.

Seniors currently on a private HMO-type of “Medicare Advantage” will no longer take on the added risk of denial of care for serious health needs or be forced into restrictive private-insurance networks to obtain services.

It should be noted that CalCare will provide for senior nursing home care as well as include enhanced options for senior homecare and capital financing of culturally-appropriate senior care facilities in underserved communities.

MediCal is the state’s insurance system for people with low to moderate incomes. You would be moved off the existing managed care organization you’re in (if you are in one), and into CalCare. You can keep your doctor, or choose any other doctors.

Gig workers often don’t get health insurance through work, and must buy it individually, or through an exchange, or go without insurance. They pay self-employment tax, which is basically the same as payroll tax. So, they will likely see an increase in the self-employment tax, and get health insurance through the state.

You will never see a NO BENEFITS sign again. Period. You get the healthcare that you need.

Covered California is a marketplace in which you purchased a health plan from an HMO company. CalCare would move you off the insurance, into CalCare. You can continue to see your providers and in fact, have more choices of providers as CalCare abolishes private network restrictions. You will no longer need to pay monthly premiums.

The majority of Californians will prefer CalCare’s superior health coverage over most private insurance packages as it will include dental/vision/hearing/long-term care at lower out-of-pocket costs, including the elimination of rising premiums, co-pays and deductibles. CalCare also actually increases provider options and choices by mostly doing away with restrictive private insurance networks.

The benefits outlined by AB 2200 are guaranteed to all California residents. Health care services will be paid through the CalCare single-payer system. Individuals will not be able use an alternative payment system for a provider reimbursed by CalCare. However, individuals could choose to receive services from providers without participating agreements with CalCare and pay out-of-pocket for services that are not covered by CalCare. They can also choose private insurance for services not covered by CalCare, such as vanity cosmetic surgery.

No. CalCare establishes a more efficient and accountable financing system for services only. CalCare would put health care decisions in the hands of you and your health care provider by eliminating private middlemen gate-keepers, in doing so, CalCare ensures that the professional judgment of health care professionals, in consultation with their patients, is the basis for health care decisions.

No, in fact Californians can expect greater benefits and access to providers than existing health coverage plans and closed integrated health systems. CalCare is a simplified payment system that will not disrupt the delivery or quality of health care that Californians have grown accustomed to. On the contrary, CalCare will end persistent disruptions to care that arise from changes in health insurance and provider networks. A visit to the doctor would be adequately reimbursed by CalCare without the need for a prior approval or authorization from an insurer or health plan. Under CalCare, the only thing that would change is how your health care is paid.

Yes, a patient will have the freedom to choose their doctors, hospitals, and other providers without worrying about whether a provider is “in-network.” Under CalCare, you will no longer be restricted to a narrow selection of private network providers. CalCare will provide Californians with more choices.

Not the services provider component of Kaiser. CalCare envisions a statewide integrated health system that is both prevention-oriented and health care accessible when you need it. Kaiser insurance is distinct from the intergrated care services of Kaiser. Because of the Kaiser insurance component, the service component of Kaiser is part of a closed network for its enrolled members. This has often lead to limited access to providers and barriers to care.

The health care providers and health care facilities that actually deliver care in integrated health systems, like Kaiser Permanente, will be able to join CalCare either as physician groups or institutional providers without the risk-bearing business model attached that tends to ration care. It is the intent that members in CalCare will be given the opportunity to automatically keep their providers they have grown used to prior to implementation. CalCare members will be able to choose from any participating provider that is accepting new patients.

That’s a complicated multi-part question. Under MediCal, you select a Managed Care Organization, which is a combination of insurance plan and healthcare network. Likewise, under Covered California Obamacare/ACA, you purchase a plan from an MCO. Under CalCare, you no longer choose an MCO, because CalCare replaces the insurance plan portion, but you choose your healthcare providers.

There are no “Chinese HMO”s in California, but there are HMOs that serve the Chinese speaking and cultural community. You would continue to be able to see your Chinese-language supporting providers. You may also find more providers who were not in the HMO’s care network.

CalCare is offered to ALL RESIDENTS of California. The residency test has yet to be determined, but will likely be based on existing tests used for IRS, school districts etc. CalCare will also begin to finally address healthcare inequalities head-on, including healthcare service accessibility for persons with limited English proficiency (LEP) and improving culturally-appropriate care.

AB 2200 will fully cover long-term care for older adults and people living with disabilities. CalCare provides long-term care with the goal to cause as little disruption to a person’s life as possible.

One of the hardest aspects of needing long-term care is the fear of losing the ability to live a healthy and independent lifestyle. The CalCare long-term care benefit is geared toward helping people remain in their homes, though it also covers long-term care facilities for those who need them.

The CalCare governance structure would include an Advisory Commission on Long-Term Services and Supports (LTSS), which must include people who use LTSS, to help guide the CalCare board’s policymaking on LTSS.

CalCare will benefit ALL patients in that it prohibits any form of discrimination in providing healthcare treatment and hold all CalCare service providers accountable to non-discriminatory practices. CalCare is the first major healthcare reform bill to finance gender-affirming care.

You will be transferred to the superior CalCare and allow your union to negotiate other benefits like pay, conditions and pensions. Currently, unions need to decide how to treat their health funds.

You will be transferred to the superior CalCare and allow your union to negotiate other benefits like pay, conditions and pensions. Currently, unions need to decide how to treat their health funds.

CalCare will benefit ALL patients in that it prohibits any form of discrimination in providing treatment. CalCare will also negotiate affordable drug pricing with pharmaceutical drug producers and improve the availability of drugs specifically for AIDS patients.

Medi-Cal rates are the problem; Medicare not so much (at least for now before it’s degraded further). CalCare will use Medicare rates as base comparison but not Medi-Cal. Doctors who want to practice in CA will have to join CalCare. Because anything that’s covered by CalCare cannot be provided outside of CalCare, and CalCare coverage will be comprehensive; whatever the Board deems medically necessary. So there is near zero danger of doctors not accepting CalCare patients. Maybe you’ll have a minuscule percentage of cosmetic surgeons that cater to the super rich that won’t join CalCare (bc elective cosmetic surgery will probably not be covered by CalCare). But that won’t be the case for 99.9999% of providers. They will have to be in CalCare to practice in CA.

Also if Medicare gets further degraded via the privatization schemes of Medicare Advantage” CalCare will act as the bulwark to protect our seniors in CA.

CalCare will determine an appropriate level of, and provide support during the transition for, training and job placement for persons who are displaced from employment as a result of the initiation of CalCare. For up to five years following the date on which benefits first become available under CalCare, at least 1 percent of the budget shall be allocated to programs providing transition assistance.

Yes, a state single-payer health care program can be granted a Medicare innovation waiver or other federal waivers making it possible for a state to capture or administer federal health care dollars and enroll residents that are traditionally covered by Medicare or other federal health care programs. In fact, the ability for states to “pass-through” or use federal funding for implementing innovative health care programs, like single-payer, was envisioned under the Patient Protection and Affordable Care Act (PPACA). Specifically, the U.S. Health and Human Services Secretary could exercise waiver authority under Section 1332 of the PPACA to integrate federal programs with a publicly financed single-payer health care system in California if the state includes a detailed plan. This is exactly what CalCare sets out to do.

CalCare seeks to enhance the lives of those with earned retirement benefits with better benefits. Prior to CalCare implementation, AB 2200 would establish an Advisory Committee on Public Employees’ Retirement System Health Benefits to recommends actions to ensure public employee retiree are not harmed and seamless transition. This could include a recommended plan to phase-out contributions and duplicative health benefits under public employees’ retirement systems and effort to ensure coordination to fully integrate beneficiaries into CalCare.

The Veterans Health Administration, military hospitals and clinics, and Indian Health Services would not be affected by CalCare, unless the federal government chooses to contract with CalCare to provide care for TRICARE or IHS enrollees. California residents eligible for care through the Veterans Health Administration, TRICARE, or the Indian Health Services would be fully eligible for CalCare just like every other California resident.

Workforce shortage is a problem with today’s system and AB 2200 is designed to remedy those systemic issues by improving efficiency and reallocating resources to areas with the most need. For example, structural issues within our health care payment system exacerbate provider shortages because far too often hospital corporations and large health care employers will try to minimize labor costs which places strain on our health care workforce, leading to “burnout” and high turnover rates. Additionally, by eliminating administrative complexity, CalCare allows doctors and nurses to spend less time on billing and coding and more time on what they do best—caring for patients.

A main tenet in CalCare’s methodology is maintaining an optimal workforce to deliver quality and equitable health care. AB 2200 has provisions to increase payment rates in areas that have provider shortages. Specifically, the CalCare Board could increase payment rates to improve the availability and accessibility of health care services and CalCare includes a special projects budget to be used to increase payment rates to improve the availability and accessibility of health care services in rural or medically underserved areas.

Health care workforce recruitment and retention expenditures will be specifically budgeted through CalCare and during its implementation. Up to 1 percent of the entire budget will be dedicated to programs providing health care workforce education, recruitment, and retention. There will also be a CalCare Health Workforce Working Group comprised of diverse expertise that will continue to identify and prioritize efforts to improve the workforce and address issues of attrition.

Yes. You will be enrolled in CalCare and you can use your self-insurance for services not covered by CalCare.