Freedom for you and your family is closer than ever! AB 1400 – CalCare has made it to the Assembly floor! Call/write your assemblymember.

The question is how much LESS will we have to pay? Neither businesses nor individuals nor families would pay any premiums, deductibles, co-pays, out-of-network bills or balance billing. The cost of medications would come way down due to the power of negotiating on behalf of 40 million Californians. 

• 1. CA’s share of federal Medicare dollars would go to CalCare ( the name of the government entity that would manage the universal access health insurance) 
• 2. CA’s share of Medicaid dollars would go to CalCare 
• 3. CA’s share of federal dollars from other government health programs would go to CalCare.
• 4. Gross Receipts Tax: Annual excise tax at 2.3% of gross income above $2 million for all qualified businesses in the state would go to CalCare.
• 5. Payroll Tax: Employer Share: Employers with 50 or more employees to pay 1.25% payroll tax rate on wages and other compensation for their employees would go to CalCare.
• 6. Payroll Tax Employee Share: Employees earning more than $49,900 in wages or compensation per year to pay 1% payroll tax for earnings over $49,900 would go to CalCare.
• 7. Personal Income Tax on Higher Earners: Taxpayers with taxable incomes above $149,509 will pay an additional income tax based on specified marginal tax rates and adjusted for inflation.

SINGLE-PAYER CALCULATOR: Try out this calculator and see how a Medicare-for-all system would work for you and your family.

Letter #1 – From Dr. Leslie-Lynn Pawson, MD

Assemblymember Chris Holden
Chair of the Appropriations Committee
P.O. Box 942849
Sacramento, CA 94249-0041

RE: AB 1400 (Kalra/Lee/Santiago) — SUPPORT

Dear Chairman Holden,

I am a Family Physician who has practiced in Ventura County for more than three decades. I am a member of Physicians for Progress Ventura County. We are approximately 50 physicians who experience on a daily basis our broken, unfair, wasteful, expensive and often inaccessible health care system. Much of the blame for this lies in our fragmented for-profit health insurance system. We strongly support AB 1400, the California Guaranteed Health Care for All Act. This bill would establish a single-payer health care system in California, called CalCare, that will ensure that all Californians, regardless of employment, income, race, gender, or any other considerations, can get the health care they need, free at the point of service. Everybody in – Nobody out.

The following is one of many examples of how our patients, “your” Californians, are hurt by the current system. I cared for a patient who had been receiving oncology treatment for a malignancy. They lost their job due to the pandemic and thus lost their health insurance. This resulted in a stoppage of cancer treatment for several months until they were able to obtain health insurance via Medi-Cal – a government run insurance that rescued them. In the meant time the aggressive malignancy progressed. This delay in treatment likely cost them their life. With CalCare they would never have lost the employer based insurance. They would not have had employer based insurance to lose. Nothing could take away their CalCare. There would not have been any disruption of their care.   

Our current U.S. health care system is a complex, fragmented multi-payer system that still leaves 3 million Californians uninsured and many more millions putting off obtaining healthcare because their copays and deductibles are dauntingly high. By streamlining payments and lowering per-capita health care spending, CalCare guarantees quality health care without creating barriers to care or out-of-pocket costs.

All wealthy democracies except the USA insure 100% of their population with some variation of a single payer system. They on average spend 10% of GDP on healthcare. The US spends 18% of GDP on healthcare while not insuring all Americans. As a result we are sicker and have a lower life expectancy than any other wealthy democracy. This information is accessible from the Organization for Economic Cooperation and Development (OECD. We Americans should all be ashamed.  Research has shown that a single-payer system can save our state billions of dollars annually, while covering our population with comprehensive health care. CalCare would make it possible for physicians to stop the current waste of time and money on billing and instead focus on patient care. 

CalCare would negotiate fair, adequate global budgets to hospitals. This will help contain the exorbitant costs by aligning health care payments with the actual cost of care. This would eliminate the for-profit incentives that are present in the system today.

CalCare has many enemies. The Ventura County Taxpayers Association is presenting CalCare as a big tax hike conveniently omitting that businesses would no longer pay the high health insurance premiums for their employees that they currently do. The vast majority of Californian households would pay less in the new tax than they currently pay for their premiums, copays, deductibles and high drug prices combined. In addition to guaranteeing Everybody In – Nobody Out it would save families and businesses thousands of dollars in annual health care costs by cutting out the bloat and inefficiencies of our fragmented, for-profit insurance system. Enemies of CalCare, such as the California Medical Association do NOT represent the majority of California’s physicians. The majority of America’s doctors support a single payer system as several surveys have shown in the last five years. 

Now is the time for action. We urge all members of the Appropriations Committee to move AB 1400 forward on to the full Assembly and urge the California state legislature to pass and enact AB 1400 into law.

Sincerely, 

Dr. Leslie-Lynn Pawson, MD

Letter #2 – Dr. Tamra Travers, MD

California Senate Appropriations Committee,

I am writing on behalf of myself as a primary care doctor in California’s Central Coast urging you to support AB 1400.I experience every day the detrimental effects that our payor-based health insurance program has on California families– my patients, staff, my colleagues and myself. 

The county primary care clinic where I work is chronically understaffed, which has only worsened with the pandemic. We use countless staff hours dedicated specifically to navigating referrals in this complex system. We have multiple full time staff members dedicated to this work alone, and because it is so complex patients experience significant delays in much needed and time sensitive care. My patients have difficulty navigating the web of complex insurance systems  as well, and I have seen many uninsured patients who did not know they qualified for coverage. This takes more precious hours from dedicated staff and social services (or myself as we are understaffed) to help them navigate the complex systems of multiple payors as they experience more delays in care. These are precious staff hours that we would prefer to use toward improving the patient care experience as well as the quality of care our clinic provides, and on community outreach to bring preventive care services to those who need them. 

The California Medical Association (CMA) has made strong positions in opposition to this bill. However, it is important to know that the CMA does not represent me or the majority of my primary care colleagues. They do not represent the families of California but instead have the interest of wealthy subspecialty physicians as their priority at the expense of California families.

In primary care however, I see the harms of this current system regularly. Patients often lose their health insurance when they need it most such as when they are between jobs, or when a disabling medical condition causes them to be unable to work. Many clinics including specialty centers, imaging centers, and other health services are extremely selective on which patients they take based on the patient’s payor source. They selectively choose who to care for based on the reimbursement of the payor sources and the ease of the navigation of reimbursements from the payor sources. This is a biased system that leaves many without necessary care. Of course, this disproportionately effects low income patients and patients of color in our communities with unequal care. Meanwhile, those with private insurance are not left unscathed as they are often left with surprise bills because of non-transparent and confusing copay and deductible and coverage systems. I have suffered from those issues myself personally when I have sought to utilize healthcare services. I also suffer from the moral injury of witnessing my patients struggle to get the care they need in our current system.

A single payor healthcare system would save money for California families and for employers. It would keep patients from preventable suffering and disease burden with greatly improved coverage, save primary care physicians and staff from moral injury and give us back countless precious primary care staff and physician hours. Most importantly, it would be better care for all of us. 

Thank you for your consideration on this important issue,

Tamra Travers, MD

Letter #3 – From us here at Indivisible Ventura

Dear Chairman Holden, 

We at Indivisible Ventura are writing in strong support of AB 1400, using the California Chamber of Commerce’s statement of opposition to this legislation as our starting point. https://advocacy.calchamber.com/2022/01/07/calchamber-announces-opposition-to-california-single-payer-health-care-bill/

Their first two issues can be combined into one “the-sky-is-falling” theory that the tax increases of AB 1400 would constitute an unsustainable burden, which would drive away our current companies and discourage others from locating here, with an apocalypse of business closings and layoffs thrown in as well. 

• First, we’re going to take as paid that many of the CalChamber members have an intrinsic interest in maintaining the current business model.
• For other employers, not having to deal with insurance brokers every year and explaining to employees how much their monthly contributions will increase, AB 1400 would be priceless. (45% of Californians pay more than 25% of the premium for single coverage, compared to 21% of workers nationally. https://www.chcf.org/publication/2021-edition-california-employer-health-benefits/)
• AB 1400 would give companies the opportunity to be truly competitive internationally. Stated Mr. Taylor Lincoln of Public Citizen’s Congress Watch, “Small businesses have rated the cost of health insurance as their top concern for a quarter century, and large businesses struggle with healthcare obligations that their international competitors do not have to worry about. If it weren’t for entrenched partisan alliances, business leaders would have demanded that Congress relieve them of healthcare burdens long ago.” (https://pnhp.org/news/report-universal-healthcare-would-be-boon-to-businesses/)

CalChamber’s next talking point is that AB 1400 would negatively affect a physician choice, forcing those who disagree with government-set rates to flee to other states. We beg to differ that Medicare rates would force wide scale abandonment of our state.

• Nationwide, only 1% percent of non-pediatric physicians have formally opted-out of the Medicare program, with the highest percentages of refusers in psychiatry and plastic surgery specialties. (https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/)
• However, nearly half of the CA physicians refuse to accept new patients covered by Medi-Cal, the state’s health insurance program for low-income families and elderly, blind and disabled individuals. (https://www.chcf.org/press-release/nearly-half-of-states-doctors-will-not-treat-medi-cal-patients/). This level of patient discrimination would no longer exist under CalCare. 

Their last issue is that the CalCare model would have a negative impact on the physician-patient experience, proving that they are merely recycling old arguments without consulting the family physicians who treat most of America’s families, or to the affected patients themselves.

• We know, as patients, that our “physician-patient” relationship has never been more fragile. It is now subject to abrupt severance as our employers renegotiate insurance plans every year. The connection can be broken by a job loss, or by having to leave the workplace to care for children or elderly parents, or by transitioning to Medi-Cal. We know that our doctor can leave us behind for another insurance network, or to leave the profession entirely. Only the wealthy, who can afford concierge medical care, have any expectation of a long-term physician-patient experience.  
• We know, from actual conversations from doctors (you have already received letters from Drs. Leslie-Lynn Pawson MD and Tamra Tavers, MD) that doctors are exhausted of being turned into code crunchers to adequately treat their patients, of spending hours on the phone haggling to get their patients’ treatment covered or to be seen by specialists, who may no longer accept the patient’s government or company-supplied insurance, of worrying that the right treatment will lead to a patient’s bankruptcy, or that a patient won’t be able to afford the necessary medication to manage their condition. All this leads to critical moral injury for these most precious resources – people who spent years training to help others, and their exit from the medical profession. 

The CalChamber article also ignores the effect of our current system on us mere mortals who are not wealthy or corporation CEO’s. Not a word about the quarter of a million gofundme campaigns held every year for medical expenses, many for those with insurance. (https://www.cbsnews.com/news/health-care-costs-crowdfunding-medical-bills/) Not a word about how escalating co-pays, deductibles and coinsurance keep us from accessing regular preventative health care, or how medical debt, even for those “insured,” remains the leading cause of bankruptcy in the U.S. Not a word about how “extra” medical services, like dentistry and vision care, have thousands of Americans lining up at pop-up tent clinics exactly like those used in third world countries to provide those services. (https://www.ramusa.org) Not a word about how the current system traps people in bad jobs and abusive marriages, keeps them from helping relatives or starting new businesses, all to keep their inadequate health care benefits. Not a word about how, even with insurance, a baby’s delivery can cost up to $5000, not counting post-natal care. It ignores how we are trapped in a rapacious and capricious system that efficiently removes our both freedom and our dignity.

We believe that AB 1400 will lead to both a renaissance for our business community’s competitiveness and create a beacon for doctors across the nation looking for a less-stressful, more patient-centered practice. And for the rest of us, we will have a chance to experience a life without worrying about the next medical issue for ourselves and our families.

Sincerely

Indivisible Ventura
IndivisibleVentura.org

Letter #4 – Open Letter to Chairman and Assemblymember Chris Holden

Dear Chairman Holden, 

We, the undersigned local community leaders, advocates, and residents are writing in strong support of AB 1400, California Guaranteed Health Care for All Act (Cal-Care).

This past weekend we honored the Rev. Dr. Martin Luther King Jr., who was famously quoted as proclaiming 

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”  

In keeping with Dr. King’s legacy against racial inequality and poverty, we respectfully urge you as our State Assemblymember and Appropriations Committee Chair to fulfill your promise to prioritize “Fighting for Social Justice and Equity” by leading the fight for guaranteed healthcare for all Californians.  

Specifically, we urge you to utilize all the resources at your disposal to co-sponsor and pass crucially needed healthcare reform in the form of AB 1400, which would ensure all Californians – regardless of employment, income, immigration status, race, gender, or any other considerations – may get the healthcare they need, free at the point of service. 

Our urgent request is based on the following:

• Inequality in healthcare was greatly exposed by the COVID-19 pandemic, and during the pandemic healthcare inequality actually increased when millions more Californians lost their jobs and employer-provided health insurance.  

• California’s implementation of the ACA significantly reduced the number of uninsured, but has proven inadequate in providing quality healthcare for all:
  • Nearly 3.2 million Californians (or about 9.5% of the population age 0-64) have no form of health insurance.
  • In addition,12+ million more (or about 30% of the population age 0-64) have insurance they can’t afford to use because copays or deductibles are too high. 
  • In a 2020 California Health Policy Survey, 20% of those surveyed reported they or someone in their family had trouble paying their medical bills within the past 12 months, and as a result, had to cut back on basic needs like food and clothing, use up their savings, etc.  
• Meanwhile, for-profit insurance companies and health care systems are reporting record-breaking profits, even while the COVID-19 pandemic continues to ravage California and medical-related bankruptcies are at an all-time high.  
• The COVID-19 pandemic has also magnified the enormous racial disparities in healthcare, especially in California where Black, Latinx, and Pacific Islanders are experiencing higher rates of infection, hospitalizations, and deaths.  

• For example, the death rate for Black and Latinx people dying from COVID-19 is 15-18% higher than statewide.
• For Pacific Islanders, it is even higher at 70% higher than statewide!
• AB 1400 presents us with a “Medicare moment” that has the potential to exponentially narrow the gaps of inequity in California’s current healthcare system, including for our State’s most vulnerable families and communities.

• The California Guaranteed Health Care for All Act, or AB 1400, would enact a single payer health care program (CalCare) for all residents in the state of California. It would include medical, dental, hearing, vision, mental health, reproductive, and long term care.
• There would be no more “in network” or “out of network” for providers – you can see any doctor or hospital of your choice.
• CalCare would be care guaranteed free at the point of service. Nearly all individuals, families, and businesses would save money with no copays, no deductibles, and no premiums.
• CalCare is like a state-level version of Medicare for All. The program would be financed through a single, public program rather than the fragmented patchwork system we have now. This system would have huge cost savings through reduced bureaucracy.
• The AB 1400 CalCare program would be a truly transformative change to California’s health care system:

• AB 1400 would guarantee Californians can get the care they need without going into medical debt, starting a GoFundMe campaign, or going homeless or not paying for food or heating bills instead.
• AB 1400 would save families, businesses, and organizations thousands in annual health care costs by reducing administrative waste and  inefficiencies of our fragmented, for-profit insurance system.  

The time is NOW to end inequality and press for quality healthcare for ALL in the form of AB 1400: 

• Compared to other wealthy countries, the U.S. spends much more on health care per person and yet our health system performs among the worst on measures of access, equity, health care outcomes, and administrative efficiency.  For decades we’ve had commissions, studies, and experts explaining a single-payer health care system would end this crisis of health insecurity, including in PERI andPLOS Medicine.
• Californians overwhelmingly support the transition to a single-payer health care system.

56 percent of all Californians supported replacing private insurance with guaranteed coverage provided by the government – even before the Covid-19 pandemic caused millions of Californians to lose their jobs and employer-provided health insurance.  

• Supporters of AB 1400 include numerous California cities and counties, universal healthcare advocates, social justice in healthcare organizations, political organizations, labor unions, including:       

California Democratic Party, Los Angeles County Democratic Party, California Federation of Teachers, California Labor Federation, AFL-CIO, California Alliance for Retired Americans, Healthy California Now, Public Citizen, California Nurses Association, National Union of Healthcare Workers, Physicians for a National Health Program, California Dental Association, Progressive Asian Network for Action,Save Our Seniors Network, Western Center on Law and Poverty, City of Los Angeles, and numerous others.

We thank you for your service to our communities, and urge you, Chairman Holden, to stand with our families and communities to end inequality and press for quality healthcare for ALL by urgently co-sponsoring AB 1400, Guaranteed Healthcare for All.  

In Hope for the Welfare of Our City, State, and Nation,

Signed:  (affiliations noted for identification purposes only)

Residents of AD 41  (full list here)

(AD41 is composed of the cities of Altadena, Claremont, East Pasadena, La Verne, Monrovia – 99.3%, Pasadena, San Dimas, Sierra Madre, South Pasadena, Rancho Cucamonga – 12.3%, San Antonio Heights, and Upland)