Two contrasting health insurance bills were introduced into California’s Legislature last week, just before the deadline for new legislation. One would cover all Californians under a single-payer plan while cutting overall health care costs. The other would shift the burden to individuals, requiring all residents to buy basic coverage for themselves if not covered by an employer.

The California Health Insurance Reliability Act (SB 840) was introduced by Sen. Sheila Kuehl (D-Los Angeles) with 12 Senate and nine Assembly co-sponsors. An updated version of Sen. Kuehl’s earlier single-payer bill, it would cover all California residents with comprehensive health insurance.

The Universal Health Care Act of 2005 (AB 1670), introduced by Assemblymembers Joe Nation (D-San Rafael) and Keith Richman (R-Granada Hills), on the other hand, would require every uninsured person to buy at least minimal insurance with an annual deductible of $5,000 or less per person, and to submit proof of coverage with their income tax return. Those failing to do so would have the cost taken out of their tax refund. The bill would also set up a purchasing pool for the minimal insurance package, and subsidize employers offering that coverage to low-wage workers.

Kuehl’s single-payer bill does not call for any new health care spending. It would be paid for by federal, state and county funds already being spent on health care and by affordable insurance premiums replacing all current premiums, deductibles, co-payments and out-of-pocket payments now made by employers and consumers.

“Everybody knows that health care costs are out of control,” Kuehl said in a statement Feb. 23, the day she introduced her bill. “The system is broken and tinkering won’t fix it,” she added. “We’re beyond the point of cosmetic surgery. What we need is a cure.”

“We believe in quality affordable health care for all, by as many means as possible,” said Anthony Wright, executive director of the Health Access coalition of over 200 organizations. Wright said the near-passage in November of Prop. 72, to mandate that employers of 50 or more workers provide coverage, gives momentum to “a whole new conversation on health care.” Other proposals include universal children’s coverage, an expansion of the Healthy Families program and a revisiting of Prop. 72. “I can’t predict what it will be, but I am optimistic that something will happen,” he said.

“We definitely believe in universal coverage, and single payer is a really good option,” said Ellen Wu, executive director of the Oakland-based California Pan-Ethnic Health Network. She added, “It’s going to take something big like single payer” to fix a system which is grossly unfair concerning who gets care and how much it costs.

Senate Bill 840 would cut total health spending in the state by an estimated $8 billion in the first year alone, according to an independent research firm, The Lewin Group. Their study predicts that employers now providing coverage would save an average of 16 percent in premiums, while families would see their average health care spending drop about 12 percent. Coverage would include inpatient and outpatient hospital care, emergency room visits, physician services including preventive care, prescriptions, lab tests, mental health and substance abuse treatment and other services. Also covered: home health and adult daycare services for the aged and disabled, dental care, vision care including eyeglasses, and hearing. No deductibles or co-payments would be charged.

Though a single-payer system is not popular with insurance companies, and Kuehl’s earlier single-payer bill was defeated, supporters say passage is now more likely because of the worsening crisis in health care. A recent Harvard University study found half of all bankruptcies related to medical costs. A Boston University study has shown that half of all health care dollars are wasted on unnecessary administrative and other costs, while the Kaiser Family Foundation has found many employers are dropping health coverage altogether.