Single-payer at

the state level?

The following text is from John McDermott. It outlines why a single-payer health-care system at the state level would be extremely difficult, if not impossible, to enact.

Single-payer coverage will only work at the federal level. Enacting "single-payer" at the state level creates the following problems:

"If a state were able to pass a ["single-payer"] bill outlining a path toward a universal healthcare system and to be granted a federal waiver from the Affordable Care Act (ACA), which are major feats, the state would still face significant barriers, some of which make it impossible to create a pure single payer program. … A state would have to succeed in obtaining multiple waivers from the federal government and changes to federal laws to enact a state-based program. One federal law, the Employee Retirement and Income Security Act of 1974 (ERISA), which prohibits states from regulating employee benefits, is a major obstacle. States also face the hurdle of being required to balance their budgets, a barrier that doesn’t exist at the national level. ...

Barriers to state single payer:

1. Federal health plans.

2. Medicaid.

3. Employer health plans – [Specfically the protection of their benefits] under a federal law, the Employee Retirement Income Security Act of 1974 (ERISA).

For many decades, states have introduced and passed laws aimed at achieving universal health care coverage. None has yet succeeded in being universal or sustainable. … It is not possible to achieve a pure single payer system at the state level and so states forego the significant savings of a single payer system. ...

Given that states are not able to achieve pure single payer systems, states take a risk when they label themselves single payer or Medicare for All. While it is understandable that these terms are popular and that most advocates for health reform support single payer, and so are inspired to work for it, it is misleading and could harm national efforts. …

What would happen if a state succeeded in passing a health law? First, it would take a tremendous effort focused on influencing state, not national, legislators to pass it. Second, that level of state-based pressure would have to be maintained to implement the law. And third, a state campaign would be so focused on these efforts that it would have little time or resources to advocate for change at the national level. Their national fight would be aimed at applying for waivers and winning changes to the Medicare law and ERISA.

Imagine if a highly-populated progressive state such as California or New York were to drop out of the national effort for NIMA to focus on their state. This would be a huge loss. Dr. Woolhandler reminds us, 'Living in New York or Massachusetts doesn’t lessen our sense of responsibility for millions in the Deep South and other ‘red state’ areas for whom national legislation is the only realistic option for health care progress.'"

Source for these quotes is

Credit to John McDermott for this text.

Thank you again.

Terry Flowers, Independence