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The Congressional Budget Office has scored Republicans’ American Health Care Act, and the picture is bleak. If the House bill passes the Senate, it would take health insurance away from twenty-three million people, reduce others’ coverage, and further raise premiums and out-of-pocket costs on older people and those with more medical needs. These attacks, which target poorer, older, and sicker people and women with almost surgical precision, would fall on tens of millions of people are already in a dire situation. Nearly thirty million people are uninsured, tens of millions more have insurance but still can’t afford needed care, health-care costs are rising unabated, crushing medical debt is forcing people out of their homes, and tens of thousands of people die every year because the insurance system denies them lifesaving care. The root of all of these problems is the private insurance system, which by design prioritizes insurance companies’ profits over human lives. Moving to a national, publicly financed, single-payer insurance system would, in one fell swoop, solve all of this. Yet since the days of Harry Truman, no one has been able to muster the power to overcome the opposition of the insurance industry. Leaders like Congressman John Conyers and Senator Bernie Sanders who back universal health care are the exceptions that prove the rule: market-fundamentalist ideologies, lobbyists, and campaign donors still hold tremendous sway over both parties in Washington. Winning universal health care will take a mass people’s movement, and building a movement means joining together with others where we live and work. The road to universal, publicly financed health care thus runs through the states. And no state is better positioned to lead than California.

States’ Golden Opportunity States have a moral obligation as well as a keen economic interest in improving public health and arresting the insane run-up in prices that insurance, drug, and hospital corporations charge to residents, employers, and state governments. Now, with widespread anger at soaring costs, Congress’s anti-health rampage, and a growing desire for government involvement in health care, the moment is ripe to build a new popular consensus around universal health care as a cornerstone for a just and healthy society. Just about every state has an active and organized grassroots campaign for universal health care. New Yorkers just passed a bill through the assembly and are gaining ground in the senate, and both Vermont and Colorado have come close to creating universal, publicly financed health care in recent years. Yet California’s political alignment and scale make it unique. Democratic officials hold supermajorities in both houses as well as the governor’s mansion, and are eager to portray themselves as the vanguard of the resistance to Trump. The powerful Healthy California campaign, which is leading the state’s fight for universal health care, has 150 coalition members who together boast four million members. And with its enormous economy and tax base, shifting health-care financing from private premiums to public taxes is an easier lift for California than for smaller states. Now, with the Healthy California Act, which passed the state senate on June 2, the Golden State has a chance to prove itself. But victory is hardly assured: the insurance industry and its allies are hugely powerful, and nowhere has the Democratic Party yet taken a stand for human health over the interests of its corporate donors. To succeed, Californians must overcome two pivotal challenges that have defeated every attempt at universal health care in recent years. They must protect against the opposition’s attempts to divide their coalition, and they must overcome and supplant anti-tax, anti-government rhetoric with a fundamentally different vision.