In the fall of 2020, our coalition of advocacy organizations, labor, community groups and healthcare professionals embarked on a revised strategy to move single payer, Medicare for All style reform in California.

We sought to take advantage of a unique confluence of events: a Governor elected as a strong advocate for single-payer, an official state Commission dedicated to producing a report on single-payer financing of universal healthcare, a worsening healthcare crisis due to the COVID pandemic, and strong support for Medicare for All in California, especially among Democrats.

Our strategic approach focused on moving the Governor to take an active leadership role in the effort to win guaranteed healthcare, including engaging with the Biden Administration to obtain federal support for California reform; advocating for a strong pro-single-payer report from the Healthy California Commission; building broader organizational engagement in single-payer among healthcare reform supporters and labor unions; and, changing the narrative about Medicare for All from the false focus on its costs to the story of the billions of dollars it saves California workers, families and businesses while controlling health system costs.

In significant ways, we have successfully advanced this strategy and achieved meaningful progress toward single payer.

We have built a broader coalition, with new labor affiliates among teachers, public sector workers, university employees, and healthcare professionals. These affiliations have strengthened our message to policy makers, and combined with existing support from hospitality, transportation, manufacturing, labor councils, and healthcare worker unions, has influenced the direction of reform.

The Commission report issued in April 2022, strongly endorsed a “unified financing” approach, validating and specifying the $500 billion in savings over the next decade achievable through single payer – a powerful official statement on the costs and perils of current healthcare financing versus a single payer model. Using the Commission’s financial studies, along with other data, HCN has sponsored and promoted a “savings calculator” created by UCSF MD and professor emeritus James G. Kahn, to show individual savings under single payer.

Also, as a result of the Commission’s report, the Newsom administration proposed and the legislature approved funding for two new staff positions in Department of Health Services and a consultant budget to begin discussions with Biden Administration on the elements of federal support for California single payer under the waiver process of the Affordable Care Act, a necessary and significant step.

We celebrated the achievement of the Health 4 All program, which provides Medi-Cal health coverage to most undocumented Californians, and we have done events with community-based reform organizations in the Health Access and Health 4 All coalitions to promote the hugely positive impact of single payer financing as a necessary but not wholly sufficient condition for addressing healthcare disparities in frontline black and brown communities, which overwhelming support this reform.

New opportunities to engage with healthcare philanthropic foundations also emerged from the Commission’s work as these foundations participated in the Commission and conducted the opinion research that showed over 2/3 support among low-income Californians for a “government-run” single payer healthcare system.

In short, the last two years have shown the value of Healthy California’s strategic program, point to the next steps we must take to deepen our work with allies and policy makers, and laid the basis for winning legislative support and ultimately a ballot initiative to establish guaranteed healthcare for all Californians.