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RELEASE: Rep. Khanna introduces State-Based Universal Health Care Act, Landmark Step toward a National Medicare For All Plan

November 8, 2019
Press Release

Washington, DC – Today, Rep. Ro Khanna (CA-17) introduced the State-Based Universal Health Care Act, a landmark step toward empowering states to expand health coverage to every resident. Recognizing the unique position of American states to lead the push for universal health care, Rep. Ro Khanna’s bill provides states with historic access to federal funding streams and regulatory flexibility necessary to implement and support affordable, universal health care plans.

“While Senator McConnell and President Trump do all they can to obstruct progress at the federal level, this bill allows states with bold leadership to establish their own successful universal health care programs in order to prove how viable our movement is on the national level. This is how bold states like California can take the lead in making Medicare for All a reality. Throughout our nation’s history, our states have served as the incubators of democratic ideas. Our neighbors in Canada established their own successful national health program by allowing the province of Saskatchewan to lead with a universal hospital care program in 1947, a decade before the plan took hold nationwide. States are in a unique position to innovate and lead in the push for universal health care. We must provide them with the tools they need to succeed,” said Rep. Khanna. “Under this proposal, the coverage you receive for health care will be either equal to what you currently receive or more expansive. You will have free choice of providers. Everyone in your community will have health care.”

The State-Based Universal Health Care Act creates a waiver that a state or group of states can apply for that would provide them with the federal funding and regulatory flexibility necessary to set up state or regional universal health care systems. In order to apply for the waiver, participating states or groups of states must propose plans to provide health care coverage for 95 percent of their residents within five years. After five years, participating states would be required to demonstrate they reached coverage targets and provide a plan to cover the remaining five percent of their population. States that do not reach the 95 percent target after five years would have to revise their plan to achieve the targets, or risk losing their waiver. Federal technical assistance would be made available for states seeking help in developing and implementing these plans.

The State-Based Universal Health Care Act also requires benefits provided under state plans to be equal to or greater than what federal beneficiaries in those states receive now. An independent panel of health care experts and officials would evaluate whether a state’s waiver application meets the designated criteria and would then provide a public recommendation of approval or rejection of the waiver application to the Secretary of HHS.

The regulatory flexibility provided and funding streams combined include: (1) the requirements for the establishment, creation, and maintenance of health benefit exchanges; (2) cost-sharing reductions under the ACA; (3) premium tax credit and employer mandate under the ACA; (4) Medicare; (5) Medicaid; (6) CHIP; (7) FEHBP; (8) TRICARE; and (9) ERISA pre-emption provision. States will have the freedom to devise their own individual state-based universal health care programs, as long as they meet the coverage breadth and depth requirements. Combining funding streams, negotiating discounts with providers and eliminating inefficiencies will help drive out-of-pocket costs down for patients.

“Families across the country are struggling to afford quality health care. If the federal government continues to drag its feet on establishing a single-payer system, states should be empowered to innovate and create their own. Our country needs a truly universal, single-payer health care system to guarantee health care as a right, not a privilege. This legislation is a step in the right direction,” said Rep. Blumenauer.

“As the Trump Administration and Congressional Republicans undertake every effort to rip health coverage away from our most vulnerable populations, states have stepped up to fill the void. This legislation incentivizes states to provide universal coverage to their residents and reaffirms that health care is a human right—not a privilege that only the wealthy can afford,” said Rep. Grijalva.

“I’m proud to support this critical bill, which builds on my state-based universal health care legislation from last Congress. So many progressive accomplishments have started at the state level and grown to fuel national change. Americans are fed up with a broken health care system that lines the pockets of insurance and drug company executives at the expense of families struggling to keep up with skyrocketing costs. Supporting state-based universal health care efforts will help build momentum for the grassroots energy we need to achieve bold, structural federal reforms through Medicare for All,” said Rep. Jayapal. 

“As the Trump administration seeks to undermine healthcare access across the country, we have a duty to give states the power to support local communities with comprehensive, universal healthcare. For too long, Republicans have mandated that healthcare is a right only for those who can afford it—lining the pockets of large insurance companies and Big Pharma. It’s time we put the American public’s health above the corporate bottom line—it’s time we make healthcare a right for all people,” said Rep. Pocan.

“You shouldn’t have to be wealthy to be healthy. Even in Massachusetts – a leader in the universal healthcare movement – there are still tens of thousands of uninsured Bay Staters, including nearly 30,000 in my district alone. The State-Based Universal Health Care Act is critical legislation in the fight for our shared rights and shared humanity.  Being sick shouldn’t push you into poverty and poverty shouldn’t push you in sickness,” said Rep. Pressley.

“In one of the richest countries, quality healthcare should be guaranteed to every citizen. Allowing states to use federal funds to create their own universal health plan will help move us in the right direction – towards a system that provides quality, affordable care for all,” said Rep. Omar.

“At the same time that the Trump Administration and Republicans in Congress try to tear down access to health care for millions, states like California and New York are leading the way in working to create single-payer health care systems that would ensure that everyone in the state has access to the care they need. We are seeing an unprecedented groundswell for state and federal action to fix our broken health care system by breaking down barriers to care and eliminating the ability of greedy corporations to profit off illness and disease. This bill would do just that. We applaud Rep. Khanna’s efforts to push the fight for single-payer health care forward,” said Lisa Gilbert, Public Citizen's Vice President of Legislative Affairs.

"The State-Based Universal Health Care Act would revolutionize state health care in this country by enabling state governments to devise innovative programs for insuring all their residents — thereby setting the stage to achieve Medicare for All nationwide. When states get the green light to operate their own single-payer health care systems that provide universal care while containing costs, it will only be a matter of time before the entire nation follows suit," said Sal Rosselli, President of the National Union of Healthcare Workers (NUHW).

"The Labor Campaign for Single Payer counts 14 national unions and dozens of regional and local unions among our affiliates.  From New York to California, many of these unions are engaged in winnable campaigns to establish state-level single-payer-style health insurance.  This bill would provide a clear path for funding and implementing such plans. We believe that this state innovation could light a fire that will ultimately make healthcare a right for everyone in America," said Mark Dudzic, National Coordinator for the Labor Campaign for Single Payer.

"Representative Ro Khanna's State-Based Universal Health Care (SBUHC) Act of 2019 will enable states to create and model equitable, cost-effective, and comprehensive healthcare systems, not only for their residents but for additional states to study and improve upon, until that day very soon when all states provide healthcare for all. Consistent with our nation's history of state-led reforms, in politically progressive states like California and New York, Khanna's SBUHC offers the clearest path to Medicare for All," said Chuck Pennacchio, President of the Twenty-State Partnership, One Payer States.

“The California Chapter of Physicians for a National Health Program is grateful to Rep. Khanna for his leadership and is in full support of HR6097. We believe this legislation will finally eliminate the false excuse used by far too many politicians of a lack of a federal waiver as an obstacle to making healthcare a human right. This bill would allow California with the world's 5th largest economy to lead on healthcare by implementing its own single payer plan which would provide far better access to care for all its citizens while bringing down costs,” said Paul Y. Song, MD, President - California Physicians for a National Health Program.

“Rep. Khanna’s State-Based Universal Care Act of 2019 is vital to getting state legislators to embrace state-based single-payer health care plans. Legislators need to be reassured that the federal waiver process will be streamlined and that federal health care funds will be available for state-based plans,” said Kelly Powers, Health Care for All – Washington.

“Health Care for All-Washington salutes Rep. Khanna and his staff for their work on this important legislation that will ensure Washington state can achieve the innovative healthcare system that a solid majority of our state's residents need, want and deserve.  Thank you!” Marcia Stedman, Health Care for All-Washington and Health Care is a Human Right-Washington

"The fight for Medicare for All is center stage in national debates, as it should be. But there are states ready to move to a single payer system right now, if they could use their federal health care dollars to build a universal plan. Their call to lead and innovate should not go unanswered. Washington CAN supports Representative Ro Khanna's State Based Universal Health Care Act of 2019, as part of the fight to win Medicare for All. Every state that is ready to make Health Care a right to all people should have that opportunity as soon as possible and the SBUHC Act allows states to do just that. This will build the movement and momentum to win a universal national plan," said Washington CAN.

"Rep. Khanna’s State Based Universal Health Care Act of 2019 is an important asset to the movement for a universal national health plan and Medicare for All. There is strong movement in a number of states to achieve universal and affordable health care at the state level. As we work towards Medicare for All, the SBUHC Act will enable some states to transition to universal, single-payer systems that can serve as models for national Medicare for All. This will build our national movement and will help us win concrete victories along the way,” said David Loud, Puget Sound Advocates for Retirement Action representative to Health Care Is a Human Right Washington.

"States that want to guarantee health care to all their residents through a universal health care system face powerful political resistance from the insurance industry. They shouldn't have to face added hurdles from our federal government. The State-Based Universal Health Care Act would make sure that states have full flexibility to respond to public demands and meet the health care needs of their people,” said Ben Palmquist, Health Care Program Director at the National Economic & Social Rights Initiative.

“Federal law governs 85% of healthcare spending in our country. Only by risking violating those laws can states dare to create their own healthcare systems for their own residents designed by their own legislatures. The State Based Universal Health Care Act of 2019 provides that freedom. If passed, this permits far-sighted states to provide better care to more people for less money, a responsibility Congress declined to assume despite decades of deadly inefficiency in America’s healthcare system. Supreme Court Justice Louis Brandeis urged each state to ‘…serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.’ Let’s bring healthcare reform back to the states,” said Samuel Metz, MD., Vice President, Oregon Physicians for a National Health Program.

"We all know that our healthcare system is broken. The healthcare our families deserve can only be achieved through a coordinated single payer system.  Everyone in and no one left out. The affiliates of the Center for Popular Democracy are committed to winning that system however we can. Many have been fighting, and winning, at the State level to advance universal healthcare in the States and Regions and Rep. Khanna's proposal allows us to use federal funding to prove the concept of Medicare for All and get a whole lot of people healthcare along the way. We are excited to offer our support," said Jennifer Epps-Addison, CPD/A Network President and Co-Executive Director.

“Whole Washington, a grassroots organization dedicated to getting single payer healthcare passed both nationally and in Washington State, proudly endorses Representative Khanna’s State Based Universal Healthcare Act of 2019. Canada passed their single payer system province by province starting with Saskatchewan, and Whole Washington strives to follow a similar model. The end goal is Universal Healthcare, delivered by a single payer system, for everyone in the U.S. Due to the current federal laws, it’s difficult for states to create a true single payer system without waivers. Rep. Khanna’s bill would streamline this process, making it easier for states like Washington to pass legislation that would cover the millions of uninsured and underinsured residents in our state, while leading the charge for a federal transformation,” said Jen Nye, Communications Director, Whole Washington.

Rep. Khanna is also the sponsor of the Prescription Drug Price Relief Act, a bill introduced with Senator Sanders, to significantly reduce prescription drug prices for Americans.

Read the State-Based Universal Health Care Act online here.

Original Cosponsors: Rep. Jayapal (WA-07), Rep. Blumenauer (OR-03), Rep. Bonamici (OR-01), Rep. DeFazio (OR-4), Rep. Garcia (IL-04), Rep. Grijalva (AZ-03), Rep. Lee (CA-13), Rep. Ocasio-Cortez (NY-14), Rep. Omar (MN-05), Rep. Pocan (WI-02), Rep. Pressley (MA-07) Rep. Raskin (MD-08), Rep. Schakowsky (IL-09), Rep. Adam Smith (WA-09), Rep. Watson Coleman (NJ-12)

Endorsing Groups: National Nurses United, Public Citizen, National Union of Health Care Workers, Social Security Works, Labor Campaign for Single Payer, Center for Popular Democracy, One Payer States, Healthy California Now!, California Physicians for a National Health Program, National Economic and Social Rights Initiative, Whole Washington, Health Care for All Oregon, Oregon Physicians for a National Health Program



About the Office

Congressman Khanna represents the 17th District of California, which covers communities in Silicon Valley. Visit his website at Follow him on Facebook, Twitter, and Instagram @RepRoKhanna.