1.
Senate​ ​Bill​ ​562
Single-Payer​ ​Health​ ​Care​ ​in​ ​California
Advocacy​ ​Plan
Jonathan​ ​Palisoc​ ​&​ ​Sonya​ ​Zhu
Public​ ​Health​ ​220D​ ​|​ ​Fall​ ​2017

2. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
I.​ ​The​ ​Issue
A.​ ​Background
Fig.​ ​1​ ​-​ ​California​ ​single-payer​ ​history.
California’s​ ​most​ ​recent​ ​population​ ​estimates​ ​have​ ​approximated​ ​that​ ​over​ ​40​ ​million
individuals​ ​currently​ ​reside​ ​in​ ​the​ ​state.​ ​Of​ ​those​ ​40​ ​million​ ​individuals,​ ​over​ ​93%​ ​are​ ​currently
insured;​ ​an​ ​estimated​ ​40%​ ​of​ ​the​ ​population​ ​receives​ ​health​ ​insurance​ ​through​ ​the​ ​public​ ​sector​ ​(i.e.,
Medicare,​ ​Medicaid,​ ​or​ ​CHIP)​ ​while​ ​the​ ​other​ ​estimated​ ​50%​ ​utilizes​ ​the​ ​private​ ​market​ ​(i.e.,​ ​small
and​ ​large​ ​group,​ ​employer-based,​ ​or​ ​the​ ​individual​ ​marketplace​ ​also​ ​known​ ​as​ ​Covered​ ​California). 1
While​ ​California​ ​boasts​ ​an​ ​impressively​ ​low​ ​uninsured​ ​rate,​ ​the​ ​future​ ​of​ ​the​ ​state’s​ ​health​ ​insurance
coverage​ ​is​ ​at​ ​risk.​ ​Many​ ​of​ ​California’s​ ​gains​ ​in​ ​coverage​ ​have​ ​been​ ​recent,​ ​due​ ​to​ ​the​ ​Patient
Protection​ ​and​ ​Affordable​ ​Care​ ​Act​ ​(ACA).​ ​Yet​ ​since​ ​the​ ​November​ ​2016​ ​national​ ​election,
Republican​ ​lawmakers​ ​and​ ​the​ ​Trump​ ​administration​ ​have​ ​revamped​ ​their​ ​efforts​ ​to​ ​dismantle​ ​the
ACA.​ ​If​ ​the​ ​current​ ​federal​ ​government​ ​succeeds​ ​in​ ​eliminating​ ​some​ ​or​ ​all​ ​of​ ​the​ ​ACA,​ ​the​ ​years​ ​of
progress​ ​in​ ​health​ ​insurance​ ​coverage​ ​and​ ​health​ ​outcomes​ ​will​ ​be​ ​undone,​ ​such​ ​that​ ​the​ ​health​ ​and
financial​ ​security​ ​of​ ​Californians​ ​are​ ​severely​ ​threatened.
Before​ ​the​ ​ACA,​ ​the​ ​state’s​ ​​ ​uninsured​ ​rate​ ​was​ ​close​ ​to​ ​20%. ​ ​Many​ ​low-income​ ​Californians 2
and​ ​undocumented​ ​individuals​ ​were​ ​left​ ​with​ ​no​ ​option​ ​for​ ​coverage​ ​other​ ​than​ ​limited-scope
Medi-Cal​ ​(i.e.,​ ​Emergency​ ​room,​ ​or​ ​ER​ ​visits)​ ​or​ ​limited​ ​coverage​ ​indigent​ ​programs​ ​(i.e.,​ ​state
funded,​ ​county​ ​run​ ​programs​ ​that​ ​provided​ ​minimal​ ​health​ ​services​ ​to​ ​extremely​ ​low-income
individuals​ ​and​ ​some​ ​undocumented​ ​individuals).​ ​After​ ​expansion​ ​of​ ​the​ ​Medicaid​ ​program​ ​to
childless​ ​adults,​ ​implementation​ ​of​ ​the​ ​Covered​ ​California​ ​exchange,​ ​and​ ​covering​ ​undocumented
children​ ​with​ ​the​ ​passage​ ​of​ ​SB​ ​75,​ ​the​ ​state​ ​was​ ​able​ ​to​ ​aggressively​ ​reduce​ ​the​ ​rate​ ​to​ ​an​ ​all-time​ ​low. 3
Besides​ ​California’s​ ​rapid​ ​growth​ ​in​ ​coverage,​ ​the​ ​state​ ​has​ ​been​ ​fairly​ ​effective​ ​in​ ​containing
costs.​ ​The​ ​state​ ​has​ ​a​ ​lower​ ​per-capita​ ​cost​ ​than​ ​the​ ​national​ ​average,​ ​although​ ​it​ ​has​ ​narrowed​ ​in
1
http://www.dhcs.ca.gov/formsandpubs/publications/opa/Pages/factsheet.aspx
2
http://www.chcf.org/publications/2017/11/californias-uninsured
3
http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/sb-75.aspx
1

3. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
recent​ ​years. ​ ​The​ ​state​ ​has​ ​also​ ​been​ ​a​ ​hotbed​ ​of​ ​innovation​ ​for​ ​payment​ ​reforms​ ​such​ ​as 4
pay-for-performance​ ​and​ ​other​ ​incentive​ ​or​ ​value-based​ ​payments.​ ​This,​ ​however,​ ​does​ ​not​ ​exempt
California​ ​from​ ​cost​ ​problems​ ​that​ ​are​ ​deeply​ ​rooted​ ​in​ ​the​ ​US.​ ​Along​ ​these​ ​issues:​ ​Medicaid​ ​rates
have​ ​been​ ​criticized​ ​as​ ​being​ ​so​ ​low​ ​that​ ​they​ ​discourage​ ​physician​ ​participation, ​ ​and​ ​many​ ​Health 5
Maintenance​ ​Organizations​ ​(HMOs)​ ​operating​ ​in​ ​the​ ​state​ ​have​ ​been​ ​criticized​ ​as​ ​having​ ​immense
reserves​ ​and​ ​margins​ ​on​ ​some​ ​populations.
Again,​ ​this​ ​is​ ​consistent​ ​with​ ​the​ ​United​ ​States​ ​as​ ​a​ ​whole​ ​–​ ​compared​ ​to​ ​other​ ​developed
countries,​ ​the​ ​US​ ​has​ ​consistently​ ​ranked​ ​around​ ​the​ ​highest​ ​in​ ​health​ ​care​ ​costs.​ ​Criticisms​ ​of​ ​the
system​ ​have​ ​been​ ​exacerbated​ ​by​ ​low​ ​marks​ ​on​ ​quality​ ​of​ ​the​ ​system,​ ​in​ ​health​ ​outcomes​ ​and​ ​patient
satisfaction.​ ​While​ ​the​ ​reasons​ ​behind​ ​high​ ​prices​ ​and​ ​low​ ​quality​ ​have​ ​been​ ​debated,​ ​many
government​ ​agencies​ ​and​ ​consulting​ ​firms​ ​have​ ​conducted​ ​reports​ ​to​ ​delve​ ​deeper​ ​into​ ​the​ ​issue.​ ​In
2007,​ ​McKinsey​ ​&​ ​Company​ ​conducted​ ​an​ ​analysis​ ​that​ ​is​ ​still​ ​widely​ ​cited​ ​today;​ ​it​ ​found​ ​that​ ​the
largest​ ​cost​ ​disparities​ ​in​ ​the​ ​US​ ​compared​ ​to​ ​other​ ​nations​ ​were​ ​due​ ​to​ ​(1)​ ​outpatient​ ​costs,​ ​(2)
pharmaceutical​ ​costs,​ ​and​ ​(3)​ ​administrative​ ​costs. 6
While​ ​outpatient​ ​costs​ ​have​ ​decreased​ ​significantly​ ​due​ ​to​ ​the​ ​increased​ ​prevalence​ ​of​ ​managed
care​ ​and​ ​upstream​ ​care,​ ​drug​ ​and​ ​administrative​ ​costs​ ​have​ ​continued​ ​to​ ​plague​ ​the​ ​system.
Proponents​ ​of​ ​health​ ​reform​ ​often​ ​point​ ​to​ ​single-payer​ ​when​ ​these​ ​issues​ ​are​ ​brought​ ​up;​ ​single-payer
systems​ ​boast​ ​low​ ​administrative​ ​costs​ ​due​ ​to​ ​a​ ​simpler​ ​system​ ​and​ ​low​ ​drug​ ​costs​ ​due​ ​to​ ​increased
government​ ​bargaining​ ​power.
There​ ​have​ ​been​ ​significant​ ​efforts​ ​to​ ​implement​ ​single-payer​ ​in​ ​California​ ​in​ ​the​ ​past​ ​35​ ​years.
In​ ​1994,​ ​proponents​ ​successfully​ ​got​ ​single-payer​ ​listed​ ​as​ ​a​ ​ballot​ ​measure,​ ​but​ ​it​ ​was​ ​soundly​ ​defeated
due​ ​to​ ​a​ ​significant​ ​monetary​ ​advantage​ ​by​ ​the​ ​opposition .​ ​Health​ ​insurance​ ​companies​ ​created 7
numerous​ ​media​ ​ads​ ​that​ ​swayed​ ​the​ ​public​ ​with​ ​threats​ ​of​ ​increased​ ​government​ ​bureaucracy​ ​in
health​ ​care.​ ​In​ ​the​ ​early​ ​2000’s,​ ​the​ ​California​ ​Health​ ​and​ ​Human​ ​Services​ ​Agency,​ ​in​ ​conjunction
with​ ​consultants​ ​from​ ​Lewin​ ​and​ ​the​ ​AZA​ ​group,​ ​built​ ​a​ ​report​ ​that​ ​proposed​ ​nine​ ​possible​ ​future
moves​ ​for​ ​California’s​ ​health​ ​system .​ ​Along​ ​those​ ​were​ ​universal​ ​coverage​ ​and​ ​single-payer​ ​options; 8
they​ ​found​ ​that​ ​single​ ​payer​ ​would​ ​result​ ​in​ ​expanded​ ​coverage​ ​and​ ​modest​ ​cost​ ​savings. ​ ​Shield 9
Kuehl,​ ​a​ ​California​ ​state​ ​senator,​ ​used​ ​those​ ​reports​ ​to​ ​construct​ ​a​ ​single-payer​ ​bill​ ​in​ ​the​ ​Legislature.
Although​ ​it​ ​was​ ​passed​ ​twice​ ​during​ ​the​ ​2000’s,​ ​Governor​ ​Arnold​ ​Schwarzenegger​ ​vetoed​ ​the​ ​bill
4
https://www.kff.org/other/state-indicator/health-spending-per-capita/
5
http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/22/are-medicaids-payment-rates-so-low-the
yre-discriminatory
6
https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/accounting-for-the-cost-of-us-health
-care
7
​ ​​https://www.kff.org/health-costs/report/the-california-single-payer-debate-the-defeat/
8
​ ​https://pdfs.semanticscholar.org/d210/6a9bd7f751a48489e1aad9c1c6aaad9fbfa0.pdf
9
​ ​To​ ​note,​ ​while​ ​universal​ ​health​ ​care​ ​coverage​ ​and​ ​single-payer​ ​health​ ​insurance​ ​are​ ​often​ ​used​ ​interchangeably,​ ​the​ ​two​ ​are
different​ ​concepts.​ ​Universal​ ​coverage​ ​is​ ​a​ ​broad​ ​umbrella​ ​term​ ​for​ ​various​ ​health​ ​policy​ ​options​ ​that​ ​ensure​ ​access​ ​to
health​ ​care​ ​for​ ​all.​ ​Single-payer​ ​falls​ ​under​ ​universal​ ​coverage,​ ​but​ ​refers​ ​specifically​ ​to​ ​a​ ​system​ ​in​ ​which​ ​a​ ​single​ ​public
entity​ ​oversees​ ​health​ ​care​ ​financing​ ​while​ ​mostly​ ​private​ ​entities​ ​provide​ ​health​ ​care;​ ​it​ ​is​ ​also​ ​known​ ​as​ ​“Medicare​ ​for​ ​all.”
2

4. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
twice,​ ​citing​ ​cost​ ​concerns.​ ​Since​ ​then​ ​and​ ​up​ ​until​ ​the​ ​introduction​ ​of​ ​SB​ ​562​ ​this​ ​year,​ ​single-payer
efforts​ ​have​ ​taken​ ​a​ ​backseat​ ​to​ ​the​ ​defense​ ​of​ ​the​ ​ACA.
The​ ​Healthy​ ​California​ ​Act,​ ​SB​ ​562,​ ​recognizes​ ​that​ ​all​ ​residents​ ​of​ ​the​ ​state​ ​of​ ​California​ ​have
the​ ​right​ ​to​ ​health​ ​care.​ ​Although​ ​the​ ​ACA​ ​expanded​ ​health​ ​care​ ​coverage​ ​for​ ​Californians,​ ​many
residents​ ​of​ ​the​ ​state​ ​remain​ ​uninsured​ ​or​ ​lack​ ​sufficient​ ​coverage.​ ​Introduced​ ​by​ ​State​ ​Senators​ ​Toni
Atkins​ ​and​ ​Ricardo​ ​Lara​ ​in​ ​February​ ​2017,​ ​and​ ​co-authored​ ​by​ ​14​ ​other​ ​state​ ​lawmakers,​ ​SB​ ​562
would​ ​establish​ ​comprehensive​ ​universal​ ​single-payer​ ​health​ ​care​ ​coverage​ ​in​ ​California​ ​and​ ​a​ ​health
care​ ​cost​ ​control​ ​system​ ​through​ ​the​ ​Healthy​ ​California​ ​(HC)​ ​program.​ ​Residents​ ​of​ ​California
would​ ​receive​ ​coverage​ ​for​ ​a​ ​wide​ ​variety​ ​of​ ​medical​ ​benefits​ ​and​ ​services,​ ​and​ ​would​ ​not​ ​be​ ​required
to​ ​pay​ ​any​ ​premium,​ ​copayment,​ ​coinsurance,​ ​deductible,​ ​or​ ​other​ ​form​ ​of​ ​cost​ ​sharing​ ​for​ ​covered
benefits.​ ​SB​ ​562​ ​aims​ ​to​ ​address​ ​the​ ​rise​ ​in​ ​health​ ​care​ ​expenditures​ ​and​ ​to​ ​ensure​ ​all​ ​Californians​ ​are
able​ ​to​ ​exercise​ ​their​ ​right​ ​to​ ​health​ ​care. 10
The​ ​Healthy​ ​California​ ​Act​ ​passed​ ​in​ ​the​ ​Senate​ ​in​ ​June​ ​2017;​ ​however,​ ​later​ ​that​ ​month,
Assembly​ ​Speaker​ ​Anthony​ ​Rendon​ ​shelved​ ​SB​ ​562​ ​and​ ​prevented​ ​it​ ​from​ ​moving​ ​forward​ ​to​ ​a
hearing​ ​in​ ​the​ ​Assembly,​ ​citing​ ​several​ ​concerns​ ​over​ ​the​ ​bill​ ​regarding​ ​its​ ​incompleteness. ​ ​A​ ​major 11
critique​ ​of​ ​SB​ ​562​ ​from​ ​the​ ​Speaker,​ ​as​ ​well​ ​as​ ​other​ ​state​ ​lawmakers,​ ​was​ ​its​ ​lack​ ​of​ ​detail​ ​on​ ​how
California​ ​would​ ​finance​ ​single-payer​ ​health​ ​care.​ ​While​ ​Rendon​ ​blocked​ ​SB​ ​562,​ ​he​ ​later​ ​announced
in​ ​August​​ ​​that​ ​the​ ​Assembly​ ​Select​ ​Committee​ ​on​ ​Health​ ​Care​ ​Delivery​ ​Systems​ ​and​ ​Universal
Coverage​ ​would​ ​hold​ ​hearings​ ​to​ ​explore​ ​and​ ​discuss​ ​universal​ ​health​ ​care​ ​coverage​ ​in​ ​California. 12
B.​ ​Why​ ​We​ ​Selected​ ​the​ ​Issue
Given​ ​the​ ​repeated​ ​efforts​ ​of​ ​the​ ​Trump​ ​Administration​ ​and​ ​Congressional​ ​Republicans​ ​to
repeal​ ​and​ ​replace​ ​the​ ​ACA,​ ​some​ ​states​ ​have​ ​taken​ ​it​ ​upon​ ​themselves​ ​to​ ​push​ ​back​ ​and​ ​promote​ ​a
progressive​ ​health​ ​care​ ​agenda.​ ​Under​ ​the​ ​Congressional​ ​Republicans’​ ​health​ ​care​ ​bills,​ ​,​ ​millions​ ​of
Americans​ ​would​ ​lose​ ​their​ ​insurance. ,
​ ​For​ ​California,​ ​the​ ​state​ ​would​ ​have​ ​much​ ​to​ ​lose​ ​if​ ​federal 13 14
lawmakers​ ​overhauled​ ​the​ ​ACA,​ ​as​ ​many​ ​Californians​ ​are​ ​currently​ ​covered​ ​under​ ​the​ ​program. ,
15 16
While​ ​Congress​ ​did​ ​not​ ​end​ ​up​ ​successfully​ ​repealing​ ​and​ ​replacing​ ​the​ ​ACA​ ​in​ ​2017,​ ​from​ ​an
advocate​ ​and​ ​activist​ ​standpoint,​ ​time​ ​is​ ​limited;​ ​the​ ​iron​ ​is​ ​hot​ ​and​ ​must​ ​be​ ​struck​ ​soon​ ​due​ ​to
increased​ ​interest​ ​in​ ​the​ ​issue.​ ​By​ ​capitalizing​ ​on​ ​resistance​ ​to​ ​the​ ​efforts​ ​of​ ​the​ ​Trump
Administration,​ ​a​ ​coalition​ ​has​ ​a​ ​serious​ ​opportunity​ ​to​ ​gain​ ​significant​ ​funding​ ​and​ ​traction​ ​from​ ​the
public.​ ​Thus,​ ​SB​ ​562​ ​is​ ​a​ ​critical​ ​piece​ ​of​ ​legislation​ ​that​ ​would​ ​protect​ ​and​ ​continue​ ​to​ ​promote​ ​the
health​ ​of​ ​Californians.
10
​ ​https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562​ ​2
11
​ ​http://www.latimes.com/politics/la-pol-sac-single-payer-shelved-20170623-story.html
12
​ ​http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-assembly-speaker-anthony-rendon-
who-1503598991-htmlstory.html
13
​ ​https://www.cbo.gov/publication/52752
14
​ ​https://www.cbo.gov/publication/52849
15
​ ​http://www.pnhp.org/sites/default/files/HR676vsACAvsAHCA.pdf
16
​ ​http://www.sacbee.com/news/local/health-and-medicine/article148703944.html
3

5. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
C.​ ​Proposed​ ​Solution
Although​ ​the​ ​push​ ​for​ ​single-payer​ ​will​ ​likely​ ​carry​ ​on​ ​in​ ​some​ ​form,​ ​it​ ​is​ ​essential​ ​that
advocates​ ​of​ ​SB​ ​562​ ​in​ ​California​ ​continue​ ​to​ ​be​ ​deliberate​ ​and​ ​strategic​ ​in​ ​their​ ​efforts​ ​moving
forward.​ ​Given​ ​that​ ​SB​ ​562​ ​was​ ​blocked​ ​in​ ​the​ ​Assembly,​ ​and​ ​that​ ​opportunities​ ​exist​ ​to​ ​delineate​ ​and
discuss​ ​the​ ​components​ ​of​ ​SB​ ​562​ ​in​ ​Assembly​ ​hearings,​ ​the​ ​next​ ​step​ ​for​ ​the​ ​bill​ ​is​ ​to​ ​undergo
revision​ ​or​ ​to​ ​be​ ​introduced​ ​as​ ​a​ ​completely​ ​new​ ​bill​ ​and​ ​pass​ ​the​ ​Legislature.​ ​In​ ​accordance​ ​with​ ​plans
for​ ​a​ ​modified​ ​or​ ​new​ ​bill,​ ​the​ ​advocacy​ ​strategy​ ​will​ ​identify​ ​sources​ ​of​ ​funding​ ​for​ ​the​ ​campaign,
address​ ​the​ ​fiscal​ ​and​ ​implementation​ ​concerns​ ​​ ​revamp​ ​communications​ ​(i.e.,​ ​framing,​ ​messaging,
narratives)​ ​to​ ​better​ ​connect​ ​with​ ​diverse​ ​stakeholders,​ ​and​ ​build​ ​a​ ​broad-based​ ​coalition​ ​unlike​ ​prior
single-payer​ ​coalitions.​ ​This​ ​plan​ ​outlines​ ​how​ ​advocates​ ​can​ ​bolster​ ​efforts​ ​to​ ​bring​ ​single-payer​ ​to
fruition​ ​e​ ​through​ ​a​ ​comprehensive,​ ​coordinated​ ​advocacy​ ​campaign.Broadly​ ​stated,​ ​the​ ​goal​ ​of​ ​the
campaign​ ​is:​ ​By​ ​the​ ​end​ ​of​ ​the​ ​2018​ ​legislative​ ​session,​ ​advocates​ ​will​ ​demonstrate​ ​the​ ​value​ ​of
single-payer​ ​to​ ​gain​ ​broad-based​ ​public​ ​and​ ​political​ ​support,​ ​and​ ​to​ ​enable​ ​the​ ​passage​ ​of​ ​a​ ​revised​ ​or
new​ ​version​ ​of​ ​SB​ ​562,​ ​ensuring​ ​that​ ​all​ ​Californians​ ​have​ ​access​ ​to​ ​comprehensive,​ ​affordable​ ​health
care.
The​ ​objectives​ ​are​ ​as​ ​follows:
a)​ ​Campaign​ ​Operational​ ​Objectives
i.​ ​Acquire​ ​grants​ ​from​ ​state​ ​health​ ​foundations​ ​and​ ​other​ ​sources​ ​of​ ​funding.
ii.​ ​Build​ ​an​ ​effective,​ ​broad-based​ ​coalition.
iii.​ ​Change​ ​the​ ​narrative​ ​around​ ​single-payer​ ​from​ ​being​ ​perceived​ ​as​ ​high-cost​ ​and​ ​increased
bureaucracy,​ ​to​ ​a​ ​more​ ​humanistic,​ ​pragmatic​ ​program.
iv.​ ​Neutralize​ ​opponents​ ​through​ ​campaigning​ ​on​ ​a​ ​well-tested​ ​framing​ ​and​ ​messaging​ ​(e.g.,
cost-effectiveness,​ ​California​ ​as​ ​a​ ​leader​ ​in​ ​the​ ​nation),​ ​including​ ​a​ ​“poem”​ ​of​ ​a​ ​bill.
b)​ ​Legislative​ ​Objectives
i.​ ​Convince​ ​previously​ ​opposed​ ​legislators​ ​of​ ​the​ ​benefits​ ​and​ ​feasibility​ ​of​ ​single-payer​ ​health​ ​care.
ii.​ ​Pass​ ​a​ ​revised​ ​version​ ​of​ ​SB​ ​562​ ​or​ ​a​ ​new​ ​bill​ ​by​ ​the​ ​end​ ​of​ ​the​ ​2018​ ​legislative​ ​session.
iii.​ ​Governor​ ​signs​ ​the​ ​single-payer​ ​bill​ ​into​ ​law.
4

6. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
II.​ ​Campaign​ ​Elements
For​ ​sake​ ​of​ ​structure,​ ​the​ ​elements​ ​of​ ​the​ ​plan​ ​will​ ​be​ ​broken​ ​into​ ​two​ ​main​ ​components:
Pre-bill​ ​introduction​ ​and​ ​post-bill​ ​introduction.
Fig.​ ​2​ ​-​ ​Pre-​ ​and​ ​post-bill​ ​introduction​ ​sequencing.
A.​ ​Pre-Bill​ ​Introduction
1.​ ​Selecting​ ​a​ ​Forum
California​ ​represents​ ​the​ ​largest​ ​population​ ​in​ ​the​ ​US,​ ​accounting​ ​for​ ​12%​ ​of​ ​total​ ​population
and​ ​over​ ​40​ ​million​ ​individuals.​ ​Of​ ​those​ ​40​ ​million​ ​individuals,​ ​over​ ​1⁄3​ ​of​ ​them​ ​receive​ ​health
coverage​ ​through​ ​Medi-Cal,​ ​the​ ​state-run​ ​Medicaid​ ​program.​ ​Including​ ​the​ ​more​ ​than​ ​1.5​ ​million
individuals​ ​gaining​ ​health​ ​insurance​ ​through​ ​Covered​ ​California,​ ​around​ ​16​ ​million​ ​individuals
receive​ ​some​ ​type​ ​of​ ​insurance​ ​through​ ​(or​ ​heavily​ ​subsidized​ ​by)​ ​the​ ​government.
Currently,​ ​the​ ​overwhelming​ ​bulk​ ​of​ ​those​ ​not​ ​insured​ ​through​ ​Medi-Cal,​ ​the​ ​exchanges,​ ​or
employer-based​ ​insurance​ ​are​ ​the​ ​undocumented.​ ​Although​ ​efforts​ ​have​ ​been​ ​made​ ​during​ ​recent
years​ ​(e.g.,​ ​SB​ ​4)​ ​to​ ​expand​ ​coverage​ ​to​ ​the​ ​undocumented,​ ​the​ ​only​ ​success​ ​has​ ​been​ ​expansion​ ​to
undocumented​ ​children​ ​in​ ​SB​ ​75.​ ​Moreover,​ ​previous​ ​state​ ​legislative​ ​efforts​ ​for​ ​single-payer​ ​have
stalled​ ​(e.g.,​ ​ColoradoCare,​ ​VT’s​ ​Green​ ​Mountain​ ​Care,​ ​CA’s​ ​Healthy​ ​California),
Nevertheless,​ ​we​ ​feel​ ​that​ ​the​ ​California​ ​Legislature​ ​is​ ​the​ ​most​ ​pragmatic​ ​and​ ​suitable​ ​forum
for​ ​single-payer.​ ​The​ ​Legislature​ ​has​ ​the​ ​power​ ​to​ ​pass​ ​universal​ ​coverage,​ ​as​ ​outlined​ ​by​ ​the​ ​rules​ ​of
Title​ ​XIX​ ​of​ ​the​ ​Social​ ​Security​ ​Act.​ ​Executive​ ​orders,​ ​rules​ ​changes,​ ​or​ ​legal​ ​changes​ ​due​ ​to​ ​judicial
lawsuits​ ​are​ ​not​ ​feasible​ ​paths,​ ​and​ ​ballot​ ​initiatives​ ​have​ ​been​ ​largely​ ​unsuccessful​ ​(see​ ​Prop​ ​186,
1994).​ ​State​ ​departments​ ​concerned​ ​with​ ​health​ ​care​ ​may​ ​also​ ​be​ ​tapped​ ​into​ ​as​ ​a​ ​complementary
forum.​ ​These​ ​include​ ​the​ ​California​ ​Health​ ​and​ ​Human​ ​Services​ ​Agency​ ​(e.g.,​ ​the​ ​Department​ ​for
Health​ ​Care​ ​Services,​ ​Department​ ​of​ ​Public​ ​Health,​ ​and​ ​Department​ ​of​ ​Managed​ ​Health​ ​Care)​ ​and
the​ ​California​ ​Department​ ​of​ ​Insurance.
5

7. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
2.​ ​Funding
From​ ​previous​ ​failures,​ ​it​ ​has​ ​become​ ​increasingly​ ​evident​ ​that​ ​California​ ​coalitions​ ​pushing
single-payer​ ​have​ ​been​ ​woefully​ ​underfunded​ ​compared​ ​to​ ​their​ ​opponents.​ ​As​ ​such,​ ​the​ ​first​ ​order​ ​of
business​ ​for​ ​the​ ​advocacy​ ​campaign​ ​should​ ​be​ ​to​ ​secure​ ​funding​ ​for​ ​future​ ​efforts.​ ​To​ ​do​ ​this,​ ​the
largest​ ​California​ ​foundations​ ​(i.e.,​ ​The​ ​California​ ​Endowment,​ ​California​ ​Health​ ​Care​ ​Foundation,
California​ ​Health​ ​and​ ​Wellness​ ​Foundation,​ ​Blue​ ​Shield​ ​of​ ​California​ ​Foundation)​ ​should​ ​be
approached​ ​to​ ​help​ ​fund​ ​the​ ​effort.
Fig.​ ​3​ ​-​ ​California’s​ ​“Big​ ​Four”​ ​Foundations.
​ ​A​ ​small,​ ​core​ ​coalition​ ​should​ ​be​ ​leveraged​ ​to​ ​approach​ ​the​ ​foundations.​ ​This​ ​coalition​ ​would
be​ ​comprised​ ​of​ ​well-known,​ ​knowledgeable,​ ​pragmatic​ ​and​ ​idealistic​ ​advocates​ ​of​ ​universal​ ​coverage
in​ ​California,​ ​and​ ​who​ ​also​ ​have​ ​existing​ ​relationships​ ​with​ ​the​ ​boards​ ​of​ ​the​ ​foundations.​ ​Individuals
from​ ​influential​ ​health​ ​advocacy​ ​organizations​ ​such​ ​as​ ​Physicians​ ​for​ ​a​ ​National​ ​Health​ ​Program
(PNHP),​ ​California​ ​OneCare,​ ​​ ​Health​ ​Access,​ ​and​ ​California​ ​Nurses​ ​Association​ ​(CNA)​ ​​ ​would​ ​be
part​ ​of​ ​the​ ​contingent.​ ​This​ ​step​ ​is​ ​already​ ​in​ ​progress,​ ​with​ ​some​ ​individuals​ ​from​ ​these​ ​organizations
currently​ ​talking​ ​to​ ​the​ ​major​ ​foundations. 17
As​ ​part​ ​of​ ​this​ ​core​ ​coalition,​ ​messaging​ ​towards​ ​the​ ​foundations​ ​should​ ​appeal​ ​to​ ​their​ ​core
mission.​ ​Take​ ​for​ ​example,​ ​the​ ​California​ ​Endowment’s​ ​mission​ ​statement:
“The​ ​California​ ​Endowment’s​ ​mission​ ​is​ ​to​ ​expand​ ​access​ ​to​ ​affordable,​ ​quality​ ​health​ ​care​ ​for
underserved​ ​individuals​ ​and​ ​communities​ ​and​ ​to​ ​promote​ ​fundamental​ ​improvements​ ​in​ ​the​ ​health
status​ ​of​ ​all​ ​Californians.”
By​ ​emphasizing​ ​that​ ​single-payer​ ​in​ ​California​ ​hits​ ​at​ ​the​ ​core​ ​of​ ​these​ ​principles,​ ​the​ ​coalition
should​ ​provide​ ​a​ ​compelling​ ​argument​ ​for​ ​funding.​ ​Alongside​ ​the​ ​mission​ ​statement,​ ​current​ ​funding
efforts​ ​should​ ​also​ ​be​ ​noted;​ ​funding​ ​that​ ​is​ ​currently​ ​put​ ​towards​ ​Covered​ ​California​ ​outreach​ ​could
be​ ​redirected​ ​to​ ​single-payer​ ​efforts.
17
​ ​Based​ ​on​ ​interviews​ ​with​ ​Andrew​ ​McGuire​ ​and​ ​Henry​ ​Abrons
6

8. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
In​ ​concrete​ ​terms,​ ​a​ ​starting​ ​ask​ ​for​ ​the​ ​foundations​ ​should​ ​be​ ​in​ ​the​ ​range​ ​of​ ​10%​ ​of​ ​their
total​ ​grants.​ ​In​ ​dollar​ ​terms,​ ​this​ ​is​ ​around​ ​$25​ ​million​ ​–​ ​the​ ​same​ ​amount​ ​that​ ​is​ ​currently​ ​being​ ​used
to​ ​fund​ ​Exchange​ ​advertising​ ​and​ ​other​ ​ACA​ ​efforts.​ ​Despite​ ​this​ ​being​ ​a​ ​significant​ ​ask​ ​of​ ​the
foundations,​ ​a​ ​large​ ​request​ ​now​ ​and​ ​negotiation​ ​down​ ​is​ ​better​ ​than​ ​a​ ​small​ ​initial​ ​ask.​ ​By​ ​appealing
to​ ​the​ ​mission,​ ​reasoning​ ​with​ ​the​ ​budget,​ ​and​ ​pushing​ ​the​ ​incredible​ ​importance​ ​of​ ​this​ ​funding​ ​to
the​ ​effort,​ ​we​ ​hope​ ​to​ ​gain​ ​a​ ​significant​ ​grant​ ​from​ ​the​ ​four​ ​major​ ​foundations.
3.​ ​Polling​ ​and​ ​Focus​ ​Groups
Once​ ​funding​ ​is​ ​secured,​ ​a​ ​significant​ ​amount​ ​of​ ​dollars​ ​should​ ​be​ ​spent​ ​polling​ ​the​ ​general
public​ ​and​ ​holding​ ​focus​ ​groups​ ​on​ ​single-payer.​ ​Health​ ​advocacy​ ​efforts​ ​in​ ​the​ ​past​ ​have​ ​been​ ​most
successful​ ​when​ ​an​ ​eloquent​ ​“poem”​ ​that​ ​captures​ ​the​ ​essence​ ​of​ ​an​ ​issue​ ​is​ ​constructed.​ ​By​ ​creating​ ​a
pleasing,​ ​palatable​ ​frame​ ​and​ ​message,​ ​grassroots​ ​efforts​ ​can​ ​convince​ ​the​ ​public​ ​(including​ ​the​ ​media
and​ ​Legislature)​ ​that​ ​single-payer​ ​is​ ​the​ ​correct​ ​way​ ​forward.
For​ ​polling,​ ​polls​ ​should​ ​be​ ​conducted​ ​to​ ​find​ ​the​ ​current​ ​level​ ​of​ ​support​ ​for​ ​single-payer.
Smaller​ ​polls​ ​have​ ​indicated​ ​that​ ​there​ ​is​ ​large​ ​approval​ ​of​ ​universal​ ​coverage;​ ​by​ ​expanding​ ​to
California​ ​as​ ​a​ ​whole,​ ​positive​ ​polling​ ​for​ ​single-payer​ ​can​ ​be​ ​used​ ​as​ ​a​ ​rebuttal​ ​when​ ​the​ ​opposition
tries​ ​to​ ​paint​ ​single-payer​ ​as​ ​negative​ ​and​ ​unpopular.
Current​ ​framing​ ​has​ ​been​ ​of​ ​health​ ​care​ ​as​ ​a​ ​right.​ ​Using​ ​focus​ ​groups,​ ​we​ ​wish​ ​to​ ​expand​ ​the
possible​ ​set​ ​of​ ​frames​ ​and​ ​corresponding​ ​messages​ ​to​ ​connect​ ​with​ ​voters​ ​of​ ​varying​ ​sociodemographic
groups​ ​and​ ​interests. ​ ​For​ ​example,​ ​the​ ​concept​ ​that​ ​no​ ​Californian​ ​should​ ​go​ ​bankrupt​ ​due​ ​to​ ​health 18
care​ ​costs​ ​may​ ​appeal​ ​not​ ​only​ ​to​ ​people​ ​who​ ​agree​ ​that​ ​health​ ​care​ ​is​ ​a​ ​human​ ​right​ ​(typically​ ​liberals
and​ ​progressives),​ ​but​ ​also​ ​to​ ​fiscal​ ​conservatives.​ ​Moreover,​ ​a​ ​poem​ ​will​ ​be​ ​constructed​ ​that​ ​best​ ​fits
the​ ​advocacy​ ​campaign.​ ​This​ ​poem​ ​will​ ​likely​ ​be​ ​along​ ​the​ ​same​ ​lines​ ​as​ ​the​ ​successful​ ​poem​ ​of​ ​“Every
child​ ​has​ ​a​ ​right​ ​to​ ​education.”
4.​ ​Policy​ ​and​ ​Economic​ ​Analysis
Perhaps​ ​the​ ​most​ ​effective​ ​critique​ ​of​ ​SB​ ​562​ ​has​ ​been​ ​its​ ​cost.​ ​Early​ ​rough​ ​estimates​ ​of​ ​the​ ​bill
have​ ​estimated​ ​the​ ​cost​ ​of​ ​single-payer​ ​in​ ​California​ ​to​ ​be​ ​anywhere​ ​from​ ​$200-400​ ​billion.​ ​While
these​ ​numbers​ ​have​ ​little​ ​basis​ ​in​ ​fact,​ ​proponents​ ​of​ ​SB​ ​562​ ​have​ ​been​ ​unable​ ​to​ ​effectively​ ​counter
these​ ​arguments.​ ​To​ ​alleviate​ ​this​ ​issue,​ ​a​ ​“New​ ​Lewin”​ ​analysis​ ​should​ ​be​ ​conducted.
18
​ ​More​ ​example​ ​frames​ ​and​ ​messages​ ​are​ ​presented​ ​in​ ​the​ ​Communications​ ​section​ ​of​ ​this​ ​plan.
7

9. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
Fig.​ ​4​ ​-​ ​Updating​ ​the​ ​California​ ​Health​ ​Options​ ​Project​ ​(CHOP)​ ​report.
Contracting​ ​with​ ​knowledgeable​ ​consultants,​ ​a​ ​comprehensive​ ​report​ ​should​ ​be​ ​produced
that​ ​lays​ ​out​ ​a​ ​tailored​ ​framework,​ ​cost​ ​analysis,​ ​bill​ ​skeleton,​ ​and​ ​implementation​ ​plan​ ​for​ ​a
single-payer​ ​program​ ​in​ ​California.​ ​This​ ​report​ ​should​ ​be​ ​conducted​ ​using​ ​consultants​ ​and
economists​ ​who​ ​are​ ​viewed​ ​as​ ​nonpartisan​ ​and/or​ ​moderate;​ ​if​ ​the​ ​campaign​ ​relies​ ​solely​ ​on​ ​analysis
from​ ​left-leaning​ ​organizations​ ​(regardless​ ​of​ ​its​ ​analytical​ ​rigor),​ ​the​ ​opposition​ ​will​ ​seize​ ​upon​ ​this
fact​ ​to​ ​try​ ​and​ ​discredit​ ​the​ ​report.
Once​ ​the​ ​report​ ​is​ ​complete,​ ​it​ ​should​ ​be​ ​distributed​ ​internally​ ​within​ ​the​ ​Select​ ​Committee
for​ ​members​ ​to​ ​collaborate​ ​on​ ​strategy​ ​and​ ​decide​ ​on​ ​how​ ​to​ ​best​ ​use​ ​the​ ​report.​ ​As​ ​of​ ​November
2017,​ ​the​ ​Committee​ ​has​ ​met​ ​twice;​ ​although​ ​these​ ​meetings​ ​have​ ​been​ ​largely​ ​informational,​ ​the
Committee​ ​members​ ​have​ ​made​ ​it​ ​clear​ ​that​ ​they​ ​are​ ​looking​ ​for​ ​a​ ​solid​ ​report​ ​and​ ​plan​ ​that​ ​is​ ​tailored
to​ ​California.​ ​While​ ​it​ ​is​ ​premature​ ​to​ ​select​ ​a​ ​consultant​ ​now,​ ​the​ ​Commonwealth​ ​Fund​ ​would​ ​be​ ​a
strong​ ​candidate. 19
5.​ ​Building​ ​Support
The​ ​main​ ​coalition​ ​of​ ​SB​ ​562​ ​supporters​ ​is​ ​known​ ​as​ ​Healthy​ ​California ​ ​and​ ​will​ ​continue​ ​to 20
be​ ​a​ ​part​ ​of​ ​advocacy​ ​efforts​ ​moving​ ​forward.​ ​Healthy​ ​California​ ​currently​ ​represents​ ​over​ ​350​ ​entities
and​ ​individuals​ ​across​ ​state​ ​and​ ​local​ ​government,​ ​healthcare,​ ​labor,​ ​community-based​ ​organizations,
faith-based​ ​organizations,​ ​businesses,​ ​and​ ​political​ ​entities.
19
​ ​The​ ​Commonwealth​ ​Fund​ ​may​ ​be​ ​perceived​ ​as​ ​left-leaning​ ​in​ ​general,​ ​but​ ​it​ ​operates​ ​as​ ​a​ ​nonpartisan​ ​organization.
20
​ ​http://www.healthycaliforniaact.org/
8

10. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
Fig.​ ​5​ ​-​ ​Proposed​ ​coalition​ ​member​ ​groups.
a)​ ​Coalition​ ​members​ ​include​ ​but​ ​are​ ​not​ ​limited​ ​to:
● State​ ​Senator​ ​co-authors:​ ​Cathleen​ ​Galgiani,​ ​Scott​ ​Wiener,​ ​Benjamin​ ​Allen,​ ​Mike​ ​McGuire,
Nancy​ ​Skinner
● State​ ​Assembly​ ​Member​ ​co-authors:​ ​Rob​ ​Bonta,​ ​Jimmy​ ​Gomez,​ ​David​ ​Chiu,​ ​Laura
Friedman,​ ​Ash​ ​Kalra,​ ​Kevin​ ​McCarty,​ ​Adrin​ ​Nazarian,​ ​Mark​ ​Stone,​ ​Tony​ ​Thurmond
● State​ ​government:​ ​Dave​ ​Jones​ ​(CA​ ​Insurance​ ​Commissioner),​ ​Gavin​ ​Newsom​ ​(CA
Lieutenant​ ​Governor,​ ​2018​ ​CA​ ​Gubernatorial​ ​Candidate;​ ​informal​ ​supporter)
● Local​ ​government:​ ​City​ ​of​ ​Los​ ​Angeles,​ ​City​ ​and​ ​County​ ​of​ ​San​ ​Francisco,​ ​County​ ​of​ ​Santa
Clara,​ ​Oakland​ ​City​ ​Council,​ ​Marin​ ​County​ ​Board​ ​of​ ​Supervisors,​ ​Richmond​ ​City​ ​Council
● Health​ ​care:​ ​Physicians​ ​for​ ​a​ ​National​ ​Health​ ​Program​ ​(PNHP,​ ​CA​ ​Chapter),​ ​California
OneCare,​ ​Health​ ​Care​ ​for​ ​All
● Labor:​ ​CA​ ​Nurses​ ​Association​ ​(CNA),​ ​CA​ ​Labor​ ​Federation,​ ​CA​ ​Teachers​ ​Association,
Service​ ​Employees​ ​International​ ​Union
● Community:​ ​CA​ ​Pan-Ethnic​ ​Health​ ​Network,​ ​CA​ ​Youth​ ​Empowerment​ ​Network,
Greenlining​ ​Institute
● Business:​ ​American​ ​Sustainable​ ​Business​ ​Council,​ ​Patagonia,​ ​The​ ​CA​ ​Healthy​ ​Nail​ ​Salon
Collaborative,​ ​The​ ​Cheeseboard​ ​Collective
● Political:​ ​Local​ ​chapters​ ​of​ ​Democratic​ ​Club,​ ​Democratic​ ​Socialists​ ​of​ ​America,​ ​&​ ​Green
Party
● Faith:​ ​CA​ ​Church​ ​IMPACT,​ ​Clergy​ ​&​ ​Laity​ ​United​ ​for​ ​Economic​ ​Justice
● Affiliate​ ​campaigns:​ ​Campaign​ ​for​ ​a​ ​Healthy​ ​California,​ ​AllCare​ ​Alliance,​ ​Labor​ ​United​ ​for
Universal​ ​Healthcare,​ ​Business​ ​Alliance​ ​for​ ​a​ ​Healthy​ ​California
In​ ​addition​ ​to​ ​the​ ​above​ ​partners,​ ​we​ ​want​ ​to​ ​build​ ​out​ ​our​ ​coalition​ ​to​ ​include​ ​a​ ​broader​ ​community.
We​ ​need​ ​to​ ​engage​ ​powerful​ ​groups​ ​and​ ​individuals​ ​who​ ​may​ ​not​ ​have​ ​previously​ ​identified​ ​with​ ​this
issue,​ ​including:
b)​ ​Current​ ​groups​ ​and​ ​individuals​ ​supporting​ ​the​ ​concept​ ​of​ ​a​ ​single-payer​ ​system,​ ​or​ ​likely​ ​to​ ​support
9

11. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
it​ ​over​ ​time​ ​and​ ​with​ ​pressure​ ​from​ ​advocates:
● State​ ​government:​ ​Jerry​ ​Brown​ ​(CA​ ​Governor),​ ​Anthony​ ​Rendon​ ​(Assembly​ ​Speaker),​ ​John
Chiang​ ​(CA​ ​State​ ​Treasurer,​ ​2018​ ​CA​ ​Gubernatorial​ ​Candidate),​ ​Antonio​ ​Villaraigosa
(Mayor​ ​of​ ​Los​ ​Angeles,​ ​2018​ ​CA​ ​Gubernatorial​ ​Candidate)
● Federal​ ​government:​ ​Kamala​ ​Harris​ ​(US​ ​Senator),​ ​Bernie​ ​Sanders​ ​(US​ ​Senator)
● Consumer​ ​advocacy:​ ​Health​ ​Access​ ​California,​ ​Consumerwatchdog.org
● Health​ ​foundations:​ ​Blue​ ​Shield​ ​of​ ​CA,​ ​CA​ ​Health​ ​Care​ ​Foundation,​ ​The​ ​CA​ ​Endowment,
The​ ​CA​ ​Wellness​ ​Foundation
● Social​ ​services:​ ​Western​ ​Center​ ​on​ ​Law​ ​and​ ​Poverty
● Research:​ ​Jim​ ​Kahn​ ​(UCSF),​ ​Stephen​ ​Shortell​ ​(UC​ ​Berkeley)
● News​ ​organizations​ ​(e.g.,​ ​editorial​ ​boards):​ ​​Los​ ​Angeles​ ​Times,​ ​San​ ​Francisco​ ​Chronicle​,​ ​smaller
newspapers​ ​covering​ ​California​ ​cities​ ​and​ ​counties
c)​ ​We​ ​also​ ​seek​ ​to​ ​draw​ ​support​ ​from​ ​unconventional​ ​allies,​ ​or​ ​people​ ​who​ ​have​ ​traditionally​ ​not​ ​been
involved​ ​in​ ​campaigns​ ​for​ ​health​ ​care​ ​reform​ ​or​ ​single-payer.​ ​These​ ​unconventional​ ​allies​ ​may​ ​be​ ​of
substantial​ ​help​ ​for​ ​the​ ​coalition,​ ​because​ ​of​ ​their​ ​high​ ​social,​ ​cultural,​ ​and​ ​financial​ ​capital.
Unconventional​ ​allies​ ​include:
● Technology:​ ​Mark​ ​Zuckerberg​ ​(CEO​ ​of​ ​Facebook),​ ​Sheryl​ ​Sandberg​ ​(COO​ ​of​ ​Facebook),
tech​ ​start-ups
● Other​ ​policy​ ​entrepreneurs:​ ​Warren​ ​Buffett​ ​(CEO​ ​of​ ​Berkshire​ ​Hathaway),​ ​Charlie​ ​Munger
(former​ ​VP​ ​of​ ​Berkshire​ ​Hathaway)
● Celebrities:​ ​Jimmy​ ​Kimmel​ ​(Television​ ​show​ ​host),​ ​John​ ​Legend​ ​(Singer),​ ​America​ ​Ferrera
(Actress)
d)​ ​Due​ ​to​ ​supposed​ ​cost​ ​increases​ ​and​ ​significant​ ​government​ ​oversight,​ ​we​ ​expect​ ​significant
opposition​ ​to​ ​the​ ​reintroduction​ ​of​ ​SB​ ​562​ ​or​ ​to​ ​a​ ​new​ ​bill.​ ​Opponents​ ​include:
● State​ ​government:​ ​Assembly​ ​and​ ​Senate​ ​Republicans
● Health​ ​plans:​ ​America’s​ ​Health​ ​Insurance​ ​Plans​ ​(AHIP;​ ​members​ ​include​ ​Anthem,​ ​Blue
Shield​ ​of​ ​CA,​ ​Kaiser​ ​Permanente),​ ​CA​ ​Association​ ​of​ ​Health​ ​Plans​ ​(CAHP),​ ​​ ​Local​ ​Health
Plans​ ​of​ ​CA​ ​(LHPC)
● Business:​ ​CA​ ​Chamber​ ​of​ ​Commerce
● Research:​ ​Pacific​ ​Research​ ​Institute
● News​ ​organizations:​ ​California​ ​newspapers​ ​covering​ ​more​ ​conservative​ ​areas​ ​(e.g.,​ ​Orange
County,​ ​San​ ​Diego,​ ​rural​ ​areas),​ ​national​ ​media​ ​organizations​ ​(e.g.,​ ​Fox​ ​News,​ ​Breitbart
News)
● Conservative​ ​policy​ ​entrepreneurs:​ ​Koch​ ​Brothers
● Federal​ ​government:​ ​Trump​ ​administration,​ ​GOP​ ​Senators​ ​and​ ​Representatives
10

12. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
Power​​Analysis
The​ ​following​ ​diagram​ ​illustrates​ ​a​ ​power​ ​analysis​ ​of​ ​the​ ​key​ ​stakeholders​ ​among​ ​single-payer
supporters,​ ​as​ ​well​ ​as​ ​several​ ​members​ ​of​ ​the​ ​opposition.​ ​The​ ​horizontal​ ​axis​ ​indicates​ ​the​ ​level​ ​of
support​ ​a​ ​given​ ​organization​ ​or​ ​individual​ ​has​ ​for​ ​or​ ​against​ ​single-payer.​ ​The​ ​vertical​ ​axis​ ​reflects​ ​the
degree​ ​of​ ​influence​ ​an​ ​organization​ ​or​ ​individual​ ​has​ ​in​ ​shaping​ ​the​ ​trajectory​ ​of​ ​the​ ​issue.​ ​The​ ​power
analysis​ ​is​ ​a​ ​dynamic​ ​map,​ ​as​ ​it​ ​can​ ​be​ ​reorganized​ ​throughout​ ​the​ ​campaign​ ​as​ ​players​ ​shift​ ​positions
and​ ​build​ ​(or​ ​weaken)​ ​influence.
Fig.​ ​6​ ​-​ ​Power​ ​analysis.
To​ ​note,​ ​unconventional​ ​allies​ ​are​ ​grouped​ ​together​ ​as​ ​a​ ​single​ ​point​ ​in​ ​a​ ​neutral​ ​positive​ ​area,
as​ ​it​ ​is​ ​relatively​ ​unknown​ ​how​ ​much​ ​support​ ​and​ ​influence​ ​they​ ​wield​ ​during​ ​the​ ​pre-bill
introduction​ ​phase.
11

13. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
6.​ ​Bill​ ​Construction
After​ ​the​ ​analysis​ ​has​ ​been​ ​conducted​ ​and​ ​circulated,​ ​the​ ​coalition​ ​should​ ​work​ ​with​ ​current​ ​authors
of​ ​SB​ ​562​ ​(i.e.,​ ​Lara,​ ​Chiu,​ ​etc.),​ ​as​ ​well​ ​as​ ​Speaker​ ​Rendon​ ​to​ ​ensure​ ​full-fledged​ ​support​ ​of​ ​the​ ​bill.
The​ ​bill​ ​should​ ​be​ ​tailored​ ​as​ ​closely​ ​as​ ​possible​ ​to​ ​the​ ​policy​ ​and​ ​economic​ ​analysis’
recommendations,​ ​as​ ​much​ ​criticism​ ​pointed​ ​to​ ​the​ ​rushed​ ​nature​ ​of​ ​the​ ​bill​ ​and​ ​lack​ ​ofs​ ​reputable
analysis.
Fig.​ ​7​ ​-​ ​Trade-offs​ ​between​ ​introducing​ ​a​ ​new​ ​bill​ ​and​ ​revising​ ​SB​ ​562.
B.​ ​Post-Bill​ ​Introduction
1.​ ​Bill​ ​and​ ​Report​ ​Introduction
The​ ​report​ ​should​ ​be​ ​released​ ​to​ ​the​ ​general​ ​public​ ​a​ ​month​ ​before​ ​introduction​ ​of​ ​the​ ​bill.
Once​ ​the​ ​report​ ​has​ ​been​ ​pushed​ ​by​ ​the​ ​coalition​ ​into​ ​the​ ​media,​ ​a​ ​large​ ​amount​ ​of​ ​pomp​ ​and
circumstance​ ​should​ ​be​ ​used​ ​for​ ​the​ ​introduction​ ​of​ ​the​ ​bill.​ ​A​ ​politician​ ​with​ ​high​ ​approval​ ​should​ ​be
used,​ ​like​ ​previous​ ​speaker​ ​Toni​ ​Atkins.
This​ ​bill​ ​introduction​ ​ceremony​ ​should​ ​take​ ​place​ ​at​ ​the​ ​state​ ​capitol​ ​with​ ​the​ ​full​ ​coalition
utilized​ ​and​ ​at​ ​the​ ​ready.​ ​With​ ​a​ ​large​ ​crowd,​ ​free​ ​media​ ​should​ ​be​ ​gained,​ ​alongside​ ​paid​ ​media​ ​from
the​ ​foundation​ ​dollars​ ​that​ ​will​ ​be​ ​used​ ​by​ ​all​ ​arms​ ​of​ ​the​ ​coalition.
12

14. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
Fig.​ ​8​ ​-​ ​Introduction​ ​elements.
2.​ ​Communications:​ ​Media​ ​Campaign
The​ ​current​ ​SB​ ​562​ ​coalition​ ​has​ ​undertaken​ ​various​ ​communication​ ​efforts​ ​across​ ​traditional
and​ ​social​ ​media.​ ​Recognizing​ ​that​ ​there​ ​is​ ​an​ ​ongoing​ ​media​ ​campaign​ ​that​ ​has​ ​started​ ​building
visibility​ ​for​ ​the​ ​cause,​ ​we​ ​propose​ ​that​ ​advocates​ ​continue​ ​upholding​ ​the​ ​values​ ​associated​ ​with
single-payer​ ​(e.g.,​ ​justice,​ ​equity,​ ​opportunity​ ​to​ ​achieve​ ​health​ ​and​ ​well-being)​ ​and​ ​with​ ​existing
communications​ ​efforts,​ ​but​ ​also​ ​aim​ ​to​ ​expand​ ​the​ ​frames,​ ​messaging,​ ​and​ ​narratives​ ​to​ ​appeal​ ​to
broader​ ​audiences​ ​and​ ​thereby​ ​augment​ ​public​ ​support.
As​ ​mentioned,​ ​various​ ​stakeholders​ ​have​ ​significant​ ​concerns​ ​about​ ​how​ ​single-payer​ ​would
be​ ​financed​ ​and​ ​carried​ ​out​ ​in​ ​California.​ ​The​ ​failure​ ​of​ ​SB​ ​562​ ​to​ ​pass​ ​in​ ​the​ ​Assembly​ ​has​ ​reiterated
the​ ​predominant​ ​narrative​ ​that​ ​single-payer​ ​is​ ​currently​ ​not​ ​a​ ​realistic​ ​and​ ​fiscally​ ​responsible
undertaking​ ​for​ ​California.​ ​Moreover,​ ​given​ ​the​ ​opposition’s​ ​past​ ​success​ ​with​ ​undermining
single-payer​ ​efforts​ ​in​ ​California​ ​and​ ​across​ ​the​ ​country,​ ​it​ ​is​ ​essential​ ​that​ ​this​ ​advocacy​ ​campaign
revamp​ ​counter-frames,​ ​-messages,​ ​and​ ​-narratives​ ​beyond​ ​the​ ​commonly​ ​used,​ ​“Health​ ​care​ ​is​ ​a
human​ ​right”​ ​frame​ ​and​ ​subsequent​ ​messaging.​ ​Frames​ ​and​ ​messaging​ ​may​ ​include​ ​but​ ​are​ ​not​ ​limited
to: 21
California​ ​is​ ​a​ ​policy​ ​leader:​ ​“Who​ ​are​ ​we​ ​as​ ​Californians?​ ​We​ ​are​ ​leaders.”
Californians​ ​value​ ​health​ ​for​ ​all:​ ​“Are​ ​we​ ​saying​ ​that​ ​we​ ​can’t​ ​achieve​ ​universal​ ​health​ ​care?”
The​ ​Trump​ ​administration​ ​and​ ​GOP​ ​are​ ​Public​ ​Enemy​ ​No.1​ ​and​ ​threats​ ​to​ ​California:
“If​ ​the​ ​ACA​ ​is​ ​successfully​ ​repealed​ ​and​ ​replaced,​ ​then​ ​the​ ​consequences​ ​for
Californians​ ​would​ ​be​ ​disastrous.”
“We​ ​need​ ​to​ ​continue​ ​the​ ​resistance​ ​against​ ​the​ ​Trump​ ​administration.”
Health​ ​care​ ​is​ ​an​ ​economic​ ​issue​ ​and​ ​linked​ ​to​ ​growing​ ​economic​ ​inequality:
“No​ ​woman,​ ​man,​ ​or​ ​child​ ​should​ ​go​ ​bankrupt​ ​because​ ​of​ ​health​ ​care​ ​costs.”
“Single-payer​ ​is​ ​pro-business.”
The​ ​current​ ​health​ ​care​ ​system​ ​is​ ​broken​ ​and​ ​rigged.
“Single-payer​ ​is​ ​the​ ​innovative​ ​disruption​ ​that​ ​the​ ​health​ ​care​ ​system​ ​needs.”
Given​ ​increased​ ​and​ ​well-funded​ ​communications​ ​efforts,​ ​we​ ​hope​ ​to​ ​grow​ ​the​ ​coalition
beyond​ ​what​ ​was​ ​previously​ ​possible.
a)​ ​Traditional​ ​Media
Traditional​ ​forms​ ​of​ ​news​ ​media​ ​will​ ​continue​ ​to​ ​play​ ​a​ ​role​ ​in​ ​communicating​ ​to​ ​the​ ​public.
Newspapers
21
​ ​The​ ​frames​ ​and​ ​messaging​ ​used​ ​will​ ​have​ ​been​ ​tested​ ​from​ ​focus​ ​groups.
13

15. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
Advocates​ ​should​ ​target​ ​a​ ​diversity​ ​of​ ​newspapers​ ​across​ ​California​ ​that​ ​cover​ ​varying
geographic​ ​areas,​ ​population​ ​sizes,​ ​political​ ​ideologies,​ ​and​ ​languages.​ ​The​ ​coalition​ ​should​ ​aim​ ​to
produce​ ​op-​ ​eds​ ​and​ ​pitch​ ​stories​ ​to​ ​reporters​ ​that​ ​leverage​ ​the​ ​diversity​ ​of​ ​its​ ​membership,​ ​but​ ​also
maintain​ ​cohesiveness​ ​for​ ​the​ ​organization.​ ​When​ ​possible,​ ​advocates​ ​should​ ​contact​ ​reporters​ ​and
write​ ​op-eds​ ​in​ ​their​ ​respective​ ​community’s​ ​newspaper,​ ​particularly​ ​for​ ​publications​ ​with​ ​smaller,
more​ ​localized​ ​audiences.​ ​For​ ​widely​ ​read​ ​newspapers​ ​like​ ​the​ ​Los​ ​Angeles​ ​Times,​ ​the​ ​coalition​ ​should
plan​ ​to​ ​roll​ ​out​ ​several​ ​pieces​ ​featuring​ ​different​ ​voices​ ​from​ ​its​ ​membership.
● Publications​ ​with​ ​wide​ ​circulation:​ ​e.g.,​​ ​Los​ ​Angeles​ ​Times,​ ​San​ ​Jose​ ​Mercury​ ​News,​ ​The
Sacramento​ ​Bee,​ ​San​ ​Francisco​ ​Chronicle,​ ​The​ ​Orange​ ​County​ ​Register,​ ​The​ ​San​ ​Diego
Union-Tribune,​ ​Contra​ ​Costa​ ​Times
● Publications​ ​with​ ​smaller​ ​circulation:​​ ​​e.g.,​ ​​The​ ​Press-Enterprise,​ ​San​ ​Gabriel​ ​Valley​ ​Tribune,
The​ ​Daily​ ​Breeze,​ ​The​ ​Modesto​ ​Bee,​ ​The​ ​Press​ ​Democrat,​ ​Long​ ​Beach​ ​Press-Telegram,​ ​Inland
Valley​ ​Daily​ ​Bulletin,​ ​The​ ​Tribune
● College​ ​and​ ​university​ ​student​ ​publications:​ ​e.g.,​ ​​The​ ​Daily​ ​Californian,​ ​Daily​ ​Bruin
● Publications​ ​in​ ​non-English​ ​languages:​ ​e.g.,​ ​​La​ ​Opinión,​ ​The​ ​Korea​ ​Times
Incorporating​ ​the​ ​frames​ ​and​ ​messages​ ​based​ ​on​ ​polling​ ​and​ ​focus​ ​groups,​ ​stories​ ​from
newspaper​ ​reporters​ ​or​ ​coalition​ ​members​ ​should​ ​address,​ ​but​ ​are​ ​not​ ​limited​ ​to:
i.​ ​Findings​ ​and​ ​conclusions​ ​from​ ​policy​ ​and​ ​economic​ ​analyses​ ​on​ ​implementing​ ​single-payer
in​ ​California:​ ​A​ ​nonpartisan​ ​entity​ ​(e.g.,​ ​The​ ​Commonwealth​ ​Fund)​ ​should​ ​conduct​ ​a​ ​rigorous​ ​study
on​ ​the​ ​costs​ ​and​ ​benefits​ ​of​ ​single-payer​ ​in​ ​California.​ ​The​ ​study​ ​will​ ​serve​ ​as​ ​a​ ​critical​ ​resource​ ​for
evidence-based​ ​policymaking,​ ​which​ ​Senators​ ​and​ ​Assemblymembers​ ​can​ ​have​ ​strong​ ​confidence​ ​in
citing.​ ​In​ ​general,​ ​a​ ​greater​ ​effort​ ​should​ ​also​ ​be​ ​made​ ​to​ ​translate​ ​and​ ​communicate​ ​health​ ​policy
research​ ​from​ ​academics​ ​and​ ​centers​ ​(e.g.,​ ​UCLA​ ​Center​ ​for​ ​Health​ ​Policy​ ​Research,​ ​UC​ ​Berkeley
Labor​ ​Center)​ ​into​ ​accessible​ ​and​ ​compelling​ ​stories​ ​for​ ​broad​ ​audiences.
ii.​ ​Financing​ ​single-payer​ ​health​ ​care:​ ​One​ ​major​ ​critique​ ​repeatedly​ ​coming​ ​from​ ​the
opposition​ ​and​ ​other​ ​non-supporters​ ​concerns​ ​the​ ​gaps​ ​in​ ​SB​ ​562​ ​regarding​ ​the​ ​costs​ ​of​ ​implementing
single-payer.​ ​The​ ​cost​ ​to​ ​undertake​ ​single-payer​ ​and​ ​the​ ​subsequent​ ​short-​ ​and​ ​long-run​ ​savings​ ​should
be​ ​addressed​ ​head-on​ ​with​ ​strong​ ​evidence​ ​from​ ​research,​ ​and​ ​accompanied​ ​by​ ​illustrative​ ​case​ ​studies
from​ ​patients​ ​and​ ​healthcare​ ​providers​ ​detailing​ ​their​ ​experiences​ ​of​ ​navigating​ ​the​ ​healthcare​ ​system’s
high​ ​costs.​ ​Pieces​ ​will​ ​also​ ​include​ ​visually-appealing​ ​and​ ​easily​ ​digestible​ ​statistics​ ​projecting​ ​health
care​ ​costs​ ​and​ ​savings​ ​under​ ​single-payer​ ​for​ ​different​ ​demographic​ ​groups​ ​(e.g.,​ ​a​ ​family​ ​of​ ​four,​ ​an
unmarried​ ​working​ ​adult,​ ​children,​ ​college​ ​students).
iii.​ ​Political​ ​considerations​ ​under​ ​a​ ​Trump​ ​administration​ ​and​ ​GOP-controlled​ ​Congress:​ ​As
the​ ​ACA​ ​continues​ ​to​ ​come​ ​under​ ​attack​ ​from​ ​politicians​ ​in​ ​Washington,​ ​defending​ ​the​ ​ACA​ ​has
been​ ​one​ ​of​ ​the​ ​Democratic​ ​Party’s​ ​top​ ​priorities.​ ​However,​ ​as​ ​many​ ​Democrats​ ​and​ ​progressives​ ​in
California​ ​have​ ​recognized,​ ​it​ ​is​ ​time​ ​to​ ​go​ ​beyond​ ​protecting​ ​the​ ​ACA​ ​and​ ​aim​ ​for​ ​single-payer
healthcare.​ ​Op-eds​ ​should​ ​seek​ ​to​ ​justify​ ​and​ ​legitimize​ ​the​ ​political​ ​feasibility​ ​of​ ​moving​ ​forward​ ​with
14

16. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
single-payer​ ​in​ ​California,​ ​demonstrating​ ​that​ ​it​ ​is​ ​the​ ​more​ ​politically​ ​sound​ ​and​ ​sustainable​ ​route
than​ ​continuing​ ​a​ ​back-and-forth​ ​battle​ ​with​ ​Republicans’​ ​attempts​ ​to​ ​replace​ ​and​ ​repeal​ ​the​ ​ACA,
and​ ​at​ ​the​ ​very​ ​worst,​ ​a​ ​definite​ ​future​ ​with​ ​no​ ​ACA.
Radio
As​ ​conservatives​ ​have​ ​successfully​ ​used​ ​talk​ ​radio​ ​to​ ​promote​ ​their​ ​views​ ​and​ ​engage​ ​audiences,
the​ ​coalition​ ​should​ ​utilize​ ​radio​ ​shows​ ​(e.g.,​ ​talk​ ​radio,​ ​podcasts)​ ​to​ ​communicate​ ​the​ ​benefits​ ​of
single-​ ​payer​ ​healthcare​ ​and​ ​to​ ​urge​ ​listeners​ ​to​ ​call​ ​their​ ​representatives​ ​to​ ​support​ ​the​ ​revised​ ​bill.​ ​The
coalition​ ​may​ ​also​ ​select​ ​representatives​ ​to​ ​participate​ ​in​ ​debates​ ​on​ ​shows​ ​of​ ​different​ ​political
leanings,​ ​so​ ​as​ ​to​ ​expose​ ​more​ ​conservative​ ​audiences​ ​to​ ​the​ ​case​ ​for​ ​single-payer.​ ​In​ ​addition,​ ​radio​ ​ads
for​ ​single-payer​ ​should​ ​go​ ​on​ ​during​ ​peak​ ​hours​ ​of​ ​listening​ ​(e.g.,​ ​morning​ ​and​ ​evening​ ​commutes,
midday).​ ​Broadcasting​ ​the​ ​campaign​ ​on​ ​the​ ​air​ ​will​ ​help​ ​reach​ ​a​ ​wide​ ​swath​ ​of​ ​audiences​ ​across
demographic​ ​age​ ​groups​ ​(e.g.,​ ​millennials,​ ​Gen​ ​X,​ ​Baby​ ​Boomers)​ ​and​ ​easily​ ​cover​ ​wide​ ​geographic
areas.
Advertisements
To​ ​increase​ ​reach,​ ​the​ ​coalition​ ​will​ ​continue​ ​sponsoring​ ​advertisements​ ​on​ ​local​ ​news
channels,​ ​billboards,​ ​and​ ​public​ ​transit.​ ​With​ ​approval,​ ​the​ ​campaign​ ​should​ ​feature​ ​its​ ​diverse
coalition​ ​members​ ​and​ ​their​ ​stories​ ​on​ ​the​ ​ads,​ ​using​ ​both​ ​everyday​ ​people​ ​whom​ ​different​ ​types​ ​of
audiences​ ​can​ ​identify​ ​with​ ​and​ ​people​ ​with​ ​name​ ​recognition.
b)​ ​Social​ ​Media
An​ ​organized​ ​and​ ​strategic​ ​campaign​ ​will​ ​also​ ​continue​ ​to​ ​be​ ​conducted​ ​across​ ​multiple​ ​social
media​ ​platforms,​ ​including​ ​Facebook,​ ​Twitter,​ ​Instagram,​ ​and​ ​Youtube.​ ​Social​ ​media​ ​should​ ​be​ ​used
to​ ​document​ ​the​ ​campaign’s​ ​ongoing​ ​activities,​ ​amplify​ ​its​ ​messages,​ ​and​ ​garner​ ​support​ ​from​ ​diverse
audiences.​ ​Best​ ​practices​ ​for​ ​how​ ​to​ ​effectively​ ​and​ ​efficiently​ ​use​ ​social​ ​media​ ​as​ ​a​ ​non-profit​ ​entity
can​ ​be​ ​found​ ​in​ ​online​ ​guidebooks​ ​and​ ​articles.
3.​ ​Events
As​ ​part​ ​of​ ​the​ ​campaign’s​ ​on-the-ground​ ​engagement,​ ​the​ ​coalition​ ​will​ ​hold​ ​several​ ​different
types​ ​of​ ​events​ ​post-bill​ ​introduction.​ ​At​ ​the​ ​time​ ​of​ ​writing​ ​this​ ​plan,​ ​the​ ​SB​ ​562​ ​coalition​ ​has
organized​ ​door-to-door​ ​canvassing,​ ​marching​ ​in​ ​parades,​ ​rallies​ ​across​ ​the​ ​state​ ​and​ ​in​ ​the​ ​capitol,​ ​and
“packing​ ​the​ ​halls”​ ​of​ ​the​ ​Select​ ​Committee’s​ ​hearings.​ ​These​ ​types​ ​of​ ​grassroots​ ​activities​ ​should
continue,​ ​and​ ​to​ ​add​ ​to​ ​the​ ​series​ ​of​ ​events,​ ​the​ ​coalition​ ​should​ ​host​ ​forums​ ​and​ ​townhalls​ ​on
single-payer​ ​health​ ​care​ ​across​ ​the​ ​state​ ​and​ ​a​ ​gubernatorial​ ​debate​ ​on​ ​health​ ​care​ ​reform.​ ​​ ​The​ ​2018
Governor’s​ ​race​ ​in​ ​California​ ​will​ ​be​ ​widely​ ​watched,​ ​and​ ​this​ ​timing​ ​can​ ​be​ ​used​ ​to​ ​the​ ​advocacy
campaign’s​ ​advantage.​ ​Whether​ ​it​ ​is​ ​Gavin​ ​Newsom,​ ​John​ ​Chiang,​ ​or​ ​another​ ​candidate​ ​who​ ​becomes
the​ ​next​ ​governor,​ ​a​ ​gubernatorial​ ​debate​ ​presents​ ​the​ ​opportunity​ ​to​ ​apply​ ​further​ ​pressure​ ​on
candidates​ ​to​ ​support​ ​single-payer,​ ​or​ ​cast​ ​non-supporters​ ​as​ ​unviable​ ​for​ ​California.​ ​Once​ ​the​ ​new
governor​ ​takes​ ​office,​ ​advocates​ ​will​ ​have​ ​a​ ​strong​ ​case​ ​to​ ​keep​ ​the​ ​governor​ ​accountable​ ​on​ ​his​ ​or​ ​her
15

17. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
promise​ ​for​ ​advancing​ ​single-payer.
4.​ ​Working​ ​Against​ ​the​ ​Opposition
To​ ​wage​ ​an​ ​effective​ ​media​ ​and​ ​on-the-ground​ ​campaign​ ​against​ ​the​ ​opposition,​ ​the
overarching​ ​communications​ ​strategy​ ​and​ ​response​ ​tactics​ ​must​ ​be​ ​agreed​ ​upon​ ​by​ ​all​ ​members​ ​of​ ​the
coalition.​ ​If​ ​reacting​ ​to​ ​the​ ​opposition,​ ​the​ ​coalition​ ​should​ ​do​ ​so​ ​with​ ​a​ ​unified​ ​message.​ ​Individual
members​ ​should​ ​not​ ​speak​ ​out​ ​as​ ​representing​ ​the​ ​coalition’s​ ​views,​ ​without​ ​first​ ​consulting​ ​the
coalition.​ ​It​ ​is​ ​important​ ​to​ ​have​ ​proactive​ ​measures​ ​in​ ​place​ ​to​ ​avoid​ ​fragmentation​ ​in​ ​the​ ​coalition.
As​ ​informed​ ​by​ ​polling​ ​and​ ​focus​ ​groups,​ ​the​ ​frames​ ​and​ ​messaging​ ​will​ ​counter​ ​the
opposition’s​ ​criticism.​ ​For​ ​example,​ ​when​ ​the​ ​opposition​ ​claims​ ​that​ ​now​ ​is​ ​not​ ​the​ ​time​ ​for​ ​single-
payer​ ​due​ ​to​ ​the​ ​impossible​ ​political​ ​and​ ​financial​ ​barriers,​ ​one​ ​possible​ ​counter​ ​is:​ ​“Who​ ​are​ ​we​ ​as
Californians?​ ​Are​ ​you​ ​saying​ ​we​ ​can’t​ ​achieve​ ​health​ ​care​ ​for​ ​all?”​ ​Rather​ ​than​ ​accepting​ ​the
opposition’s​ ​frame​ ​that​ ​single-payer​ ​is​ ​a​ ​lofty​ ​policy​ ​goal,​ ​the​ ​coalition​ ​subverts​ ​the​ ​frame​ ​with​ ​this
counter-frame,​ ​insinuating​ ​that​ ​the​ ​opposition​ ​does​ ​not​ ​fundamentally​ ​identify​ ​with​ ​Californians​ ​and
their​ ​values.
Considering​ ​the​ ​Trump​ ​administration​ ​and​ ​GOP’s​ ​persistent​ ​efforts​ ​to​ ​eliminate​ ​the​ ​ACA,
there​ ​will​ ​certainly​ ​be​ ​negative​ ​opinions​ ​expressed​ ​and​ ​even​ ​funding​ ​directed​ ​at​ ​quashing​ ​the
single-payer​ ​campaign​ ​in​ ​California.​ ​The​ ​campaign​ ​should​ ​anticipate​ ​attacks​ ​from​ ​Trump,
Republican​ ​lawmakers,​ ​the​ ​conservative​ ​news​ ​media,​ ​and​ ​conservative​ ​think​ ​tanks.​ ​As​ ​the​ ​federal
government​ ​is​ ​a​ ​particularly​ ​volatile​ ​arena​ ​that​ ​is​ ​difficult​ ​to​ ​predict,​ ​we​ ​recommend​ ​that​ ​most
advocacy​ ​work​ ​steer​ ​clear​ ​of​ ​the​ ​federal​ ​government​ ​as​ ​much​ ​as​ ​possible. ​ ​However,​ ​if​ ​the​ ​coalition 22
decides​ ​to​ ​respond​ ​to​ ​Trump’s​ ​tweets,​ ​for​ ​example,​ ​the​ ​response​ ​should​ ​be​ ​carefully​ ​crafted​ ​and​ ​used
to​ ​augment​ ​the​ ​issue​ ​(as​ ​the​ ​news​ ​media​ ​will​ ​likely​ ​pick​ ​it​ ​up).
Perhaps​ ​most​ ​concerning​ ​from​ ​the​ ​opposition​ ​is​ ​the​ ​money​ ​flowing​ ​from​ ​health​ ​plans,​ ​health
care​ ​organizations​ ​against​ ​a​ ​single-payer​ ​system,​ ​and​ ​wealthy​ ​conservative​ ​policy​ ​entrepreneurs​ ​(e.g.,
Koch​ ​Brothers),​ ​which​ ​have​ ​influence​ ​over​ ​California​ ​lawmakers​ ​through​ ​campaign​ ​donations​ ​or
other​ ​financial​ ​incentives.​ ​Moreover,​ ​these​ ​well-funded​ ​opposition​ ​members​ ​can​ ​easily​ ​pay​ ​for​ ​and​ ​set
up​ ​a​ ​public​ ​relations​ ​campaign,​ ​and​ ​do​ ​so​ ​more​ ​quickly​ ​than​ ​the​ ​coalition.​ ​Advocates​ ​will​ ​need​ ​to​ ​keep
a​ ​careful​ ​eye​ ​on​ ​how​ ​the​ ​opposition​ ​is​ ​funded​ ​and​ ​note​ ​which​ ​Senators​ ​and​ ​Assemblymembers​ ​have
received​ ​or​ ​will​ ​likely​ ​receive​ ​donations,​ ​such​ ​that​ ​they​ ​may​ ​deliberately​ ​target​ ​and​ ​pressure​ ​these
lawmakers.​ ​The​ ​media​ ​campaign​ ​will​ ​also​ ​aim​ ​to​ ​directly​ ​assert​ ​counter-frames​ ​and​ ​-narratives​ ​to
neutralize​ ​the​ ​opposition’s​ ​public​ ​relations​ ​efforts.
6.​ ​Internal​ ​and​ ​External​ ​Strategy​ ​Lanes
22
​ ​If​ ​the​ ​state​ ​does​ ​desire​ ​some​ ​funding​ ​assistance​ ​from​ ​the​ ​federal​ ​government,​ ​it​ ​will​ ​likely​ ​need​ ​to​ ​apply​ ​for​ ​a​ ​1332
Waiver.​ ​While​ ​it​ ​is​ ​unlikely​ ​this​ ​waiver​ ​would​ ​be​ ​approved,​ ​the​ ​coalition​ ​should​ ​leverage​ ​Republican​ ​support​ ​of​ ​state’s
rights​ ​to​ ​allow​ ​the​ ​state​ ​as​ ​much​ ​autonomy​ ​as​ ​possible​ ​in​ ​the​ ​implementation​ ​and​ ​use​ ​of​ ​federal​ ​dollars​ ​towards
single-payer.
16

18. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
Throughout​ ​the​ ​post-bill​ ​process,​ ​it​ ​should​ ​be​ ​emphasized​ ​within​ ​the​ ​coalition​ ​there​ ​are​ ​two
“swimlanes”​ ​of​ ​advocacy:​ ​internal​ ​and​ ​external.​ ​Any​ ​problems​ ​with​ ​messaging​ ​or​ ​the​ ​bill​ ​should​ ​not​ ​be
made​ ​public;​ ​instead,​ ​coalition​ ​members​ ​should​ ​communicate​ ​their​ ​concerns​ ​internally​ ​and​ ​put​ ​the
item​ ​up​ ​for​ ​discussion​ ​within​ ​the​ ​group.​ ​​ ​A​ ​united​ ​front,​ ​alongside​ ​internal​ ​collaboration​ ​with
California​ ​Legislature,​ ​will​ ​make​ ​the​ ​strongest​ ​coalition​ ​possible.
IV.​ ​Campaign​ ​Timeline
Pre-Bill​ ​Introduction
Fall​ ​2017​ ​-​ ​Spring​ ​2018​:​ ​Conduct​ ​research,​ ​recommend​ ​best​ ​single-payer​ ​plan.
Winter​ ​2017​ ​-​ ​Fall​ ​2018:​​ ​Build​ ​coalitions,​ ​secure​ ​funding​ ​from​ ​foundations,​ ​and​ ​acquire
endorsements​ ​from​ ​Senators​ ​and​ ​Assemblymembers.
Summer​ ​2018:​​ ​CA​ ​Legislature​ ​reconvenes​ ​after​ ​Spring​ ​Recess,​ ​introduce​ ​single-payer​ ​bill.
Increase​ ​coalition​ ​building​ ​efforts​ ​through​ ​grassroots​ ​and​ ​media​ ​campaign.
Post-Bill​ ​Introduction
Fall​ ​2018:​​ ​Push​ ​bill​ ​through​ ​process​ ​and​ ​have​ ​signed​ ​by​ ​Governor​ ​by​ ​end​ ​of​ ​session.
Winter​ ​2018​ ​-​ ​Onward:​​ ​Program​ ​implementation.
V.​ ​Personal​ ​Issues
As with any graduate-level report, this advocacy plan was very difficult to compose. From an
egotistical standpoint, we feel that we must have some amount of hubris to even consider making an
impact​ ​on​ ​an​ ​issue​ ​as​ ​large​ ​as​ ​single-payer.
Looking at struggles, the items we most had problems with were forming a plan that took all
advice into account. Among the advocates we spoke to, they often had strikingly contrasting
viewpoints. This made it difficult for us, as we felt compelled to choose between viewpoints. Even
further, we sometimes disagreed with some advice – this had us wondering if we were truly correct, or
if we were turning our nose in the face of advice from others who had been working on this issue for a
very long time. For example, we are more open to other ideas of universal care, while those we spoke to
were entrenched in single-payer. If any other method of universal coverage was suggested, they
indicated​ ​that​ ​they​ ​thought​ ​it​ ​would​ ​still​ ​fall​ ​short​ ​(like​ ​the​ ​ACA)​ ​​ ​and​ ​opposed​ ​the​ ​idea.
We​ ​have​ ​collaborated​ ​on​ ​previous​ ​projects,​ ​so​ ​working​ ​as​ ​a​ ​team​ ​was​ ​quite​ ​successful.​ ​While
our​ ​mindsets​ ​are​ ​quite​ ​contrasting,​ ​they​ ​actually​ ​make​ ​a​ ​successful​ ​combination​ ​–​ ​one​ ​of​ ​us​ ​is
polychromatic​ ​and​ ​flowing​ ​to​ ​give​ ​the​ ​paper​ ​feeling,​ ​while​ ​the​ ​other​ ​is​ ​more​ ​methodical​ ​and​ ​critical​ ​to
make​ ​sure​ ​the​ ​plan​ ​is​ ​pragmatic.​ ​For​ ​both​ ​of​ ​us,​ ​it​ ​is​ ​extremely​ ​exciting​ ​to​ ​work​ ​on​ ​an​ ​issue​ ​that​ ​we​ ​care
about​ ​deeply.​ ​We​ ​have​ ​no​ ​ethical​ ​concerns​ ​and​ ​are​ ​hopeful​ ​that​ ​this​ ​project​ ​may​ ​inform​ ​our
educational​ ​and​ ​professional​ ​career.​ ​Most​ ​important,​ ​we​ ​present​ ​this​ ​advocacy​ ​plan​ ​with​ ​a​ ​hope​ ​that​ ​it
can​ ​support​ ​a​ ​worthwhile​ ​cause,​ ​and​ ​an​ ​openness​ ​to​ ​continually​ ​learning​ ​how​ ​to​ ​be​ ​better​ ​advocates
for​ ​public​ ​health.
17

19. Sonya​ ​Zhu​ ​&​ ​Jonathan​ ​Palisoc Public​ ​Health​ ​220D​ ​|​ ​Tony​ ​Iton​ ​&​ ​Harry​ ​Snyder
VI.​ ​Appendix
Fig.​ ​9​ ​-​ ​Challenges​ ​to​ ​the​ ​advocacy​ ​campaign.
Fig.​ ​10​ ​-​ ​Strengths​ ​of​ ​the​ ​advocacy​ ​campaign.
18