"Even one small tweak to the system could have huge ramifications to another part of the system," he said.
Arguing that it would take several years and a lot of heavy political lifting at the state and federal levels to move to a so-called single-payer health care system, the report recommends taking a series of short-term steps to improve coverage, affordability and access while simultaneously studying how to get to universal coverage.
Some of the key proposals:
- Expand Medi-Cal to all eligible adults who are in the U.S. illegally. The program is currently available to unauthorized immigrants under the age of 19.
- Permit unauthorized immigrants to buy subsidized insurance through Covered California.
- Use state money to expand Covered California subsidies for consumers who make too much to qualify for federal subsidies.
- Increase payments to providers who treat Medi-Cal patients.
- Explore setting up a "public option," a state-backed insurance plan that would compete against private plans.
- Create a state tax penalty for failing to buy health insurance, replacing the Affordable Care Act mandate that the federal government eliminated in the recently passed tax bill.
While generally endorsing the report's recommendations, Wood and Arambula were not ready to back the call for a state mandate, which also has the support of Covered California and the California Association of Health Plans.
"Subsidies are more of an incentive than mandates are," said Arambula.
He said "multiple proposals" will end up in legislation this year. Under legislative rules, any new bills must be introduced by the end of March.
The Long-Term Vision
The report points to a number of state and federal legal hurdles to single payer in the short term. Both Arambula and Wood expressed doubt that the Trump administration would support changing federal rules and laws to allow California to use Medicaid and Medicare dollars to pay for a state-run health care system.
"We can’t do it without the federal resources," said Wood.
The experts said the Legislature could create a "planning commission" that could start the hard work of laying the political, legal and financial groundwork for a single-payer system.
The commission would work on designing the system and figuring out how to pay for it, which would include helping the state seek legislative and statutory changes at the federal level, the report said.
The select committee was created to look at the issues raised by SB 562, which proposed a Canadian-style single-payer health system for California. It passed the state Senate last spring but never reached the Assembly. Speaker Anthony Rendon shelved it, calling the measure "woefully incomplete" because it lacked details on how to implement or pay for single payer.
SB 562's main backer, the California Nurses Association, slammed the report's call for an incremental strategy.
"The report inflates the obstacles to single payer, all of which are a reflection of lack of political will," said Bonnie Castillo, the association's executive director.
Many of the short-term proposals are "a deceptive facade," she said, "pretending to address the problem."
They will "do little to address the biggest hole in our health care system, the failure to guarantee actual health care, not 'insurance' for all Californians," said Castillo.