1000.
The Legislature finds and declares all of the following:(a) Established by the Governor and the Legislature, the Healthy California for All Commission endorsed a system of unified health care financing that is accessible, affordable, equitable, high quality, and universal.
(b) The commission described the present health care system as one that is fragmented, wasteful, and disproportionately harmful to low-income Californians and communities of color and provided the rationale for a new single, government-administered funding system.
(c) The commission found that a
unified financing system would create significant opportunities to deliver health care more effectively, efficiently, and equitably.
(d) California could save more than five hundred billion dollars ($500,000,000,000) over the next decade if a unified health care financing system is implemented, with overall costs lower even after most of those savings go to minimize consumer cost sharing and expand long-term care supports and services to all Californians.
(e) The report by the commission calls for the elimination of corporate profitmaking as the basis of health care decisions.
(f) The magnitude of the change from the status quo in cost savings and positive impact on Californians’ access to health care services that the
commission contemplates represents a profound breakthrough in health policy and would establish California as the nation’s leader in pursuing health equity.
(g)The California Health and Human Services Agency has initiated preliminary discussions with the federal Centers for Medicare and Medicaid Services on the terms of a waiver that would provide program approval and full federal financing for a unified health care financing system in California.
(g) Federal engagement is critical to the process of developing the framework for a waiver that would provide program
approval and full federal financial participation in a unified health care financing system for California.
(h) Based on these findings, the Legislature endorses the The commission’s recommendations for a health care system with unified financing that guarantees all Californians the benefit of a standard, comprehensive package of health care services and supports
the agency’s discussions with the federal government regarding the terms of a potential waiver to effectuate the creation of a health care system consistent with this part. points the way toward better care at lower cost for our state’s residents.
(i) Based on these findings, the Legislature endorses a health care system with unified financing, such as a single-payer health care system, to provide accessible, affordable, equitable, and high-quality health care for all Californians.
1001.
The Secretary of the California Health and Human Services Agency shall research, develop, and pursue waiver discussions of a waiver framework in consultation with the federal government with the objective of creating a health care system that incorporates the following features and objectives:(a) A comprehensive package of medical,
behavioral health, pharmaceutical, dental, and vision benefits, which includes primary, preventive, and wellness care services.
(b) A package of long-term care support supports and services, including measures to slow deterioration and provide palliative care. support health and well-being while Californians age.
(c) Guaranteed services Services
that will not vary by age, employment status, disability status, income, immigration status, or other characteristics.
(d) The elimination of the distinctions that currently exist among the disparate systems of identification of disparities among Medicare, Medi-Cal, employer-sponsored insurance, and individual market coverage coverage, with the goal to eliminate those disparities to the greatest extent possible.
possible in the new system.
(e) The elimination of the adverse impacts of insurers attempting to avoid covering the sick or providing the benefits patients need in favor of a system that has a proactive, mission-driven focus on keeping Californians well. within the health care system of attempts to avoid covering the sick or providing the benefits patients need.
(f) The absence of cost sharing for essential services and treatments covered under the program, including primary, preventive, and wellness care services.
(g) The establishment of sufficient reserves to guarantee solvency during public health emergencies and times of economic disruption, supported in part by the elimination of the state’s unfunded benefit liabilities.
disruption.
(h)A detailed program to ensure a just transition for insurance industry personnel or other individuals whose jobs are
disrupted by the creation of a single payer system.
(h) A program to implement a just transition for members of the health industry workforce whose jobs may be disrupted.
(i) Assurances that no individual will pay more than a specified percentage of their income on a progressive sliding scale for the cost of financing the health system.
(j) Unified financing that delivers health care more effectively, efficiently, and equitably.
(k) Cost-effectiveness by systemwide pooled purchasing to negotiate rates with providers.
(l) Greater freedom Freedom for patients to choose providers and for primary care providers to choose practice models, which will
create greater competition, quality improvements, reductions in health disparities, and cost reductions from other system improvements. models.
(m) Greater investments in primary care and public health and public health, primary care, and health equity efforts to address the social determinants of health through an improved mix of health care and human services.
(n) Improvements in cost, quality, and health care system oversight and integration built on the accomplishments of the Office of Healthcare Affordability and other current initiatives, including the Data Exchange Framework and California Advancing and Innovating Medi-Cal, implemented in a manner that reduces overall administrative burdens to providers.
integration, which may include reducing overall administrative burdens on providers and improving connectivity and affordability of health care, built on the accomplishments of the Office of Healthcare Affordability and other current initiatives, including the Data Exchange Framework and California Advancing and Innovating Medi-Cal.
(o) A ratesetting process that uses could use Medicare rates as the starting point for the development of final rates that avoid disruptions in the health care system and expand the availability of high quality vital services by sustaining a stable, experienced, and equitably compensated workforce. This process shall include policies and payments to
should address historic inequities in primary care physician reimbursements as compared to other specialty practices and include policies and payments to support those providers that serve a disproportionate percentage of low-income Californians and other disadvantaged communities.
(p) Promotion of a workforce that addresses geographies and specialties with the greatest shortages and is diverse and able to provide culturally and linguistically competent care to all Californians regardless of race, nationality, ethnicity, sexual identity, and socioeconomic status.
(q)Adoption of policies and payments to support safety net providers that serve a disproportionate percentage of low-income Californians and other disadvantaged communities. These providers may need more generous funding than those serving affluent communities in order to effectively address the adverse effects of health disparities and other social determinants of health among their patients.
(r)
(q) Prohibition on the kinds of risk-bearing contractual arrangements that may could incentivize providers to withhold needed care, while allowing for payment models that guarantee access, promote quality, ensure equity, and enable multidisciplinary teams.
(s)
(r) Specific details on how care would be coordinated and organized.
(t)Ensure that the methods
(s) Methods of payment, delivery, and oversight implemented under the unified health care financing system that will continue to allow California the ability to receive the full benefit of federal expenditures and tax credits that currently underwrite the full scope of health
services.
1002.
(a) The In developing the waiver framework, the Secretary of the Health and Human Services Agency shall establish a Waiver Development Workgroup. engage stakeholders to provide input on topics related to discussions with the federal government and key system design issues identified by the Healthy California for All Commission for further analysis.(1)The workgroup shall consist of key stakeholders to advise the Governor on topics related to federal negotiations. The workgroup shall include representatives of consumer, patient, and community-based health care service providers, community organizations, health care professionals, labor unions, employers, and health policy experts, as well as representatives of government agencies.
(2)The members of the workgroup shall be appointed by the Governor, the Speaker of the Assembly, and the
President pro Tempore of the Senate as follows:
(A)Nine members shall be appointed by the Governor with a balance of expertise and perspectives, including five members with technical expertise in health care delivery, finance, operations, and public administration, and four members focused on the availability and quality of community health services.
(B)Four members shall be appointed by the Speaker of the Assembly and four members shall be appointed by the
President pro Tempore of the Senate. These members shall include representatives of health care professionals, labor unions, employers, and community organizations, and individuals with experience as beneficiaries of Medi-Cal or Medicare, or of being uninsured.
(3)The workgroup should represent a variety of health care professionals and community voices and include representatives from philanthropic organizations focused on health care.
(4)The workgroup shall meet quarterly and undertake a program of stakeholder engagement at sites across the state to address issues including, but not limited to, the specifics of the transition to a unified health care financing system from the current system of private and public coverage, adapting existing consumer protections to
the new system, applying reforms to move toward systems that reward and prioritize improvements in health outcomes, health care quality, and health care equity, and how to reduce costs and provide consumers the comfort and security they deserve.
(b)(1)The secretary shall provide quarterly reports to the Chairpersons of the Assembly and Senate Health Committees that detail the status and outcomes of federal discussions, as well as the progress of the Waiver Development Workgroup.
(2)The requirement for submitting a report imposed under this subdivision is inoperative on January 1, 2028, pursuant to Section 10231.5 of the Government Code.
(c)(1)The secretary shall report to
the Legislature, no later than June 1, 2024, a complete set of recommendations regarding the elements to be included in a formal waiver application, along with all legislative action necessary to proceed with the application and to establish a unified financing system consistent with the outcomes of the agency’s discussions with the federal government. The recommendations shall identify all of the elements among those proposed that the state may implement without a federal waiver, as well as any proposed elements that may require changes in federal statute in addition to a waiver.
(1) Stakeholder engagement shall include representatives of consumers, patients, and community-based health care service
providers, community organizations, health care professionals, labor unions, employers, and health policy experts, as well as representatives of government agencies and philanthropic organizations focused on health care.
(2) Key system design issues include health care delivery, finance, operations, public administration, the specifics of the transition to a unified health care financing system from the current system, adapting existing consumer protections to the new system, applying reforms to move toward systems that reward and prioritize improvements in health outcomes, health care quality, and health care equity, and how to reduce costs and improve the experience of health care consumers.
(b) The secretary shall, no later than January 1, 2025, provide an interim report to the chairs of the Assembly and Senate Budget and Health Committees that details the agency’s policy priorities and preliminary analysis of issues related to the federal discussions, as well as a summary of the input received to date through the stakeholder engagement process. The secretary shall, no later than January 1, 2025, also propose statutory language to the chairs of these committees authorizing the development and submission of applications to the federal government for waivers necessary to implement the unified health care financing system.
(c) The secretary shall, no later than June 1, 2025, complete the drafting of the waiver framework, inclusive of input gathered through the
stakeholder engagement process, make the draft available to the public on the agency’s internet website, and shall hold a 45-day public comment period thereafter.
(d) The secretary shall, no later than November 1, 2025, provide the Legislature and the Governor with a report that communicates the finalized waiver framework, informed by public comment received, and sets forth the specific elements to be included in a formal waiver application to establish a unified financing system consistent with the outcomes of the agency’s discussions with the federal government.
(2)
(e) The requirement for submitting a report imposed under
the reports specified in this subdivision is inoperative on June 1, 2028, pursuant to Section 10231.5 of the Government Code.
(3)
(f) A report submitted under pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
