The Coalition Pushing for Single Payer in California Is Fracturing

Key members have grown frustrated by CNA’s lack of consultation about its aggressive tactics and strategy.

Members of the California Nurses Association and supporters rally on the second floor rotunda at the Capitol calling for a single-payer health plan, Wednesday, June 28, 2017, in Sacramento, Calif. The demonstrators were demanding that Assembly Speaker Anthony Rendon, D-Paramount, bring a health care bill, SB562, by state Senators Ricardo Lara, D-Bell Garden, and Toni Atkins, D-San Diego, to a vote in the Assembly. (AP Photo/Rich Pedroncelli)
Members of the California Nurses Association and supporters rally on the second floor rotunda at the Capitol calling for a single-payer health plan in Sacramento, Calif. on Wednesday, June 28, 2017. Photo: Rich Pedroncelli/AP

The coalition organized to bring universal single-payer health care to America for the first time has sparked an unprecedented level of enthusiasm in state politics. Behind the scenes, however, Campaign for a Healthy California is fracturing, amid complaints of brass-knuckle leadership on the part of the California Nurses Association, the public face of the movement.

According to interviews with more than a half-dozen leading activists within the coalition, a collection of scores of progressive groups big and small, some key members have grown frustrated by CNA’s lack of consultation about its aggressive tactics and strategy, and its refusal to disclose amendments that could improve the legislation — amendments that are repeatedly referenced in the press, but remain hidden to both the public and other coalition members.

One labor group, the National Union of Healthcare Workers, is in active discussions with its executive board to withdraw from Healthy California’s steering committee, according to its president, Sal Rosselli. At least two additional steering committee members, the California Federation of Teachers and Unite Here, may also be on the outs, according to sources familiar with their planning. And others are stepping outside the coalition to engage with one another and devise how to move forward separately

In an interview, Rosselli, who has worked with CNA since the 1980s, stressed the positives of CNA’s leadership, such as “organizing more people than ever” to the cause of health care for all. But he expressed disappointment with what he called CNA’s unwillingness to collaborate.

“They established the steering committee two months ago, the price was $25,000,” Rosselli said. “It was framed to me and the executive board that we would meet to make strategic decisions. But it’s not real.” After Rosselli brought his concerns to CNA about not being consulted on the strategy to pass SB562, the single-payer legislation, he said that the nurses union replied, “we appreciate the criticism, but we’re not changing tactics until the legislature adjourns.”

Elizabeth Sholes is a senior official with California Church IMPACT, the 1.5 million-member policy arm of the California Council of Churches, which is currently part of the coalition, and has been advocating single payer for decades. “CNA could do the work needed to craft a decent bill with a good proposal for funding but have chosen the path of faux outrage and destruction instead. We were betrayed by CNA and people desperate for health care were abandoned,” said Sholes, who is known around the Capitol as “the Church Lady.”

The single-payer movement, said Sholes, is merely being used as a weapon in intraparty politics, calling the CNA strategy “a political hit against Dems whom the CNA wishes to replace with Bernie Sanders supporters.”

Rosselli, Sholes, and the other disappointed coalition members describe a consistent picture: they feel Healthy California is a coalition in name only, with CNA driving the process and shutting out would-be allies.

It’s an unusual fight, because all the participants support single payer, not just rhetorically but through the commitment of financial resources and with decades of effort given over to the cause. And though labor groups in particular are relatively close to the state Democratic Party, some of the coalition members doing the complaining were part of the effort to successfully toss a corporate Democrat out of office last year in a primary fight. Moreover, all involved want to continue to work together, and channel the groundswell of energy to revolutionize the health care system.

But activists interviewed by The Intercept worry that, given the enormous sums of cash the health care industry will eventually bring to bear if the movement comes within striking distance, any grassroots movement can ill afford to alienate coalition partners. And no single group can do it alone.

CNA declined to respond to several requests for comment for this story. But Paul Song, co-chair of Healthy California, disputed that CNA has micromanaged the process. “I came on board under the condition that things would be more democratic,” Song said. “I think sometimes things move rapidly, but there’s an attempt to keep all members informed.”

The discontent dates back to Healthy California’s formation at the beginning of the year. At an early meeting, CNA told coalition members the legislative vehicle would “look very, very much like the Kuehl bill,” said one one official with a coalition member, who asked for anonymity because their group has so far decided to stay in. CNA was referring to SB840, a decade-old single-payer bill written by then-Sen. Sheila Kuehl, which passed the legislature twice. This made sense, since Kuehl’s framework was considered quite strong, incorporating virtually every aspect needed for a single-payer system, from cost control and delivery system reform to incentive payments for more health professionals to care for the increased patient population.

When Sholes, the Church Lady, approached Sen. Ricardo Lara’s office about adapting the Kuehl bill, “they said we’re not using her stuff, we’re doing our own, CNA wants to do that. And then came this bill that was so insufficient.” A shell bill is harder to turn into real policy, but also more difficult for opponents to find reasons to object to it. It was the first hint that CNA was planning to prioritize building momentum and grassroots enthusiasm as the centerpiece of their strategy.

SB562 wound up delegating most policy decisions for the system to an unelected board, without codifying details into law. As the bill was attacked for being empty, CNA began promising it had elusive amendments that would fill it in. Song said that CNA tried for months to find a sponsor, and that once Lara signed on, the organization scrambled to commission an economic study, raise money, and come up with amendments. “They were always playing catch-up,” he said.

One sign of how Sacramento viewed the effort was the curious lack of opposition to the bill. “Insurers, doctors, I’ve been on the other side when they’re actually opposed to something,” said Anthony Wright of Health Access California, which supports the legislation but hasn’t formally joined the coalition. “I’ve seen what they can do, hiring lobbyists in the Capitol. You see none of that.”

After passing the state Senate, SB562 was described as “woefully incomplete” by Anthony Rendon when he shelved it for the year, to much consternation from activists. While Rendon is clearly not committed to overhauling the health care system, instead preferring to cover for conservative elements of his caucus, the hollow nature of the bill made it easier for Assembly lawmakers to blow it off, coalition members and former lawmakers claim. “They’ve taken the very important newfound energy in politics, anxiety and fear and hate around Trump, and tried to position it against the wrong villain,” said Jim Araby, executive director of the United Food and Commercial Workers Western States Council, a coalition member.

Sholes was even more direct about it. “They made it a litmus test for every Democrat, except no Democrat would support a bill this shitty,” she said. “They’re not supporting single payer because [CNA] did crap work, not because they support the insurance companies.”

It’s not unusual to turn major legislation in California into two-year bills, to allow lawmakers to refine the content. “This bill is far from dead,” said Roy Ulrich of the Goldman School of Public Policy at the University of California, Berkeley. But in response to Rendon’s shelving, CNA targeted him as the ultimate betrayer of single payer, holding back an overhaul that was ready to go. No other coalition member received a heads-up about this strategy, which has become a major source of anger within the coalition, members said. It has also shifted headlines from a bid to deliver health care for all to a “civil war” inside the state Democratic Party.

“There are people in the coalition in favor of the aggressive approach, not just CNA,” maintained Song. “Others would prefer us try to not alienate all of our base.”

The policy maneuvers have also been questioned. Take the numerous amendments to SB562 that CNA says cannot be grappled with because Rendon shut down the legislative process. “We asked to see amendments weeks ago, and they said they need Sen. Lara’s OK to show them to us,” said NUHW’s Sal Rosselli last Friday. “They said the same thing today. Which you know, that’s ridiculous, give me a break.”

Sen. Lara’s office did not respond to a request for comment.

Other coalition members believe they have found a way around CNA’s argument that amendments cannot be incorporated while the Assembly has shelved the bill. According to them, the Senate could add those amendments into a new bill at any time. While the deadline for bills to pass their chamber of origin expired in May, senators can use a process called “gut and amend,” where they take a bill that passed the Assembly, remove all the language, and substitute with their own text. The Senate could even add the financing option, as spelled out by University of Massachusetts economist Robert Pollin. (Passing the financing would require a two-thirds vote; Democrats hold such a majority in both houses.)

The gut-and-amend tactic, which occurs commonly in the legislature, is one idea coalition members are discussing apart from CNA. Another is having the legislature establish a select committee on health care to hold hearings across the state. Such a commission would serve the dual purpose of educating the public while advancing single-payer improvements to the legislature. Several coalition members want to pursue these alternatives, and pressure CNA to accept different ideas to move forward. “We need a true coalition around health care reform,” said UFCW’s Jim Araby.

Song endorsed both concepts in a Monday piece for The Huffington Post. “I wrote the op-ed to say to legislators, you can do something, don’t just say it sucks. All the amendments that CNA has gotten together, make [Sen. Lara] get them in now, so they can’t hide behind something being woefully incomplete.” Gut-and-amend would also force corporate-friendly Democrats, like Sen. Steve Glazer (former campaign manager for Gov. Jerry Brown), to reveal their support for health care for all, or broadcast their fealty to industry campaign contributions.

Meanwhile, CNA continues to organize against Rendon. On Tuesday, they held a “People’s Assembly” committee meeting on the Capitol steps in Sacramento, where activists planned to “vote” for SB562. And at a town hall meeting last Saturday in Lakewood, a city in Rendon’s district, 125 supporters came out to rally for passage and hear a single-payer presentation by Michael Lighty, CNA’s policy director.

A town hall participant asked Lighty whether establishing a single-payer system would require a ballot measure, a concern raised by The Intercept because of the need to exempt new revenues from Proposition 98, which requires that roughly 40 percent of state revenues go to education. Lighty again responded that CNA is working with legislative staff and constitutional lawyers to devise a way around the Prop 98 restriction, without providing specifics.

But he added that the only opinion that matters on the question “is not me, or some blogger” — a reference to yours truly — but the Legislative Counsel, a nonpartisan public agency that assists lawmakers in drafting legislation and making legal determinations. “By blocking the legislative process from moving forward, Rendon is blocking that opinion,” Lighty said.

This is incorrect. The Legislative Counsel’s website states clearly that the office routinely prepares “informal legal guidance” in response to requests from members of the Legislature. So Senator Lara, for example, can supply the Legislative Counsel with draft language exempting SB562 from Prop 98 requirements at any time, and get a legal opinion on the merits. The office of Legislative Counsel confirmed this procedure to The Intercept.

In fact, “other persons may discuss drafting problems or other legal issues regarding legislation with the Legislative Counsel and staff” if a member of the legislature authorizes it, according to the Legislative Counsel’s website. So CNA, the bill sponsor, could go to the Legislative Counsel directly with the language, if Sen. Lara allows it. Rendon’s shelving of the bill simply does not block advocates from getting an answer to the critical question of whether single payer would have to go to the ballot to get implemented.

“I believe you can’t do it in legislation,” said Elizabeth Sholes of California Church IMPACT. “If you could we would have figured that out a long time ago.” If that’s correct, and a ballot measure looms at the end of the fight, the coalition needs to remain robust to counteract the hundreds of millions of dollars of industry money that will combat any initiative.

But Sholes alleged that CNA prefers to be in charge, and appears to have a larger political project to take over the state Democratic party. “We who are in it for health care don’t want to be in it for intrapartisan politics,” she said.

The irony is that CNA’s implied threat, to primary lawmakers who don’t endorse single payer, has already been accomplished in the past by the very coalition CNA is marginalizing. In 2016, labor and environmental groups successfully tossed out Cheryl Brown, a corporate Democrat funded by oil interests. But that took millions of dollars and mutual cooperation, and it’s unclear whether CNA, which typically spends roughly $1 million per cycle on California elections through its political action committee, can pull it off by themselves.

That said, the outpouring of energy that CNA has facilitated is critical. “The passion and dedication is something like we have never seen before in California,” Song said. “Some Assembly members will have uncomfortable summers. That to me is healthy. I think the only way we move any fundamental legislative agenda is we have to take this passion and start scaring the shit out of moderate Democrats.”

Frustrated coalition members maintain that CNA has earned its place as a major part of the single-payer movement; they just want to see a more equal partnership. “We need the CNA, but they can’t drive the bus,” said Sal Rosselli. “It has to be a collective thing.”

Top photo: Members of the California Nurses Association and supporters rally on the second floor rotunda at the Capitol calling for a single-payer health plan in Sacramento, Calif., on Wednesday, June 28, 2017.

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