In 2017 there was quite a flap in the California legislature over a single-payer healthcare bill. That bill, SB 562, known as “The Healthy California Act”, passed the California Senate in June 2017 by 23 to 17 on essentially a party-line vote.
Sponsored by the California Nurses Union, a panoply of labor organizations and liberal activist groups joined forces in support of the bill (see link at the bottom of this post to the bill text as well as the Senate analysis of the bill).
SB 562 did not advance further in 2017, as Assembly Speaker Anthony Rendon refused to move forward on the bill on the Assembly side. It is unclear what will happen with SB 562 in 2018.
This bill has potential consequences for California workers’ comp, as it would institute universal comprehensive health coverage for all California residents. However, SB 562 was short on specifics as to how this would affect workers’ comp, leaving it to the Healthy California board to sort out the details. Likewise, SB 562 made many assumptions as to the cost and funding of universal comprehensive coverage.
The issue is not likely to go away, however. Many are concerned that the ACA and Covered California are vulnerable under an unsupportive Trump administration. And generally, most political observers see the California Democratic party as moving further leftward, with activists continuing to push a single payer goal. Many of the 2018 statewide Democratic candidates are publicly supportive of universal coverage single payer even if some of them may be privately wary. Senator Ricardo Lara, a sponsor of the bill, is a high profile 2018 candidate for California Insurance Commissioner.
So it is interesting to see that the California Workers’ Compensation Institute has now issued a report on single payer and workers’ comp. The March 2018 CWCI study is titled “Revisiting 24-Hour Health Care Coverage and Its Integration With the California Workers’ Compensation System” (see link to it below). The authors, Alex Swedlow and Rena David of CWCI and consultant Mark Webb, are some of the brightest minds in the workers’ comp arena.
SB 562 could have significant consequences for CWCI’s insurer members.
The study analyzes the history of efforts to create 24-hour care in California and two models, single-payer and “pay or play” mandates. In an appendix the study reviews efforts to institute 24-hour care going back to AB 3757, a 1992 24-hour pilot program signed into law under Governor Pete Wilson. And it notes several studies undertaken for CHSWC, including a 2004 RAND study.
As the 2018 CWCI study notes, “the California workers’ compensation system makes up approximately 2 percent of the overall health care economy”.
Workers’ comp is important, but with such a small share of the overall health care spend, it is not the tail that is going to wag the dog, so to speak. It is apparent that workers’ comp is an afterthought for the drafters of SB 562.
The CWCI study does an excellent job at cataloging the many issues that would arise in meshing workers’ comp with a 24-hour care system. The study does not provide in-depth analysis of potential solutions to these problems, however, so the CWCI study is in my mind really a “phase-one” effort. Offhand, some of the issues in integrating 24-hour coverage with the comp system appear to be solvable with some creativity, while others may be more vexing.
Legislators and policymakers would do well to read the CWCI study to get a handle on the issues that will need to be addressed, including potential unintended consequences for other state programs.
Here is the CWCI study:
The last available text of SB 562 can be seen here:
And here is the June 2017 California Senate analysis of SB 562:
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