Prospective Passage of CalCare Could Pave the Way to Medicare for All

An assembly bill being voted on in Sacramento could make or break the nation’s progressive agenda. The squabble over AB 1400 also highlights the power dynamics and special interests at play in the legislature.

This upcoming January, a vote in the California Assembly will tell Americans how much momentum is truly behind the implementation of a single-payer healthcare system in the United States. Progressives nationally are trying to get medicare expansion passed in Congress, but to no avail as of yet. The passage of California Assembly Bill 1400, also known as CalCare, could prove that a single-payer healthcare system in the United States is achievable.

Since its introduction on February 19, 2021, California progressives have fought long and hard for AB 1400. This has been especially true in Los Angeles, where Councilmember Mike Bonin introduced a resolution for the City Council to endorse CalCare on March 24, 2021. “On some level, what the City Council says about a state bill has limited value… People in L.A. have a harder time having access to Sacramento or Washington… The fact that [progressive activists in Los Angeles] get to organize locally around an issue helps build the movement and that helps push things… [because people know] that there is a movement out there,” said Bonin in a recent Jaguardian interview. This movement consisted of “organizing on the streets and in the neighborhoods.”

Local support for CalCare continues to be reflected in nationwide opinion regarding Medicare for All, a similar, but nationwide version of CalCare that has been proposed. A Morning Consult poll taken in mid-March of 2021 shows that 55% of Americans support Medicare for All, while only 32% of Americans oppose it. The passage of CalCare would suggest to a majority of Americans that Medicare for All is a plausible policy proposal.

Essentially, if AB 1400 is signed into law, every Californian will have guaranteed health care without the need for private health insurance, including the more than 2.7 million Californians who were uninsured and remained that way since the onset of the Covid-19 Pandemic. Support for CalCare was initially ignited by Assemblymembers Ash Karla, Miguel Santiago, and Alex Lee. This past February, Assemblymember Karla introduced Assembly Bill 1400 onto the floor of the Assembly on behalf of the three Assemblymembers.

(Caroline Crain / The Jaguardian)

The passage of California Assembly Bill 1400, also known as CalCare, could prove that a single-payer healthcare system in the United States is achievable.

The bill was shelved in late April, delaying the bill’s vote until January 2022. A similar bill, Senate Bill 562, was shelved only four years prior and ultimately the bill was killed in the Assembly, despite Democrats holding 75% of the seats. Bonin, a progressive who is a staunch supporter of CalCare, explains the outcome, “[In] Sacramento, just like in Washington, special interests are very powerful… The gun lobby, the fossil fuel lobby, the pharmaceutical lobby, you name it. Those bodies carry a lot of weight and that makes it harder to get big stuff done up there.”

In terms of special interests, Councilmember Bonin’s point about pharmaceutical lobbyists connects directly to AB 1400. Big pharma currently regulates their own prices, but under CalCare, there would be an organization that would have that responsibility, threatening to lower the amount of money that these companies can make in California. This organization will be created strictly for administration of CalCare, and will be run by the California Health and Human Services Department.

A prime example of the power that big pharma holds in local politics can be seen through Assemblywoman Autumn Burke of the 62nd district. She represents Californians from Venice to Inglewood and received a total of $30,750 from the drug industry for her 2020 reelection campaign, which includes $5,000 from AstraZeneca and $4,500 from Johnson and Johnson. The influence of special interests is represented in all of California because 81.7% of California legislators (Senators and members of the Assembly) receive donations from pharmaceutical companies. In fact, California is a close second to Louisiana only in terms of big pharma’s contributions to candidates.

While fewer drug companies support Democratic legislative candidates than Republicans, they contributed around one hundred thousand dollars more to Democrats than Republicans from 2019 to 2020. Pharmaceutical companies have an enormous impact on Congress as well. During the 2019 and 2020 congressional races, this industry donated over 49 million dollars to 480 House of Representative and 106 Senate races.

It is difficult to see a pathway where Democrats unite on AB 1400, bu Bonin “…would argue to them about how this is going to help their constituents. If you’re representing Los Angeles, most of the representatives are representing… people who are living in poverty. Many of them are representing people who are undocumented and may otherwise go without medical care and that causes a lot of suffering for their constituents for whom they should be looking out.”

There are real worries about the bill. The amount of money that is needed to fund it is substantial and would come mostly from taxing the upper class and large corporations. However, as Councilmember Bonin puts it, the difference between a one-year bill and a two-year bill “is the difference between it dying and it staying alive for another year.” Moreover, this extra time has made it so that members of the Assembly can finalize the financial details and activists can organize longer to get more and more members of the Assembly on board.

The real test for AB 1400 will be in January. The voting will start in the two major committees: the Assembly Health and the Assembly Appropriations Committees. If the bill is approved, then it will go to the entire Assembly for a vote in late January. The members of the Assembly will reconvene in the first few days of January so there will only be a few weeks to make sure that AB 1400 passes. If CalCare manages to pass, it moves on to the Senate. If everything goes smoothly, then it should arrive on Governor Newsom’s desk. This will occur in June at the earliest, and it needs to be signed into law by October.