California nurses move their 'Medicare-for-all' fight to the national stage

Oct. 26--The union representing 100,000 nurses across California has shifted its "Medicare-for-all" campaign from California to the national stage, perhaps relieving political pressure on Democratic gubernatorial candidate Gavin Newsom to fulfill what the union sees as his top campaign promise: Delivering a single-payer health care system in the nation's largest state.

The California Nurses Association, which led the coalition behind the high-profile 2017 push for a single-payer system, has re-branded its campaign with the slogan "Fight to Win Medicare-for-All!" Its social media feeds reflect the new national scope of their efforts.

Until this month, the coalition, previously called "Campaign for a Healthy California," was focused solely on passing a single-payer health care bill in California. Their campaign reached a fervor in late 2017 and early 2018, when nurses and single-payer activists stormed the California Democratic Party convention and later, the state Capitol, calling on Democratic lawmakers to approve their single-payer bill.

Representatives for the union, joined by its parent organization, National Nurses United, are now expanding their efforts to Congress and other states, such as Florida, Maine, Minnesota and Texas. They say they're not letting up in California.

"We're not conceding or taking a loss here. There will be a single-payer bill next year," said Stephanie Roberson, a spokeswoman for the California nurses union. "Our aim is to put strategic pressure on states where we see opportunities to provide health care for all, so we can make that national shift."

"California is a starting point," Roberson said.

Still, individual states face steep challenges in creating, within their borders, a new health care system that operates under a different set of rules and laws than the nation as a whole, said Gerald Kominski, a professor of health policy at the UCLA Center for Health Policy Research.

He said the nurses' new efforts to apply pressure on Congress, and national candidates, could also be an acknowledgment that California can't do it alone.

To create and pay for a single-payer system, under which the government would be the sole "payer" of health care services, California would need multiple approvals from the federal government to both collect federal health care dollars for the state-run system and to bypass regulations on employer-based private health plans. It would also have to amend the state Constitution.

"I think it's the realization that developing a single-payer system at the state level faces significant legal barriers that maybe they've acknowledged...are more substantial than they were willing to admit publicly a year ago," Kominski said. "It also might be a recognition that you're pushing the next governor out too far on a limb, where you're likely to be left hanging."

Newsom has shifted his tone on single-payer, a system under which government, generally, becomes the primary payer of all health care services. Before the primary he said of single-payer: "It's about time, Democrats." He now says universal health care is the ultimate goal.

Nurses say they plan to hold Newsom accountable on his earlier comments and expect him sign a single-payer health care bill into law should he become governor. But their shift to a national focus could also be an opening to letting Newsom off the hook, Kominski said.

"Part of what this shows is the fight really does need to take place in Washington," he said.

Holly Miller, a spokeswoman for the national nurses union, said the expansion into other states also aligns the push for a nationwide single-payer system, championed by Sens. Bernie Sanders and Kamala Harris.

"We did the re-branding of the social media feeds so we could show the much broader focus of the 'Medicare-for-all' campaign," Miller said. "We're using the movements in California and Florida to talk about the national fight. We're for single-payer health care, whether we get it at the state level, or nationally."

President Donald Trump, meanwhile, has blasted the idea of single-payer as an expensive fantasy for Democrats.

"In practice, the Democratic Party's so-called Medicare for All would really be Medicare for None," Trump wrote in a USA Today editorial earlier this month. Large portions of it have been widely discredited as false and misleading.

Critics say the nurses' move could aid efforts underway to steer the next governor and the Legislature away from single-payer.

"It may...clear some space for more constructive discussions about how to achieve universal health care," said Ned Wigglesworth, a political strategist working with doctor and hospital groups to oppose state single-payer efforts.

Newsom has acknowledged the political and financial challenges he'd face should he and others lawmakers decide to push for a single-payer system.

"We need partners in the federal government, so I'm not Pollyannaish about any of this. I'm a hard-headed pragmatist about it," Newsom said in an interview last month.

Still, he said, "I do believe single-payer financing, as broadly defined in (a) "Medicare-for-all" type system, is an advantageous system compared to our multi-payer system, and I'm deeply engaged in figuring out the how...I'm not walking away from this."

He said ultimately, his goal is "universal health care, regardless of pre-existing condition, ability to pay, immigration status."

Nurses are not letting up. The unions say universal health care -- extending coverage to everyone -- alone does not go far enough. Universal health care can be achieved through a single-payer financing system, or under California's current multi-payer system.

"We are absolutely aware of what appears to be waffling with respect to Newsom's stance on single-payer," Roberson said. "But we are going to hold him to what we know to be the case, which is if there is a single-payer bill -- which there will be in the state of California -- that gets to his desk, he will sign it and we will hold him to that."

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