By Thomas Beaton

April 03, 2017 - California lawmakers have introduced a single-payer healthcare bill that would provide all Californians comprehensive coverage with minimal out-of-pocket costs.

The State Senate will review SB 562, or “The Healthy California Act,” around mid to late April. The bill is sponsored by 11 state senators, the California Nurses Association, and National Nurses United.

Should the law pass, the state would consolidate existing federal funds such as payments for Medicare, Medicaid, and tax revenues to support universal health insurance eligibility for all state residents.

Lawmakers prefaced the bill with concerns over the increased healthcare costs for individuals and businesses within the state of California.

“Californians, as individuals, employers, and taxpayers have experienced a rise in the cost of health care and health care coverage in recent years, including rising premiums, deductibles, and copays, as well as restricted provider networks and high out-of-network charges.”

“While the federal Patient Protection and Affordable Care Act (PPACA) brought many improvements in health care and health care coverage, it still leaves many Californians without coverage or with inadequate coverage.”

The legislation would take the Affordable Care Act even further by extending coverage to all residents without restrictions.

“All residents of this state have the right to health care,” the bill reads.

The bill envisions a payment system that prioritizes care coordination and reduces excess spending.

“The [Healthy California] board shall adopt regulations regarding contracting for, and establishing payment methodologies for, covered health care services and care coordination provided to members under the program by participating providers, care coordinators, and health care organizations,” the bill reads.

“There may be a variety of different payment methodologies, including those established on a demonstration basis. All payment rates under the program shall be reasonable and reasonably related to the cost of efficiently providing the health care service and ensuring an adequate and accessible supply of health care services.”

The act also would require the support of an established Healthly California Fund, or a collective bank of revenues generated from state and federal healthcare programs.

“State moneys that would otherwise be appropriated to any governmental agency, office, program, instrumentality, or institution that provides health care services for services and benefits covered under Healthy California. Payments to the fund pursuant to this section shall be in an amount equal to the money appropriated for those purposes in the fiscal year beginning immediately preceding the effective date of this title,” the bill reads.

Legislators noted in the bill’s text that other revenue streams would need to be created to support the proposed single-payer system.

New funding sources would be administered and organized by a new Health California Board, an independent public organization that would make sure payments are allocated to providers and carry out other statutes.

A key provision within the bill’s text includes the right for every California to enroll without any age, income, or employment restrictions.

Enrollees would receive 33 essential health benefits that include diagnostic imaging tests, inpatient and outpatient services, emergency care, and pediatric care.

These covered benefits would also be mandatory for coverage through California’s CHIP program, Medi-Cal (Medicare/Medicaid), federal programs under the Social Security Act, and other healthcare services sponsored with federal dollars.

The bill also aims to lower prescription drug costs and expand Medi-Cal home services with emphasis on community and in-home health services.

A large section of the bill is devoted to outlining provider participation in A Healthy California. The bill allows providers extended communication with the Health California Board and allows providers to negotiate payer reimbursement.

“Health care providers may meet and communicate for the purpose of collectively negotiating with Healthy California on any matter relating to Healthy California, including, but not limited to, rates of payment for health care services, rates of payment for prescription and nonprescription drugs, and payment methodologies,” the bill reads.