CA Democrats Pushing to Give Illegal Adults Full Health Care Benefits

MedizinCalifornia Democrats are reportedly pushing to give full healthcare benefits to illegal immigrant adults, which would mean that the Golden State not only may have to raise taxes but will also be a magnet for even more illegal immigrants.

According to a Monday Politico report, state Senator Ricardo Lara (D-Bell Gardens) is leading the charge by reportedly arguing that “California needs to be a laboratory for social change by taking the lead on progressive causes.”

“We are trying to address the fact that, whether you like it or not, our undocumented community needs the care, and we are paying for it anyway,” he reportedly said.

Politico points out that California Democrats are trying to extend the state’s Medi-Cal program this legislative session to nearly 1.2 million illegal immigrant adults who would qualify for it, and “companion bills in the state Assembly and Senate” have already “passed their respective health committees with party-line votes.”

The cost to expand Medicaid coverage to adult illegal immigrants in California is reportedly projected to cost $3 billion annually.

California Governor Jerry Brown, who extended Medi-Cal coverage to illegal immigrant children in 2015, has not commented on the pending measures but “is required by law to sign or veto bills passed this session by Sept. 30, just five weeks before the midterm elections.”

Political and health analysts are reportedly astounded that Democrats are trying to extend healthcare benefits to illegal immigrants before this year’s important midterm elections, reportedly saying that the measure would give Republicans in California relevance “they would never have before” in an election cycle in which House races in California could decide which party controls Congress.

Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy, told Politico that the proposal would be “fiscally very dangerous” and  Jay Bhattacharya, a Stanford physician and health economist, suggested to the outlet that such a plan would have to be paid for with tax increases.

Bhattacharya also pointed out the obvious—giving full healthcare coverage to illegal immigrant adults will make California, which is already an official “sanctuary” state, even a greater magnet for illegal immigrants.

The illegal immigrant who murdered Kate Steinle, for instance, told authorities that he came to San Francisco after being previously deported five times because he knew San Francisco was proudly a “sanctuary city.”

“If you make a program like this available, undocumented workers in other states might be attracted to California because of this,” Bhattacharya, the Stanford physician, reportedly said.

This article was originally published by Breitbart.com/California

New bill would put state in charge of setting California health care prices

MedizinAssemblyman Ash Kalra, D-San Jose, has introduced a new bill that would put California in charge of setting prices for hospital visits, trips to the doctor and other medical services.

Under the legislative proposal, the state would create an independent agency that would set prices for the health care market – prices that would be based off the current pricing structure for Medicare.

However, there would be a process for hospitals to appeal and argue that certain procedures require a higher rate.

“By building upon existing models, we can establish a transparent process by which increases in health care costs can be kept reasonable while also expanding access to care,” Kalra said at a Monday press conference.

Proponents of Assembly Bill 3087, including major labor groups, argue that it would help control rising health care costs and give consumers more predictability in assessing health care pricing, while opponents, like doctors and hospitals, maintain that it risks decreasing the quality of care and would cause physicians to leave the state.

“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said California Medical Association President Theodore M. Mazer said in a statement. “It threatens to reverse the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.”

California spends about $8,000 per capita on health care every year, totaling around $300 billion, according to the California Health Care Foundation, and it’s a cost that is affecting everything from the state budget, business’s bottom lines and employee paychecks.

“Medical monopolies are the only ones who benefit from skyrocketing prices; the rest of us are paying the price because we have no choice,” Roxanne Sanchez, President of SEIU Local 1021 and SEIU California, said in a statement supporting the bill posted on care4allca.org.

But the overarching concern is that state officials would be making decisions on behalf of patients – raising concerns about rationing, a lower quality of care and longer wait times.

Additionally, the proposal is also being opposed by progressives in support of single-payer, seeing the legislation as just making a dent in a larger problem that needs complete overhaul.

More broadly, it’s just the latest effort to overhaul the Golden State’s health care system. Last March, state Sen. Ricardo Lara, D-Bell Gardens, introduced a bill to create a single-payer model, but the plan stalled in Sacramento after there were few details laid out on how to pay for the “Medicare for all” system.

This article was originally published by CalWatchdog.com

California Democrat lawmakers are working on bills to increase government control over health care

Watch out—the Socialist/Democrat Party of California is using 14 bills, so far, to limit your choice in health care and to use government to control your health care, medical procedures and more.

“Arguing that it would take several years and a lot of heavy political lifting at the state and federal levels to move to a so-called single-payer health care system, the report recommends taking a series of short-term steps to improve coverage, affordability and access while simultaneously studying how to get to universal coverage.

That will lead to at least 14 bills from select committee members, said Cathy Mudge, spokeswoman for committee co-chair Assemblyman Jim Wood (D-Healdsburg). She said that other legislators may introduce their own reform bills.”

Please note there are NO moderate Democrats in this—every Democrat in the Assembly and Senate will support all or most of these bills—those that supported Steve Glazer for Senate and kept him there, will be losing the right of determining their own health care.  People will die because Glazer was a “moderate”.

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California lawmakers are working on bills to lower health costs and expand access

Michelle Faust and Paul Glickman, KPCC,  3/23/18

Key state lawmakers are set to introduce a series of bills designed to lower costs and expand access to health insurance on California’s individual market, following through on a strategy they embraced earlier this month that calls for an incremental approach to reform rather than an immediate push for government-backed universal health coverage.

Much of the legislation is based on recommendations in a report by three independent consultants to the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage. The consultants based their analysis on 30 hours of testimony given to the committee between October and February.

Short-term reforms

Arguing that it would take several years and a lot of heavy political lifting at the state and federal levels to move to a so-called single-payer health care system, the report recommends taking a series of short-term steps to improve coverage, affordability and access while simultaneously studying how to get to universal coverage.

That will lead to at least 14 bills from select committee members, said Cathy Mudge, spokeswoman for committee co-chair Assemblyman Jim Wood (D-Healdsburg). She said that other legislators may introduce their own reform bills.

Lawmakers are still working on the language of most of the bills, said Mudge, but she provided a list that states “the intent and goal” of each one, along with its sponsor:

Bill Sponsor Description
AB 2965 Select Committee co-chair Assemblyman Joaquin Arambula, D-Delano Expand Medi-Cal coverage to all income-eligible adults regardless of immigration status.
AB 2472 Wood Establish a public option.
AB 2416 Wood Increase health plan competition by requiring plans with Medi-Cal contracts to participate in Covered California.
AB 2459 Assemblywoman Laura Friedman, D-Glendale Provide for state subsidies and/or tax credits for those people in the individual market with incomes more than 400 percent of FPL and/or place a cap on the cost of premiums at a percentage of income.
AB 2565 Assemblyman David Chiu, D-San Francisco Provide increased state subsidies for individual market policies for people with incomes between 138 percent and 400 percent of FPL.
AB 3148 Arambula Limit amount of cost sharing for people in individual market plans with incomes between 138 percent and 400 percent of FPL.
AB 2430 Arambula Increase Medi-Cal eligibility for seniors/disabled individuals whose income is between 123 percent of the federal poverty level (FPL) and 138 percent of FPL to create consistency in eligibility and expand coverage to 60,000 seniors/disabled.
AB 2499 Arambula Limit health plan administrative costs by establishing a medical loss ratio (MLR) in statute that assures 85 percent of premium goes to care.
AB 2502 Wood Establish an all-payer claims data base to gather information on the actual cost of services.
AB 2579 Assemblywoman Autumn Burke, D-Inglewood Streamline eligibility to enroll uninsured individuals who are eligible for Medi-Cal, creating an
AB 2597 Arambula Increase availability of primary care physicians by fully funding and expanding the Public Hospital Redesign and Incentives Program in Medi-Cal (known as PRIME)
AB 2275 Arambula Increase accountability for health care quality standards and reducing disparities in Medi-Cal managed care plans.
AB 2427 Wood Addressing profits in Medi-Cal managed care plans.

One of the reports’ recommendations was missing from the list of legislation: the creation of a state health insurance mandate. Wood and Arambula said earlier this month they weren’t ready to back a state mandate, which has the support of Covered California and the California Association of Health Plans.

“Subsidies are more of an incentive than mandates are,” said Arambula.

While acknowledging their strategy is more “methodical” than many activists want, Wood was not apologetic about backing a step-by-step approach.

“Even one small tweak to the system could have huge ramifications to another part of the system,” he said.

The long-term plan

Following the consultants’ recommendation, Wood and Arambula did endorse the consultants’ recommendation to start the hard work of laying the political, legal and financial groundwork for a government-run single-payer system. They’re sponsoring AB 2517, which Mudge said would “provide a road map, with benchmarks, to move California toward a uniform publicly funded health care system.”

The consultants pointed to a number of state and federal legal hurdles to single payer in the short-term. Both Arambula and Wood expressed doubt that the Trump administration would support changing federal rules and laws to allow California to use Medicaid and Medicare dollars to pay for a state-run health care system.

“We can’t do it without the federal resources,” said Wood.

The experts suggested creating a “planning commission” that would work on designing a single-payer system and figuring out how to pay for it.

The select committee was created to look at the issues raised by SB 562, which proposed a Canadian-style single-payer health system for California. It passed the state Senate last spring but never reached the Assembly. Speaker Anthony Rendon shelved it, calling the measure “woefully incomplete” because it lacked details on how to implement or pay for single payer.

SB 562’s main backer, the California Nurses Association, slammed the report’s call for an incremental strategy.

“The report inflates the obstacles to single payer, all of which are a reflection of lack of political will,” Association Executive Director Bonnie Castillo said earlier this month.

Many of the short-term proposals are “a deceptive facade,” she said, “pretending to address the problem.”

They will “do little to address the biggest hole in our healthcare system, the failure to guarantee actual health care, not ‘insurance’ for all Californians, said Castillo.

The Association said it will continue to press the legislature to consider SB 562.

 

The Missing Item in Health Care Discussion — the Tax Code

MedizinAttempts at creating a single payer health care system have stalled so a group of liberal organizations are backing a package of bills to achieve a form of universal coverage. But you can pull out the same label on this attempt that sidetracked single payer—“woefully incomplete.”  They don’t want to say how much this universal health care plan will cost or where the money is coming from.

Sure the state treasury is brimming with unexpected cash and the budget is at an all time high. However, anyone who has ridden the California budget rollercoaster over the last couple of decades knows that flush times won’t last.

Creating new entitlements on health care that provide subsidies as called for in the plan and includes all residents despite legal status has big dollar signs all over it.

The single payer proposal was weighted down with a $400 billion price tag. Even if the new effort would cost a smaller portion of that amount, the health care change would still add billions to state spending.

Tax increases would probably be part of the proposal to cover the cost. It is hard to see how they can be avoided. But, the M.O. of those seeking tax increases generally has been to get support for tax measures by limiting tax increases on someone else — the rich or corporations are favorite targets.

Such an idea just adds another story onto a tax structure built on a wobbly foundation. When the next economic downturn hits, the structure crumbles and many government programs will be gasping for fiscal oxygen, especially the proposed universal health care.

If health care reformers want to create a new way to expand health care coverage, they first better consider thinking about a tax code that will not undercut the economy and at the same time be able to better manage economic pitfalls.

Such a bill doesn’t exist in the proposed healthcare reform package.

ditor and Co-Publisher of Fox and Hounds Daily.

This article was originally published by Fox and Hounds Daily

Assembly wants to spend $1 billion on health coverage for illegal immigrants

California, flush with cash from an expanding economy, would eventually spend $1 billion a year to provide health care to immigrants living in the state illegally under a proposal announced Wednesday by Democratic lawmakers.

The proposal would eliminate legal residency requirements in California’s Medicaid program, known as Medi-Cal, as the state has already done for young people up to age 19.

It’s part of $4.3 billion in new spending proposed by Assemblyman Phil Ting, a San Francisco Democrat who leads the budget committee. Assembly Democrats also want to expand a tax credit for the working poor, boost preschool and child care, and increase college scholarships to reduce reliance on student loans.

They also would commit $3.2 billion more than required to state budget reserves. …

Click here to read the full article from the Sacramento Bee

Covered California to Guarantee Health Insurers’ Profits to Save Obamacare Exchange

covered caCovered California is so desperate to keep insurance companies on its Obamacare exchange that the state plans to guarantee profits to the giant corporations.

Breitbart News reported early this month that despite the annual inflation rate of only 1.6 percent, Covered California is granting healthcare insurers average premium increases of 12.5 percent. But that appears to not be enough to lure insurers to stay on the exchange, if President Trump ends U.S. Treasury “cost-sharing” side payments to insurers that the courts have ruled are illegal.

According to the a study by the non-partisan Congressional Budget Office (CBO), titled “The Effects of Terminating Payments for Cost-Sharing Reductions,” Obamacare exchange insurance premiums will spike by another 20 percent in 2018. Given that 75 percent of Obamacare enrollees received free insurance through Medicaid, the CBO estimates that the U.S. deficit will jump by another $194 billion between 2017 and 2026 as a result.

Obamacare was sold to voters on a promise to slash healthcare insurance premiums by up to $2,500 per family. But new mandatory rules caused insurance premiums to spike by 68 percent between 2010 and 2015, according to the National Association of State Legislatures.

The national average cost of healthcare for a family of four in the United States is now $17,322. But in highly-regulated California, the average family healthcare premium is even worse, at $18,045.

With the tsunami of cash flooding into the health insurance industry since 2010, profits have more than doubled, and the healthcare stock index is up by 251 percent. The industry’s biggest Obamacare winner has been America’s largest health insurer, United Healthcare. With profits more than tripling since Obamacare passed, United Healthcare’s stock is up a stunning 592 percent.

But with concerns that President Trump or the courts will stop making illegal cost-sharing payments, big insurers like Anthem Blue Cross, Aetna and Humana are duping Obamacare coverage for 2018. One of the reasons that United Healthcare’s stock has been hitting a series of new all-time-highs this month is that the company is cutting its Obamacare coverage from 34 states in 2016 to 3 states in 2017, and possibly leaving Obamacare completely in 2018.

With many of the top health insurance industry players jumping ship on Obamacare, Southern California Public Radio reported that the board of Covered California will consider a plan on August 17 that would incentivize health insurers to offer coverage by guaranteeing that for any lack of profit or losses they suffer in 2018, California will guarantee them the right to jack up profits with higher premium increases in each of the following three years.

Covered California is referring the to the plan as an initiative to address market uncertainty over the actions that might be taken by the Trump administration and the courts.

But “[a]n economic system characterized by close, mutually advantageous relationships between business leaders and government officials” is the Oxford Dictionary’s definition of crony capitalism.

This article was originally published by Breitbart.com/California

Summer of discontent continues to rage for California progressives

In this photo taken Monday, Dec. 5, 2016, California Assembly Speaker Anthony Rendon, D-Paramount, third from left, flanked by Senate President Pro Tem Kevin de Leon, D-Los Angeles, right, and other Democratic lawmakers, discusses a pair of proposed measures to protect immigrants, during a news conference in Sacramento, Calif. California is among the states that voted for Hillary Clinton and that could find themselves at odds with President-elect Donald Trump on such issues as immigration, health care and climate change. Rendon said the intent of the legislation is to put a "firewall" around Californians. (AP Photo/Rich Pedroncelli)

The California progressive movement’s summer of discontent continues, with anger still on display over the abrupt withdrawal of a single-payer health care bill and over the May election of a party insider as California Democratic chairman.

This week, the Associated Press reported that progressives remain interested in pursuing a recall campaign against Assembly Speaker Anthony Rendon, D-Paramount, (pictured) for his decision to kill Senate Bill 562, the Healthy California Act. Los Angeles activist Steve Elzie is a lead organizer.

The California Nurses Association last month paid for two mailers to be sent to constituents in Rendon’s Los Angeles County district blasting him for “holding health care hostage” and “protecting politicians, not people’s health care.” The mailers urged constituents to complain to Rendon’s offices over the decision, but did not advocate a recall.

That decision may reflect that CNA President RoseAnn DeMoro – who initially led the criticism of Rendon – has realized how difficult it would be to ultimately remove him from office.

Obtaining the 20,000-plus signatures needed to trigger a recall election might not be much of a problem, given that single-payer champion Bernie Sanders got 44 percent and 48 percent of the vote in the June 2016 Democratic presidential primary in California’s 38th and 47th Congressional Districts, respectively. The districts cover much of Rendon’s 63rd Assembly District district which includes parts or all of Commerce, Bell, Lynwood, Paramount and Lakewood.

But Rendon has gotten at least 69 percent of the vote in his three Assembly bids. He also has more than $1.2 million in his campaign war chest and has the support of other influential unions, meaning ready access to more donations and help campaigning.

Rendon killed SB562 because he said it failed to adequately identify how it would pay its $400 billion in annual costs to provide health care to every Californian.

‘Berniecrat’ still won’t accept loss in party chair vote

The other flap pitting the party establishment against “Berniecrats” also flared this week when Bay Area political organizer Kimberly Ellis launched a new salvo over her narrow loss for state party chairman to Eric Bauman, a nurse who has long been a fixture in Los Angeles County Democratic politics and was deputy to the last state chair, former Congressman John Burton.

At May’s state Democratic convention in Sacramento, Bauman held off a late surge from the lesser-known Ellis to win 51 percent to 49 percent. Ellis immediately challenged what she said were election irregularities, leading to a July recount in which 47 of about 3,000 ballots were thrown out but Bauman’s margin of victory was unchanged.

Ellis and her fellow Sanders’ supporters, however, still don’t accept the results.

On Tuesday, she called on the California Democratic Party to accept binding arbitration to determine who really won the May election. She hinted it was the only way the party could head off a lawsuit that she suggested last month was forthcoming if she were unhappy with how party officials handled her appeal, which continues this month with a hearing of the Democratic Party credentialing committee.

California Democratic Party spokesman Mike Roth said the party would stick to its rules, which don’t provide for arbitration.

“Ms. Ellis is now deep in her own end zone and throwing a desperate Hail Mary pass in hopes of changing the outcome of an election that she lost fair and square,” Roth said.

But Ellis’ “Vote for Kimberly” website remains unchanged and continues to feature sharp – if indirect – criticisms of Bauman for allegedly close ties to corporate interests.

This article was originally published by CalWatchdog.com

Covered California announces increased rates of 12.5 percent for its 2018 health insurance plans

As reported by the Orange County Register:

Covered California on Tuesday announced that insurance rates will jump an average of 12.5 percent for next year, amid uncertainty about the future of Obamacare.

“Californians are paying about 3 percent more than they would have if not for the uncertainty,” said Peter Lee, executive director of the state’s exchange.

Additionally, Anthem Blue Cross will stop selling individual health plans in the Southern California market even as it continues to sell plans in parts of Northern and Central California.

“The uncertainty is also having an impact on plan participation,” Lee said. “It’s significant. About 153,000 of (Anthem Blue Cross) consumers will need to shop and change into 2018.”

Last year, rates increased an average of 13 percent statewide, a bigger jump than in 2015. This year, insurance companies were left in the dark as lawmakers pushed a bid to repeal Obamacare to the last possible minute before voting against such a move. …

Click here to read the full article

California single-payer health bill shelved – for now

Pills health careSACRAMENTO – Assembly Speaker Anthony Rendon, D-Paramount, an avowed supporter of single-payer health care, nevertheless announced last week that he was pulling the plug on a Senate-passed measure that would create such a system in California.

Rendon, who is holding the bill in committee, was only the proximate cause of AB562’s death. Its fate was sealed after a Senate floor analysis last month pinned its likely cost at $400 billion – more than three times the state’s entire general-fund budget.

“It didn’t make any sense,” Rendon recently told the Sacramento Bee. “It just didn’t seem like public policy as much as it seemed a statement of principles. I hope the Senate takes this chance to take the bill more seriously than they did before.”

According to its bill language, the Healthy California Act would “provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.” The measure would have tossed out California’s myriad systems of private, insurance-backed and government-funded health care and replaced it with a single, government-managed system run by a newly created state agency.

Such a massive change would demand volumes of detailed legislative language, yet the bill itself was remarkably brief and lacking in specifics. It even failed to include any explanation for how it would receive the necessary waivers from the federal government.

The Appropriations Committee analysis concluded the bill would lead to “increased utilization of health care services,” given that all residents would be free to “see any willing provider, to receive any service deemed medically appropriate by a licensed provider, and the lack of cost sharing, in combination, would make it difficult for the program to make use of utilization management tools such as drug formularies, prior authorization requirements, or other utilization management tools.” So all financial bets were off, given an expected – and probably massive – hike in demand.

To fund the $400 billion program, the Appropriations Committee concluded the state would have to raise about $200 billion in new tax revenues. That would mean a new 15 percent payroll tax, with no cap on the wages subject to the tax. Shifting any of those costs from taxpayers to enrollees would be impossible under provisions that prohibit “members from Healthy California from being required to pay any premium” or “from being required to pay any co-payment, co-insurance, deductible and any other form of cost-sharing for all covered benefits.”

State officials often argue about programs that spend millions of dollars, but had a surprisingly short debate about one that would cost hundreds of billions of dollars. One reason that might be is that Gov. Jerry Brown already had expressed deep skepticism about the measure. “This is called ‘the unknown by means of the more unknown,’” he told reporters in March. It was unlikely he would have signed it, especially given his concern about creating new spending programs. Critics argue that the governor’s public views gave Democrats a free pass to vote for it and assuage their political base while knowing it was unlikely to become law. Rendon’s comments to the Bee certainly give ammunition to those who saw the bill as a half-baked “statement” bill.

Support and opposition fell along predictable and partisan lines. Liberal interest groups, unions and Democratic politicians typically supported the bill, while conservative groups, taxpayer organizations and Republicans opposed it. Some groups expressed views similar to Rendon’s – supporting the single-payer concept but expressing concern about specifics.

The latter, cautious point of view won the day. After all, the bill raised more questions than it answered. It’s unclear how the new system would work or how the new government agency would operate. There are questions about the effects a 15 percent payroll tax would on the economy and jobs creation and about the magnet effect if California created an unlimited, valuable new benefit available to anyone who simply lives in the state. There are questions about federal waivers and how the California system would intersect with federal programs. And that’s just for starters.

Instead of trying to answer those questions thoroughly, the bill’s backers did as Rendon suggested – introduced a measure that stated some principles and goals, but didn’t really explain how the state government might fund them. Given the debate the health care issue sparked at the latest state Democratic Party convention and on the floor of the Legislature, it’s clear that the single-payer issue will be around or a while, regardless of the fate of this particular bill.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

This piece was originally published by CalWatchdog.com

Supporters of single-payer must explain how to pay for it

Healthcare costsSince the best feature of the Healthy California Act is that all health care will be free, it seems churlish to suggest that someone must pay for something.

Sadly, even after asserting more than $70 billion in new savings from efficiencies that highly motivated private providers and government regulators have not achieved, and after assuming that federal authorities will hand over about $150 billion in program funding and tax subsidies for use by state health care officials, the academics hired by program proponents find that revenues still fall short by $106 billion.

That’s in year one. Before health care inflation kicks in and utilization of free health care services metastasizes. An analysis of the measure by the author’s own staff found that, “Given all the factors that would make utilization management difficult, a 10% utilization increase is likely a conservative assumption.” That translates into tens of billions annually in higher health care costs.

So how does one resolve an annual $106 billion hole in the state’s health care budget?

  • Double the personal income tax? Nope. That will only bring in $89 billion.
  • Quadruple the state sales tax? Nope. That will only bring in $98 billion.
  • Ok, increase the corporate tax by eight-fold. Sorry, that’s just $87 billion.

But California already is a tax machine. This can’t be that hard.

Actually, it isn’t that hard, if you’re willing to dive deeply into the dumpster of discarded ideas.

Voila! That’s where you’ll find the gross receipts tax, the revenue stream preferred by academics supported by the bill’s union sponsors.

A gross receipts tax is levied against the receipts of a sale by a business of a product or a service. According to the Tax Foundation, “gross receipts taxes are largely a historical novelty to the developed world because it is a singularly unsuitable tax for the modern age.” It is economically inefficient, inequitable, and nontransparent.

The tax is not based on profits, wealth, measures of income, or any other indicator of consumption power that is the signal feature of most taxes in modern developed economies.

The tax gives a competitive advantage to bigger businesses that can make their own inputs rather than buy them. As taxes get added to the various stages of production they “pyramid” into the final price, so that the effective tax rate on goods exceeds the tax rates presented to final consumers. Businesses that must pass through this pyramided rate are less competitive than businesses that can integrate value added processes internally.

For the most part, the gross receipts tax is an artifact of history, trendy about a century ago, but abandoned by much of the world for a very long time.

A handful of states have retained versions of a gross receipts tax at very low rates, mostly far less than one percent of sales.

But even more states are abandoning this archaic tax. Indiana, New Jersey, Kentucky and Michigan all repealed their gross receipts taxes within the past 15 years. Even progressive Oregon voters swamped a gross receipts tax at the polls last year.

It takes a tax that bad to support the single-payer plan in California.

The putative rate for the California gross receipts tax would be 2.3 percent, about the same as the 2.5% tax that lost by 19 points in Oregon last year. (Only one state has a gross receipts tax anywhere near this rate, that’s on radioactive waste by Washington state.)

But wait, there’s more.

According to the academics, even a 2.3% gross receipts tax is not enough to close the funding gap for single-payer. (It “only” raises $92.4 billion.) So sponsors also suggest a new sales tax to top up revenues – not only on goods but on many services. This new tax – also at a 2.3% rate – would raise $14.3 billion, the equivalent of a 58% increase of the existing state sales tax.

Still … this may not work.

Implicitly acknowledging that their multi-layered sales tax mechanism may be a nonstarter, the academics suggest a payroll tax as a fallback revenue source to replace the gross receipts tax. While they believe a gross receipts tax is the superior mechanism because it “does not discriminate in its impact between labor-intensive and capital intensive firms,” they nonetheless calculate that a payroll tax paid by both employees and employers at a 3.3% rate would raise sufficient taxes to replace the gross receipts tax and fill the revenue need.

Existing payroll taxes for Social Security, Disability Insurance, Unemployment Insurance are capped at certain wage levels. This new payroll tax would not be capped – similar to the payroll tax for Medicare. The Medicare tax is 1.45% of payroll for both employers and employees, so this new payroll tax would be the equivalent of more than doubling the existing Medicare tax – which taxpayers would continue to pay even if Medicare spending is consolidated with the single-payer plan.

To conclude, under the most absurdly favorable circumstances – never-before achieved cost savings, minimal health care inflation and utilization increases, and enthusiastic cooperation by federal officials – a single-payer plan would require either an untried and economically unsound gross receipts tax, a new sales tax on services, or an record state-level payroll tax.

Yet somehow the single-payer bill is still considered a serious proposal.

resident of the California Foundation for Commerce and Education.

This article was originally published by Fox and Hounds Daily