Twenty months ago, then-Lt. Gov. Gavin Newsom sealed the endorsement of the powerful California Nurses Association in the governor’s race with an impassioned promise to bring single-payer health care to the Golden State.

“There’s no reason to wait around on universal health care and single-payer in California. It’s time to move [Senate Bill] 562. It’s time to get it out of committee,” Newsom told a nurses union conference in September 2017. “If we can’t get it done next year, you have my firm and absolute commitment as your next governor that I will lead the effort to get it done. We will have universal health care in the state of California.”

But now, as Newsom undertakes a “California for All” tour of the state’s largest cities, that ambitious rhetoric has long since given way to more modest proposals – and to attempts to dampen expectations. Instead of the governor reviving Senate Bill 562 – a 2017 measure passed by the Senate that would have committed the state to creating a single-payer system – he now says that’s not feasible without the assistance of the federal government.

Newsom has asked the Trump administration to give California a waiver from federal laws allowing the state to set up its own unique health care system – and for a sum equivalent to the amount the federal government now spends on health care for state residents. Senate Bill 562 died in the Assembly over expectations it would cost about $400 billion a year – double the state’s budget.

Governor risks backlash from fellow Democrats

The May Revise of the 2019-20 state budget that Newsom unveiled last week includes several proposals to expand availability of health care partly subsidized by the state government, in particular raising the income threshold of eligibility up to $73,000 a year. Individuals who make $48,000 a year or more are not eligible for federal subsidies under the Affordable Care Act. But he stopped short of extending Medicaid coverage to unauthorized individuals in California, citing its $3.4 billion cost. And he made no concrete proposals on advancing single-payer beyond previously announced plans to use the newly created state Council on Health Care Delivery Systems to examine how the state could transition to such a system.

The potential for a backlash from Newsom’s own party is clear. Politico reported in March than Newsom believed strongly that leadership on single-payer should be led by “the horseshoe,” an insider’s term for the governor’s unusually shaped office. But having a commission look at the state’s possible courses of action isn’t the dramatic move that fans of Democratic presidential candidates like Sen. Bernie Sanders and Sen. Elizabeth Warren want. A Quinnipiac University poll released in February showed 61 percent of state Democrats back a government-run single-payer system in California.

The California Nurses Association has expressed disappointment with the lack of progress. In February, CNA lobbyist Stephanie Roberson told the Sacramento Bee that it was “baffling” that no state lawmaker had introduced a measure like Senate Bill 562 and said her union strongly believed that incremental improvements in health care access were not enough.

“We can’t, as leaders, just protect what we have because we fundamentally believe that health care is [a] human right,” Roberson said.

Lt. Gov. Gavin Newsom appears comfortable with borrowing from Bernie Sanders’ playbook and embracing single-payer health care in his bid to succeed Gov. Jerry Brown in the June open primary and the November general election.

That’s a key takeaway of campaign watchers from the past month of the California gubernatorial campaign. Perhaps the signature moment: Newsom taunting “defeatist Democrats” in a San Diego debate last week – a clear shot at his main Democratic rivals, former Los Angeles Mayor Antonio Villaraigosa and state Treasurer John Chiang, who both support expanded state health care but are leery of single-payer’s potential cost.

The emergence of the former San Francisco mayor as an outspoken advocate of single-payer amounts to a triumph for the California Nurses Association, the leading champions of Senate Bill 562 – which commits the state to providing health care for all residents without providing key details on how that would be achieved. Despite the lack of details, the bill – known as the Healthy California Act and co-sponsored by Sens. Ricardo Lara, D-Bell Garden, and Toni Atkins, D-San Diego – passed the Senate on a 23-14 vote last June.

But Assembly Speaker Anthony Rendon, D-Paramount, incensed the nurses union later in June when he shelved the bill, declaring it “woefully incomplete.” Rendon cited its failure to identify how it would pay the estimated $400 billion that SB562 would cost per year – more than triple the state’s general fund budget. He also faulted the measure for violating spending limits in the state Constitution and for not making the case on how California would get many needed federal waivers to proceed.

In January, Rendon repeated his criticisms, saying there had been no progress in making SB562 into a serious legislative proposal.

But with polls showing national Democrats consider single-payer health care a high priority, Newsom is eager to take advantage of their enthusiasm. Yet while it may help him in the short term in the run-up to the June primary, it is unclear whether backing SB562 will be popular with the broad electorate in the long term.

A May 2017 poll by the Public Policy Institute of California found that 65 percent of adults surveyed support single-payer health care – but that the number plunged to 43 percent when those being surveyed were told substantial new taxes would be needed. A follow-up PPIC poll in September found just 32 percent of likely state voters backed single-payer.

Rendon recall bid fails without collecting a single signature

Another sign that single-payer support may have its limits has been the collapse of an effort to recall Rendon that was launched last summer after he blocked the advance of SB562. The bid received national attention after an Associated Press story depicted it as one more sign of how divided California Democrats had become.

But the recall campaign unceremoniously ended in early February, with organizers saying they were now focused on defeating Rendon’s bid for re-election – not on recalling him. To force a recall vote, 23,000 petition signatures would have to be gathered. According to the Los Angeles Times, the most recent official report on the recall campaign filed with the state showed no signatures had been gathered.

Public and private polls for months have generally shown Newsom to be leading Villaraigosa, with Chiang, former Superintendent of Public Instruction Delaine Eastin (a Democrat) and Republican candidates Travis Allen, a Huntington Beach assemblyman, and Rancho Santa Fe businessman John Cox substantially behind them. But the last poll by PPIC, released Feb. 7, showed a statistical dead heat, with Newsom getting 23 percent and Villaraigosa 21 percent – within the poll’s margin of error.

The November

Progressive Democrats in both the state Assembly and Senate are eager to broadly expand public services. Brown, however, has spent his second go-around as governor emphasizing the dubiousness of adding permanent new spending programs when state revenue is so volatile because of its dependence on income and capital gains taxes paid by the very wealthy.

The governor warns that even a moderate recession could lead to a loss of $55 billion in revenue over three years. Given that revenue plunged $30 billion in one year at the start of the Great Recession, the memories of the budget carnage under Gov. Arnold Schwarzenegger are fresh, especially the huge cuts in K-12 education spending.

But the California Nurses Association and its legislative allies are signalling they’re ready for another full-on push for a single-payer health care system. Assembly Speaker Anthony Rendon, D-Lakewood, continues to ask proponents how such a system could be funded, given that its estimated annual cost of $400 billion is more than triple the state’s current general fund budget of $125 billion. He effectively killed Senate Bill 562, the CNA-backed single-payer measure, last session, perturbed that advocates refused to offer clear explanations of how it would be funded.

Universal free preschool, health care for undocumented sought

The next most costly initiative on the table is a long-discussed proposal to provide universal free preschool to 4-year-olds. Many Democrats share former Assembly Speaker Darrell Steinberg’s view that it should be first on the list of any new state programs. Steinberg’s 2014 proposal would have cost an estimated $2.5 billion a year. More recently, the Common Sense nonprofit advocacy group has been lobbying for a more ambitious program than Steinberg’s with a price-tag of at least $5 billion a year.

Assembly Budget Committee Chairman Phil Ting, D-San Francisco – the lawmaker who so far has issued the most comprehensive proposed budget – wants to spend $4.3 billion of the $7.5 billion in additional revenue expected by the LAO, with the remainder going to the state’s rainy-day fund.

Ting’s most notable proposal is to provide Medi-Cal health care to undocumented immigrants up to age 19, at an annual cost of about $1 billion after smaller initial outlays. He also wants to increase college scholarships, restore cost-of-living increases for state benefits going to the aged, blind and disabled, and increase access to child care. Ting’s plan also calls for an expansion of preschool, but with a plan that’s less far-reaching than Steinberg’s proposal.

Under the California Constitution, the governor must present a budget for the fiscal year starting July 1 by Jan. 10. In May, after the state Department of Finance updates its revenue and expenditure forecasts, the governor’s office issues a revised budget.

Brown made few concessions during the last budget cycle. In May, he ignored the then-loud push for a dramatic expansion of state health care, but he did agree to increase salaries for child care providers and to continue funding a joint state-counties program meant to ease access to health services for seniors and low-income families.

Seizing on the growing concern about the deadly West African virus, the California Nurses Association, one of the state’s most powerful unions, has added several Ebola-related provisions to its list of demands in its ongoing dispute with Kaiser Permanente. The two sides have been at an impasse for months over a new four-year contract for nurses at Kaiser’s Northern California hospitals.

In addition to more training about the Ebola virus and full-body hazardous material suits, the union wants hospitals to carry an extra life insurance policy that would make a cash payout for any Ebola-related death or injury.

“We are asking in our contract negotiations for an extra insurance policy,” Diane McClure, a Kaiser Permanent nurse, told KQED. “We’d like to have an extra supplemental coverage, specifically for Ebola, if we were to contract Ebola while we’re at work.”

The nurses say their new contract demands are merely a matter of health and safety.

“They went in with full Hazmats,” McClure said, explaining why the union was seeking access to the expensive equipment. “We want the same high standard for health care workers that are directly dealing with patients who are very ill.”

California Nurses Association blocked surgical masks mandate

The union accused the hospitals of spreading lies about Ebola.

“We’ve been lied to in terms of the preparation in the hospitals,” said RoseAnn DeMoro, executive director of the CNA, at an Ebola-related union rally this week.

The same could be said about the nurses union.

The union that’s now demanding full Haz-Mat suits just two years ago rejected a requirement that nurses wear surgical masks. Back in 2012, the CNA blocked common-sense legislation that would have decreased the spread of the flu in hospitals.

Senate Bill 1318, authored by Senator Lois Wolk, D-Davis, would have required employees in health clinics and hospitals “to either annually receive an influenza vaccination or, as an alternative to the annual influenza vaccination, wear a clinic-provided surgical or procedural mask.”

“These individuals regularly come in contact with health care personnel, and are at higher risk of flu complications and death,” Wolk said in a press release about her bill. “My legislation is an essential step toward preventing unnecessary deaths. The goal of SB1318 is to decrease deaths from influenza and make California hospitals and health care facilities safer places for patients and workers.”

You’d think workers in the health industry, who have a greater risk of infection, would understand the benefits of vaccinations and see the deadly effects of the flu and would be motivated to get a flu shot. However, based on data from the California Department of Public Health and a report by California HealthLine, four out of every 10 hospital workers were not vaccinated during the 2010-11 flu season.

“As a doctor of internal medicine, I would like nothing better than to tell this medical assistant to get a flu shot or stay away, but I have no such authority. Nor does my healthcare organization, which employs this medical assistant,” wrote Dr. Charity Thoman, an internal medicine physician in Southern California, in a piece at Zocalo Public Square.

Nurses worried about Ebola, but not flu

Organized labor came out in full force to stop the bill.

The CNA, the AFL-CIO, the California Labor Federation, Laborers’ Locals 777 and 792, the Service Employees International Union and the United Nurses Associations of California lobbied lawmakers that the surgical mask requirement was harmful to workers who, according to the legislative analysis, “should not be forced to wear the ‘Scarlett Letter’ of a mask just because they’ve chosen not to get a flu shot.”

Eventually, the bill was amended to remove the surgical-mask requirement. The watered-down version of the bill simply mandated that clinics and health facilities have a 90 percent or higher vaccination rate. That mandate — with no enforcement — was eventually vetoed by Gov. Jerry Brown.

“Health care workers are protected by union contracts, and unless the state of California overrides a given provision, the contract determines what employers can demand,” explained Dr. Thoman. “As things stand, if you want a healthy nurse, you have to keep your fingers crossed.”

Public health threat: Flu vs. Ebola

From a public health perspective, the flu is a greater threat to public safety than the Ebola virus. In 2010, 53,826 people died from influenza, making it the eighth leading cause of death in the United States, according to the Center for Disease Control. By comparison, the global death toll from the 2014 Ebola outbreak stands at 4,500 people — with just a single death in the United States.

The flu, which doesn’t get the same headlines as Ebola, isn’t a concern for the nurses union.

On Ebola: “We’re scared because as nurses we are the front line people to first come in contact with these types of patients,” Carol Kisner, a Sacramento nurse representing the CNA, told News 10 this week.

On the flu: The CNA told Fox 11 News earlier this year the nurses “strongly encourage voluntary vaccinations, but oppose forced vaccinations or the scarlet-letter type wearing of masks under threat of job loss or other discipline.”

California hospitals could be facing millions of dollars in increased workers’ compensation claims if a bill sponsored by the California Nurses Association is signed by Gov. Jerry Brown. As of Tuesday afternoon, Brown had not made a decision.

Assembly Bill 2616, by Assemblywoman Nancy Skinner, D-Berkeley, would expand workers’ compensation claims for nurses (and other hospital employees in direct contact with patients) who also are infected with methicillin-resistant Staphylococcus aureus.

MRSA is usually a mild skin infection, causing sores and boils, but occasionally can be life-threatening, according to WebMD.com. It is spread through contact, and is resistant to treatment with antibiotics.

Currentl,y hospital employees must prove that they contracted MRSA in the hospital in order to collect workers’ compensation benefits. AB2616 changes that to mandate that there is a presumption that hospital workers contracted the disease in the hospital.

In addition to private hospitals, the bill would apply to state-run hospitals, developmental centers and prison facilities. Those facilities are supported by the state General Fund, which could take a hit if AB2616 becomes law, according to an Assembly legislative analysis of the bill.

“[I]f even one additional MRSA-related workers’ compensation claims [sic] was filed and approved as a result of this presumption, the cost could easily be in excess of $200,000 GF,” the analysis states.

$172 million

That translates to more than $172 million in additional workers’ compensation payouts if just 1 percent of the approximately 86,000 nurses represented by the CNA file MRSA claims. And that does not include the thousands of hospital workers not covered by CNA who would also benefit from AB2616.

About 52,000 MRSA patients were treated in California hospitals in 2007, according to one of the bill’s findings citing the Office of Statewide Health Planning and Development.

While the bill would be a boon to hospital workers, it could come at the expense of their patients, according to Wendy Kaler, infection control manager at St. Francis Memorial Hospital in San Francisco.

“We’re deeply concerned that if AB2616 becomes law, unnecessary claims against hospitals will escalate and our workers’ compensation costs will increase,” she told the Assembly Insurance Committee on April 23. “Which ultimately means fewer dollars for patient care and quality improvement efforts.

“At a time when hospitals are focused on successful implementation of health care reform and improving the quality of the care we provide, AB2616 leads us in the wrong direction.”

Overblown

Kaler, who said she’s been working in hospital infection control for 22 years, believes the concern about hospital workers acquiring MRSA is overblown. All hospitals have procedures in place to prevent the spread of infection, she said, unlike the outside environment where 2 percent of the public carry MRSA in their noses and MRSA has been found on a BART car seat.

“This bill is unnecessary and not rational,” she said. “Health care workers have never been identified, based upon surveillance and outbreak investigations, as an at-risk population for MRSA skin infections. The hospital is a far more controlled environment, and risk to employees is actually far lower.”

Kaler also pointed out that many health care employees work at more than one hospital, making it difficult if not impossible to prove which hospital should be held liable for the workers’ compensation claim.

Skinner pointed out that workers’ compensation regulations already provide a presumption that public safety employees who have contracted MRSA caught it on the job.

“Now I would not at all withdraw those presumptions for our public safety,” she told the committee. “They put their lives on the line for us every day. We have many more females in the profession, but it’s a male-dominated profession.

“The female-dominated profession, direct-care hospital workers, that encounter MRSA on a daily basis are not given a presumption on that, and must prove under a workers’ comp setting that they contracted it at the workplace.

“The issue is that we would be extending this to a class of employees who by their profession put themselves at risk to help others. So in that context, while it’s not completely analogous to public safety workers, there is some similarity.”

Outbreak

She was supported by CNA President Malinda Markowitz, who is also a nurse at Good Samaritan Hospital in San Jose.

“Last December my hospital had an MSRA outbreak on the mother-baby unit,” she said. “And management decided to issue a letter stating that all employees in the infected units would be tested. And those who tested positive, including workers who were asymptomatic, would be sent home between seven and nine days. And that employees may access their vacation time or not be paid during the forced time off.

“The employees were never told about their rights to access workers’ compensation for this type of situation. When the RNs were tested positive, they inquired if the situation qualified for workers’ compensation. And they were told it did not.

“This type of situation goes on every day in California hospitals. RN and other health care workers face an enormous amount of pressure and intimidation from management to not file workers’ compensation claims, or face claim rejections.

“When nurses do file claims, they are often harassed and embarrassed to the point where they do not proceed with the claim or do not file an appeal if they were rejected.”

Deposition

Mike Herald, representing the California Applicants’ Attorneys Association, said that one nurse who filed a MRSA workers’ compensation claim “was put through a lengthy deposition in which they explored virtually every aspect of her private life, including her sexual history, to try to determine if in fact that MRSA could have occurred in any other circumstance. It was a humiliating experience for this person. That’s exactly what we want to try to avoid, and why we support AB2616.”

But Scott Neely, vice president and chief medical officer for St. Joseph’s Medical Center in Stockton, agreed with Kaler that there’s good reason to suspect that nurses are not contracting MRSA in the hospital.

“I oppose adoption of the presumption that MRSA skin infections represent an occupational injury due to the fact that there is no clinical or scientific basis upon which to support this conclusion,” he said. “There is no data whatsoever to support the idea that health care workers following accepted infection-prevention behaviors are at risk for developing MRSA skin infections as a result of their occupation.

“Thus a presumption that a health care worker acquired an MRSA skin infection at work is simply not based on sound scientific evidence. To the contrary, the only presumption that can be supported by current evidence would be that an MRSA skin infection in a health care worker did not arise as a result of a workplace exposure.”

By KATY GRIMES

Despite warnings that tooth decay in children can lead to a life in prison, the latest attempt at a single-payer health care bill in California failed to pass the Senate Thursday.

Surprising many supporters, SB 810, authored by San Francisco Democratic Sen. Mark Leno, didn’t get enough votes even from his own party to pass the “Medicare for all” bill.

Perhaps the projected $250 billion annual cost of the government-run healthcare system weighed heavily on the minds of lawmakers.

Democrats have lauded SB 810 as providing “Medicare for all” in California. But it failed on a 19-15 vote, with four Democrats abstaining, and one voting against it. No Republicans voted in favor of it.

Last week, the Senate Appropriations Committee passed SB 810 out of the committee on a party-line vote of 6-2. The committee estimated the cost of a single-payer healthcare system in the state to be as high as $250 billion annually.

Sponsored by the California Nurses Association and the California School Employees Association, the bill would cover a government-run healthcare system for all 37 million California residents.

A New Healthcare Agency

In all of the floor debate between Republican and Democratic Senators, not once was it mentioned that the bill would establish an entirely new state agency. “This bill would establish the California Healthcare System to be administered by the newly created California Healthcare Agency under the control of a Healthcare Commissioner appointed by the Governor and subject to confirmation by the Senate,” the bill’s language reads.

Described as a public-private partnership, Leno said the proposal would make sure that every Californian has a primary care provider. “It’s not socialized medicine. What changes is who pays for it.”

“12 million Californians went without some type of health care last year,” Leno said. “500,000 children missed school last year due to tooth decay. This is criminal.” Leno said that missing school leads to dropping out of school, no diploma, no job and eventually prison.

“The author mentioned kids with tooth decay and then all of a sudden they’re not making it in life,” Sen. Tony Strickland, R-Moorpark, said. “It’s almost like that cable commercial where if you don’t buy cable, you’ll end up with a grandson with a spiked dog collar.”

“If you want the compassion of the IRS and the efficiency of the DMV running your healthcare, then this bill is for you. SB 810 doubles the size of state government,” Strickland added.

According to Strickland, the Department of Finance opposes it. The LAO has warned against implementing statewide single-payer healthcare. “SB 810 promises health care for everyone, but it’s more like Medi-Cal for everyone,” Strickland said, comparing it to the state’s government assistance healthcare system.

Another Dental Analogy

“Medicare for all extends to every human being in California. Our prisons are filled with people who couldn’t succeed in school because of dental pain, because they couldn’t hear or see,” said Sen. Loni Hancock, D-Berkeley, using the same analogy that a lack of health care leads to prison.

Hancock said that nurses and doctors support SB 810, but warned, “the insurance company mill literally tortures them – this is the most important topic we can address.”

Hostile Business Climate

Sen. Doug LaMalfa, R-Richvale, said that he talks to frustrated doctors who currently can’t get Medi-Cal to reimburse them. “California is becoming more of an island of hostile practices. We can’t afford to lose more employers in this hostile business environment,” said LaMalfa.

Sen. Joe Simitian, D-Palo Alto, said the debate was only about whether every Californian ought to have access to health care.

“We are living in an era of limits,” said Sen. Sam Blakeslee, R-San Luis Obispo. “I can’t imagine the pressure on education if this $250 billion cost competes with the $30 billion for education.”

In a letter sent to the Senate Appropriations Committee last week about SB 810, the California Taxpayers Association wrote, “The Legislative Analyst’s Office opined in a 2008 report that payroll taxes for employers and employees would need to be 4 percent higher than they are now for single-payer costs and revenues to balance. The necessary increase in taxes would discourage business growth, hurt investments and chase jobs away from this state.”

This is not the first single-payer healthcare bill for California. However, all previous attempts have either failed to pass the Legislature, or were vetoed, most recently by former Gov. Arnold Schwarzenegger.

Introduced in February 2011, Tuesday is the deadline for passage of SB 810.