The single-payer health care debate has been relatively quiet inCalifornia since Senate Bill 562, The Healthy California Act, wastabled by the Speaker of the Assembly at the end of July. But theconversation is about to heat up again in California—and at thenational level. For employee benefit advisors who aren't fascinatedby the legislative process, or who think we have a long way to gobefore a concrete policy could actually be implemented, thesingle-payer debate can be a distraction. But it's important to beaware of the issue, since it could have a major impact on thecurrent employee benefits landscape. Here are four things alladvisors should know about the current state of single-payer inCalifornia and beyond.

1. California Senate Bill 562, The Healthy California Act, isnot dead. The bill was approved by the State Senate on June 1,2017, and then moved on to the State Assembly. In a surprise move,Speaker of the Assembly Anthony Rendon delayed the bill in theAssembly Rules Committee for further discussion and debate. It willbe revisited in January 2018, and could continue its progressthrough the state legislature and ultimately land on the governor'sdesk for approval in 2018. It's important for advisors to know thatthis particular bill proposes an extreme form of universal coverageknown as single-payer, which would eliminate the private insuranceindustry in California, including health insurance carriers,brokers and employer-sponsored benefits. It would replace not justhealth insurance (including Medicare and Covered California), butdental, vision, workers' compensation and long-term care insurance,with a state-run program.

2. On August 24, 2017, Speaker Rendon announced that he wasestablishing an interim Select Committee on Health Care DeliverySystems and Universal Coverage, made up of Assembly members. TheCommittee will hold informal hearings to discuss various methods ofhealth care delivery and funding, including Medicare for all,single-payer, hybrid systems and Affordable Care Act expansion. Thecommittee will hold a number of hearings now that the legislativesession ended in September. While the Committee doesn't have theauthority to move SB562 forward, it will certainly bring moreattention to the issue.

3. A ballot initiative called the “California HealthcareRoadblock Removal Act” was submitted by Enact Universal Healthcarefor CA, Inc. to California Attorney General Xavier Becerra onAugust 18, 2017. The ballot initiative process gives Californiacitizens a way to propose laws and constitutional amendmentswithout the support of the governor or the Legislature. Theinitiative was assigned Initiative #17-0019 and is currentlyawaiting title and summary. The language of the initiative proposesa single-payer type system in California, but it is poorly writtenand incomplete, and may be sent back to the author before it canmove ahead. If the Attorney General decides to make it an activemeasure, supporters will collect signatures with the intention ofgetting it qualified for the November 2018 ballot, where theresidents of California will approve or deny it.

4. At the national level, Vermont Senator Bernie Sandersintroduced his highly anticipated “Medicare for all” bill inSeptember, after Congress reconvened. His plan is an expansion ofthe current Medicare system, which is a federally funded basiclevel of health care. While he has acknowledged that his proposalis unlikely to pass a Republican-controlled Congress, hispopularity, along with widespread frustration about the failedreforms to the Affordable Care Act, will propel this issue intomore of a national debate.

While it's clear the idea of some type of universal health caresystem is gaining popularity, there is also a lot of confusionabout what these various proposals would actually do, andterminology is consistently being misused by many, including themedia and those leading the charge. It's important for advisors tounderstand the difference between “universal care” (which wouldprovide a basic level of care but also leave room for privateinsurance), “Medicare for all” (expansion of the current federalprogram) and “single-payer” (a government-run plan with no privateinsurance option). It's also important for advisors to understandthat supporters of universal health care see this as a socialmovement, and they are passionate and vocal about this issue.Advisers must become active participants in this debate, usingrational, informed voices with clients, colleagues, legislators andeven friends and family, since this is an issue that could have anexceptional impact on our businesses and our industry.