The states' rights con and single-payer healthcare, by @DavidOAtkins

Universal coverage, Medicare for all, single payer — call it what you will. It's clear that conservative forces are determined to prevent such a system from ever being introduced at the national level. So it's up to the states.

The catch is that to make universal coverage work at the state level, you'd need some way to channel Medicare, Medicaid and other federal healthcare funds into the system. At the moment, that's difficult if not impossible.

But legislation quietly being drafted by Rep. Jim McDermott (D-Wash.) would change that. It would create a mechanism for states to request federal funds after establishing their own health insurance programs.

If passed into law — admittedly a long shot with Republicans controlling the House of Representatives — McDermott's State-Based Universal Healthcare Act would represent a game changer for medical coverage in the United States.

It would, for the first time, create a system under which a Medicare-for-all program could be rolled out on a state-by-state basis. In California's case, it would make coverage available to the roughly 7 million people now lacking health insurance.

"This is a huge deal," said Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group. "This is a lifeline for people who want to create a Medicare system at the state level."

I learned of McDermott's bill after getting my hands on documents he had sent to other members of Congress seeking support for the legislation.

McDermott's office confirmed that the documents and legislation are real but declined to make the congressman available for comment until the bill is formally introduced, which could happen as soon as next week.

Kinsey Kiriakos, a spokesman for McDermott, said by email that the bill is intended to advance the goals of President Obama's healthcare reform law, which would extend coverage to about 30 million of the 50 million people nationwide without insurance.

The reform law is now under scrutiny by the U.S. Supreme Court, primarily because of its requirement that most people buy health insurance or face a modest tax penalty.

McDermott's bill "is based on the congressman's belief that the Affordable Care Act will be upheld and the congressman's new bill is meant to achieve the overall goals of the Affordable Care Act while giving states the option to build an alternative single-payer system," Kiriakos said.

California came close to building such a system in 2006 and again in 2008 when the Legislature passed bills laying the groundwork for statewide universal coverage. Then-Gov. Arnold Schwarzenegger vetoed both bills.

The bill could warm the hearts of liberals who expressed frustration with the Affordable Care Act’s more moderate approach of building on the existing health care system and should also satisfy GOP presidential candidate Mitt Romney. The former Massachusetts governor has sought to differentiate his 2006 health reform from Obamacare by rejecting a federal prescription for reform and promising to “pursue policies that give each state the power to craft a health care reform plan that is best for its own citizens.”

The ACA creates state flexibility by granting waivers to states that meet certain coverage standards and a bipartisan group of lawmakers has offered legislation expanding the provision by allowing states with innovative health care solutions to opt out of certain provisions beginning in 2014. Romney, meanwhile, has pledged to build on the ACA’s flexibility and grant states to the ability to opt out of the law entirely.

McDermott’s measure would go even further and encourage states to repurpose federal funds to build a universal single-payer health system of their own. If Republicans are truly interested in states rights, they will back it in mass.