State legislature quietly shelves latest single payer health care bill

Despite its reputation for championing inclusive medical coverage, the California Legislature has quietly shut down yet another attempt to establish a state-run single payer health care system.

AB 1900, known as CalCare, was Assemblymember Ash Kalra’s (D-San Jose) third time introducing a single payer health care bill to the legislature in recent years. The bill would have laid the groundwork for a health care system in which one single government agency finances universal healthcare for all California residents. The bill was dead before it even reached a hearing in the Assembly Health Committee.

“I wasn’t sure what was going to happen as the date got closer and it wasn’t referred yet,” Kalra told CALÓ News. “I’m certainly disappointed, because I feel that the crisis that Californians are facing when it comes to health care is worse than ever.”

The deadline for a bill to be referred to its corresponding committee was last Monday, April 21. AB 1900 was never referred to the Health Committee, meaning it was essentially killed before it was ever heard or debated upon. With over 300 official endorsements, CalCare had widespread support among labor and health organizations, including the California Nurses Association (CNA). 

The bill also had key support in the Capitol, with 25 lawmakers signing on as co-authors.

CNA President Catherine Kennedy joined Tom Steyer, a gubernatorial candidate and strong supporter of single payer health care, in a virtual press conference late last week condemning the bill’s outcome.

“For too many years, we've seen politicians make empty promises about single payer,” Kennedy said. “They tell us to be patient, to wait for the right political moment and to be okay with incremental change. All the while, our patients suffer to afford even basic medical care, working families going bankrupt every day because of preventable, chronic health conditions.”

What went wrong?

This version of CalCare would cost the state around $731 billion, $14 billion more than Californians currently pay for the state’s health care, according to an analysis completed by the California Health Benefits Review Program (CHBRP) out of UC Berkeley. 

The analysis found there would likely be long-term savings from CalCare, and that the system “would enhance greater equity and may reduce the financial burden that millions of Californians, even those with insurance, experience.”

In regards to why CalCare was never referred to committee, Kalra said his sense was that Legislature leadership’s “primary focus” is on fighting back against federal health care cuts due to H.R. 1, the “One Big, Beautiful Bill.” 

Medi-Care, known as Medi-Cal in the state, is set to be severely impacted by H.R.1. Alongside cuts in other areas, the bill will gut around $30 billion worth of federal Medi-Cal funding per year, according to the California Health Care Foundation.

Latinos are set to be disenfranchised beyond the federal cuts, as California balanced its 2025-26 budget by rolling back on historic expansions it made to Medi-Cal. Just two years ago, California became the first state to offer comprehensive coverage to all undocumented adults. 

Then, in the face of a $12 billion deficit, the governor and state legislature announced last year it would be freezing new Medi-Cal enrollments for immigrants alongside introducing new premiums and restricting dental benefits.

In response to H.R. 1 health care cuts, voters in L.A. County will have the opportunity in June to vote on a temporary half-cent funding measure meant to generate revenue for public health services, emergency rooms and community clinics.

Doubling down on the federal cuts argument, a spokesperson for Assembly Speaker Robert Rivas (D-Salinas) said in a prepared statement “single payer is a powerful idea … but under Trump, it’s impossible.”

“Democrats’ focus is simple: protect coverage and stop Trump from ripping it away from Californians,” said spokesperson Nick Miller.

“I think we can do two things at the same time, because single payer health care won’t happen overnight," Kalra said. “I felt like we had an opportunity to move that along while we were also pushing back against the Trump cuts. Unfortunately, it seems like that wasn’t agreed to.”

Given California is facing an unsteady federal budget that is particularly brutal toward health care, “this conversation would be very different,” if we were having it a few years ago, according to Ted Lempert, a former California assemblymember and political science lecturer at UC Berkeley.

What it means to “kill” a bill

A bill can be “killed,” or simply quietly shut down, when it is deemed too controversial and legislators want to avoid a public debate, or when a bill has little chance of being approved by the Assembly and Senate and signed by the governor.

“That happens, especially on a high profile issue,” said Lempert. He added, “I think in this case, there probably were a number of legislators who might have wanted to vote for it publicly and show their support, but because there was a feeling it wasn't going to get all the way through to the governor this year, the decision was made not to have that debate.”

Single payer has been introduced and shut down at least 10 times since the 1990s. The closest the idea got to being implemented was in the mid-2000s, when a single payer bill passed the Assembly and Senate, but was vetoed by then-Governor Arnold Schwarzenegger.

Kalra said he will continue to introduce similar bills as long as he is in the Legislature. 

It’s probable the idea of an in-state universal health care system will continue to gain public support, but “it would be a huge lift and it would take a lot of the stars aligning to have it,” Lempert said.