No Vote on Assembly Floor for California Single-Payer Health Care Bill Despite Strong Support From Insurance Commissioner Ricardo Lara and Others


By: Jackson Sullivan

AB 1400 (Kalra), known as the California Guaranteed Health Care for All Act, as amended January 24, 2022, would have created CalCare, a state-run universal single-payer health care program enrolling all residents of California. CalCare would have provided a wide range of medical benefits and other services to Californians, incorporating existing federal and state health care programs like Medi-Cal, Knox-Keene, Children’s Health Insurance Program (CHIP), and Medicare in addition to extending coverage to residents currently ineligible for those programs. The bill also would have prohibited participating providers from contracting directly with CalCare-covered individuals for covered benefits, but contracting with individuals for health care benefits not covered by CalCare would have been authorized as long as specified criteria were met.

Assemblymember Kalra also introduced ACA 11 on January 5, 2022, to pay for the increased costs of CalCare on the state’s budget. This measure would impose an additional excise tax, payroll taxes, and a state personal income tax, and funnel those tax revenues into the newly created CalCare Trust Fund in order to fund the health care coverage, cost controls, and fiscal reserves.

According to the bill analysis, proponents of AB 1400, including several California cities and counties, universal healthcare advocates, and labor unions, argued that the measure would provide comprehensive health benefits to the nearly three million Californians with no health insurance, as well as the millions more with insurance they cannot afford, while California is still reeling from the effects of the COVID-19 pandemic. Proponents also pointed to record-breaking profits from private insurance companies while medical bankruptcies were at an all-time high. Opponents of the bill, including several health insurers and provider organizations, hospitals, and chambers of commerce, argued that the bill would upend the existing health care system and transform the practice of medicine in unknowable ways without input from medical practitioners.

In a January 26, 2022 press release, Insurance Commissioner Ricardo Lara voiced strong support for the measure in a letter to Assemblymember Kalra. Citing how “[t]he COVID-19 pandemic has exposed how grossly flawed and inequitable our multi-payer health system is and how critical it is for all Californians to be guaranteed access to health care,” Commissioner Lara wrote that he looked forward to “working with the author and sponsor [of AB 1400] to ensure that the new system has appropriate consumer and fiscal solvency protections in place to maximize Californians’ access to quality, accessible, and affordable care.”

However, in a January 31, 2022 press release, Assemblymember Kalra stated that he had decided not to put AB 1400 for a vote because it had become “clear that we did not have the votes necessary for passage.” Assemblymember Kalra cited “heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system,” as well as “four democratic vacancies in the Assembly” as reasons for the lack of votes. Still, he made it clear that he would not give up. “Healthcare is a human right and CalCare has made clear the just path as an alternative to the inequitable system we have in place today.”

On February 1, 2022, the bill died on third reading without being submitted to the full Assembly floor for a vote.


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