Key Questions When Considering a State-Based, Single-Payer System in California

Susan Philip, Senior Health Care Management Consultant, Milliman Inc.
Marian Mulkey, Principal, Mulkey Consulting


Over the past year, mirroring increased national interest, momentum has been growing in California to create a state-based, single-payer system. However, there is still no broad, shared understanding of what the term “single payer” means. And the potential of a state-based, single-payer system to deliver improved outcomes depends on policy decisions and design issues that have not yet been fully defined and vetted for California.

This paper identifies key questions and issues that bring into better focus what single payer could mean for California. Some of these key questions, discussed in more detail in the paper, include:

  • What does “single payer” mean?
  • What problems is a single-payer system being designed to solve?
  • What money is available to support a single-payer system in California?
  • How would a single-payer entity arrange to purchase health care services?
  • How would payments to providers of health care services be set and structured?
  • What would be the conditions of provider participation?
  • Who would be eligible to use the system?
  • What would be the covered benefits and services?
  • How would the system’s governance and administrative structure be designed?

The full report is available below.