SACRAMENTO—Single-payer advocate Los Angeles Mayor Antonio Villaraigosa sent a letter to Senator Sheila Kuehl (D-Santa Monica), chair of the Senate Health Committee, and other committee members, urging them to vote in favor of AB 1X, the comprehensive health care bill co-authored by Speaker Fabian Núñez (D-Los Angeles) and Senate President pro Tem Don Perata (D-Oakland).

“As a strong supporter of a truly universal health care system, I write to urge you to support AB1x (Nunez) as a significant strategic step toward our shared goal,” Villaraigosa said in the letter. “I strongly believe that health reform need not be an “either/or” situation, and that supporting the reforms of AB1x is not inconsistent at all with being a whole-hearted supporter of SB 840 and single-payer health care.”

SB 840 was the single-payer health care bill authored by Senator Kuehl last year that was vetoed by Governor Arnold Schwarzenegger and is not up for consideration this year.

Mayor Villaraigosa’s complete letter is below.

AB 1X is the result of over a year of negotiations between legislative leaders, the Governor, and leading labor, business, health care, and community groups. It is based on a principal of shared responsibility with employees, employers, and hospitals. Specifically, AB 1X:

Brings health care coverage to over 70% of California's 5.1 million uninsured, most of whom are low-income working individuals and their families, including 800,000 children;

• Establishes a state-administered health care purchasing program that will lower the costs of health insurance for small businesses and their employees;
• Requires all health insurers to accept for coverage all applicants who are subject to the mandate, regardless of previous conditions;
• Requires every California resident to have and maintain health care coverage and provides a combination of public program expansions, subsidies, tax credits and other tax breaks to make the coverage affordable;
• Exempts from the individual mandate those individuals and families with incomes at or below 250% the federal poverty level if their share of premiums would exceed 5% of income. Temporary and permanent exemptions are also available for individuals and families above 250% of the federal poverty line for whom coverage is not affordable or presents a hardship;
• Includes significant cost-containment and transparency language to reduce costs and hold stakeholders accountable;
• Requires minimum employer contributions ranging from 1-6.5% depending on the payroll of the employer;
• Increases tobacco taxes by $1.75 per pack; and
• Imposes a 4% contribution on hospitals based on net patient revenues.

The Senate Health Committee will vote on the historic legislation at 2 p.m. Monday.  

Dozens of organizations have embraced AB 1X, including the Service Employees International Union, American Federation of State, County and Municipal Employees, AARP, California Hospital Association, Safeway, March of Dimes, Children Now, Mental Health Association of California, American Nurses Association of California, California Association of Nurse Practitioners, Kaiser Permanente, Blue Shield, and Small Business California.

Here is Mayor Villaraigosa’s letter:

“Dear Senator Kuehl and Committee Members:

“I write to you as a strong supporter of universal health care.  As you know, throughout my career, particularly during my time in the Assembly, I have had a long history of advocacy for single-payer policy proposals and far-reaching health care coverage for all Californians.

“As a strong supporter of a truly universal health care system, I write to urge you to support AB1x (Nunez) as a significant strategic step toward our shared goal.  I strongly believe that health reform need not be an “either/or” situation, and that supporting the reforms of AB1x is not inconsistent at all with being a whole-hearted supporter of SB 840 and single-payer health care.

“I believe that AB1x not only will do no harm — your appropriate minimum test for health legislation – but will do a great deal of good and benefit millions of Californians.

“Moreover, I believe that passage and enactment of AB1x will be a strategic advance for the cause of single-payer health care because it will establish public programs that are the foundation of universal coverage, including a single-payer system.  

“AB1x embodies policy elements of single-payer health care. Passage of this law would make it easier to enact truly universal coverage and to pass a single-payer system in the future, since it already includes:

• “a major expansion of public program coverage to moderate-income Californians as well as low-income residents, setting the stage for single-payer and similar universal coverage reforms;
• “the setting of a minimum employer contribution to health care, which is essential to funding universal coverage and an important part of the financing for SB 840;
• “the creation of a statewide purchasing pool that could be the beginning of a huge purchasing pool that could grow into a single universal system; and
• “an increase in Medi-Cal rates, helping providers realize that rates could be reasonable under a public program such as a single-payer system.

“It also includes additional oversight over insurers.  While some have critiqued the notion of preserving the role of insurers, the proposal would significantly change the way insurers do business, including having to take all customers “guaranteed issue,” and having to negotiate with a large purchasing pool to access millions of California customers. The proposal creates a framework where insurers will either have to change their behavior, or face future reforms that place further oversight on them, if not replace their function.

“AB1x does not undertake the massive transformation of the health care system that SB 840 proposes, but it accomplishes important elements while providing security to those who have good coverage and want to keep it, and creates the framework to take extra steps.  Just as passage of family leave legislation created a framework to return to the issue and pass paid family leave, I believe this proposal creates political and policy tools to advance broader reforms.

“Some fear that passage of any plan would stall the coming of SB 840, and our leaders would believe the issues had been resolved.  I believe that the opposite is true. Failure begets failure, and if health reform is stalled now, elected leaders will be discouraged from supporting any reforms of our health system (and certainly more far-reaching proposals like single-payer).  They will move on to other issues.

“On the other hand, success brings success:  passage and enactment of such a proposal would create a positive environment surrounding health care reform, as elected leaders will continually seek to raise the bar above the last reform. The people of California are not satisfied with the health care system as it is, and they will want to see it change further to become a health care system worthy of our country and our state. 

“The comparison of AB1x should not be with SB 840, which I agree is a “gold standard,” but with the status quo in health care, where millions are uninsured, people are denied because of “pre-existing conditions,” low- and moderate-income families pay uncapped premiums and unlimited liability, and the situation continues to worsen.  AB1x does not provide every protection we want to see in our health care system, but it provides protections that currently do not exist at all:

• “it dramatically expands and assures coverage to increasingly desperate families and individuals;
• “it offers protection against the unaffordability of health insurance premiums;
• “it establishes strong oversight of insurers; and
• “it strengthens health care access of insured and uninsured Californians alike by more adequately funding health care providers, especially hospitals, whose current underpayment threatens their ability to provide emergency services for anyone and their willingness to serve low-income patients.

“Under AB1x, there are millions of people, particularly those with low and moderate incomes, who would get substantial help in receiving the care and coverage they need. We have a moral obligation to meet their pressing needs.  Additionally, the more we can reduce the number of uninsured, the shorter the gap we have to bridge to get to universal coverage and a single-payer system.  AB1x provides a solid foundation on which we can and will continue to advance additional health care reforms.

“I will continue to be very active in support of truly universal coverage, but I urge you to consider the strategic steps needed to win ultimate victory.

“Thank you for your leadership and your hard work on behalf of the people of Los Angeles, and for your vigilance on this critical issue.

“Very truly yours,
“ANTONIO R. VILLARAIGOSA
“Mayor”