Bipartisan Support for Removing Barriers to State Single-Payer Experiments

The mark-ups in the House may seem to have gone by in a twink, but they crammed much matter into the days they had, with an all-night session to 6 am for at least one of the committees.  But one amendment stands out from the rest.  Dennis Kucinich (D-OH) who was the only presidential candidate in 2007 to embrace single-payer Medicare for All, introduced an amendment to finally make it possible for states to experiment with creating single-payer without fear of litigation from businesses.

Whether the country as a whole is ready for an equitable system whereby the government pays for everyone’s health care costs out of tax revenue is clearly a debatable question.  But many states and localities may already be.  A consistent roadblock has been legal interpretations of ERISA, the Employee Retirement Security Act of 1974.  ERISA governs the laws surrounding benefits offered by an employer, including health care benefits.  ERISA, of course, does not require employers to provide health insurance.  The fact that it does not always comes up when as the basis of legal challenges for employer mandates, like the one that Golden Gate Restaurant Association launched against Healthy San Francisco, the City’s “public option” for the uninsured, paid for in part by a modest employer mandate.  It’s ironic for a bill that was originally developed to guarantee transparency and a minimum set of pension and benefits has been used so often to prevent more progressive benefits from being developed at the state level.  Since a state-based single-payer system would doubtlessly either involve more money from employers in the form of a higher tax rate to compensate for the benefit costs they no longer have to provide, or either forbidding or discouraging them from purchasing benefits plans, you can bet someone would squawk.  The possibility of a drawn-out legal process was always part of the calculus.

If the House bill passes and Kucinich’s amendment is still attached, that’s not in the calculus anymore.  That’s good news for those of us in New York, where Assemblymember Dick Gottfried has begun aggressively pushing a New York Health Plus plan which would enroll all New Yorkers into a state-financed health insurance system built on the already-successful Family Health Plus and Children Health Plus (employers would be able to “opt-out” and provide their own benefits if they insisted).  It’s good news for the efforts at Sustinet in Connecticut and the single-payer proposal in California, as well as half a dozen other states.  They’ll have other challenges to be sure, from funding to ideology.  But this was an unnecessary barrier, and one removed with bipartisan support, 25-19.

States are supposed to be the laboratories of democracy.  In every state, health care costs are either the biggest or second biggest item in the budget.  Every state is already spending exorbitant amounts of money on a fragmented system that leaves far too many behind.  Washington may not be ready for single-payer, but it shouldn’t get in the way of Albany, Sacramento or St. Paul giving it a try.

(Photo credit:  Cheshire County Democrats on Flickr.)