A longtime goal of the Democratic Party for the government to take over health insurance may become a reality in California if it can get past major concerns about cost that could lead to its defeat.
The California Senate recently approved a bill that would create a single-payer healthcare program in which the state is the only payer for healthcare. California essentially would eliminate private insurance, with residents signing up for a state program that would give them access to healthcare with no out-of-pocket costs.
Single-payer, long a goal of Democrats, has received renewed energy this year in Congress, despite Republican control of Congress and the White House.
Advocates say there is broad support for single-payer, not just among Democrats.
"There is broad support for single-payer not only in California, but nationally, even among registered Republicans and Republican and conservative business leaders," said Charles Idelson, spokesman for National Nurses United and the California Nurses Association, which is pushing the California bill.
The California Senate passed the single-payer bill June 1 by a vote of 23-14 with three members not present. The bill now heads to the state assembly. If it passes there, it will move to Democratic Gov. Jerry Brown for his signature.
However, several hurdles remain.
It is not clear if Brown supports the effort, and the governor has questioned how the state would pay for it. A recent legislative analysis found the bill would cost the state $400 billion per year, more than double the current state budget of $125 billion.
Lawmakers want to add a 15 percent payroll tax to pay for it and hope to get about $200 billion from existing federal, state and local funding, according to the legislative analysis.
But even if California passed the bill, the Trump administration would have to approve a waiver that allows federal funds to be redirected to single-payer. The Department of Health and Human Services did not return a request for comment on whether it would be willing to give the state a waiver.
Activists on the Left have found renewed energy in pushing for single-payer, which several countries such as the United Kingdom and Canada use.
Grassroots activists have been emboldened by the popularity of Sen. Bernie Sanders, I-Vt., who advocated for a Medicare-for-all plan during his failed presidential bid last year.
A new Medicare-for-all bill was recently introduced in the House and co-sponsored by more than 100 Democrats. And New York's legislature also is considering the program.
Rep. John Conyers, D-Mich., told the Hill last month that he has never "seen more energy behind this issue of Medicare for all."
But despite their efforts, Democrats don't have a practical path toward nationwide single-payer. Congressional Republicans and President Trump are working to replace Obamacare and move toward a more free-market system that they say would lower premiums.
In addition, the grassroots energy for single-payer hasn't affected everyone in the Democratic Party. Some liberals have lashed out at Democratic incumbents skeptical of the idea.
Sen. Dianne Feinstein, D-Calif., up for re-election next year, felt the brunt of that anger during a town hall in April where she was booed for not endorsing the plan.
"Single-payer now," the crowd chanted, according to news reports.
Another state's effort to change to a single-payer system failed in November. Colorado voters rejected a ballot measure after activists failed to win key support from major Democratic players such as Gov. John Hickenlooper.
Hickenlooper said the state had already made strides under Obamacare and didn't want to disrupt them.