Newsom Administration Moves to Launch New Health Reform Commission

October 9, 2019

by Sandra Hernandez

On September 26, 2019 the California Health and Human Services Agency (CHHS) released a Request-for-Proposal (RFP) for a vendor to provide project management services in support of the new Healthy California for All (HCFA) Commission.

Pursuant to the 2019-20 state budget, the Commission is charged with developing options for a health care delivery system that “provides coverage and access through a unified financing system, including, but not limited to, a single-payer financing system, for all Californians.”

The RFP acknowledges California’s success under the Affordable Care Act (ACA), but also emphasizes the work yet to be done, describing California’s health care system as too expensive and too complex even for those who have insurance.

The RFP concludes, “California must make continuing progress towards universal coverage, while advancing cost containment, quality improvement and as necessary, reorganization of state programs to meet these challenges.”


California’s progress under the ACA has been unprecedented, resulting in a drop in the state’s uninsured rate from 16 percent to 8.4 percent in five years. The state implemented the first ACA exchange in the country and adopted the ACA Medi-Cal expansion bringing millions of uninsured Californians into coverage. Going beyond the ACA, the state extended Medi-Cal to all children regardless of immigration status and recently extended coverage to low-income youth ages 19-25. From the early days of ACA implementation, California invested substantial resources in outreach, marketing and enrollment assistance. When Congress reduced the ACA penalty for not having health insurance to $0, California imposed a state coverage requirement and state tax penalty. The final 2018-19 budget includes state funding to expand premium assistance available to individual’s buying coverage in the state exchange, Covered California, beyond the federal support available under the ACA.

Despite this progress and aggressive state actions to protect that progress, more than three million Californians remain uninsured. (See the ITUP Snapshot on the Uninsured and the ITUP fact sheet, Coverage at a Glance: California.)

The new Commission follows several years of focus by policymakers on ways that California can move to universal coverage and improve the state’s health care delivery system.

Between October 2017 and February 2018, the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage held hearings on a comprehensive range of topics affecting health care and coverage in California. (Read the Select Committee’s final report here.) As part of the 2018-19 state budget, Assembly leaders spearheaded and Governor Brown signed into law the Council on Health Care Delivery Systems to develop options for a “unified financing system” to achieve universal coverage in California.

In his January 2019 budget, Governor Newsom proposed to reshape the Council as a Commission, increase its membership from five to 13 and task the Commission with considering a single-payer financing option. The RFP appears to go beyond the enabling statute specifically stating that the Commission will develop a plan for advancing “a health care delivery system that provides coverage and access through a single-payer financing system.”

Next Steps

The RFP outlines a scope of work for the selected contractor that includes, among other things:

  • Communications support, including development of content for the Commission website,
  • Meeting support for the Commission and the Commission’s Advisory Committees,
  • Development of a Project Charter for the Commission, and
  • Creation of key strategic outcomes in consultation with CHHS and the Commission Chairperson.

In Phase One, the RFP calls for the vendor to support the Commission’s statutory mandate and deliver an environmental analysis report by July 1, 2020 that addresses the current state of California’s health and health outcomes, analysis of the current health care delivery system, as well as options for expansion and additional steps California can take. In Phase Two, the Commission will deliver by February 1, 2021 the required second report outlining options and key design considerations for a single-payer financing system.

Proposals to serve as Project Manager for the Commission are due by 2:00 p.m. on October 17, 2019.

The new Commission is an important next step in advancing the goals of universal coverage and health system improvement in California. ITUP will monitor the Commission’s progress and provide regular updates on Commission activities. Stay tuned!