California Health Care: Bill's Co-Author Votes Against It

What a long, strange trip it's been for health care reform in California. After a yearlong effort ABX1-1, the health care bill backed by California Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Núñez, has been voted down. The Senate Health Committee delivered a coup de grace in the form of a 7-1 vote against the measure, including a nay vote from Senate President Pro Tem Don Perata (D – Oakland) who originally co-authored the measure.

Rhonda Rundle at the Wall Street Journal talks about the factors that lead to this turnaround (page A9 if you prefer hardcopy):

Support began to erode in the senate as the outlines of the state's $14 billion budget deficit came into focus late last year.

Last week, the Legislature's nonpartisan fiscal analyst raised questions about funding for the package, further undermining its prospects. Lawmakers who had been leaning in favor of the negotiated bill began backing away in the face of uncertainty about how the state could enact an ambitious new program at a time of fiscal crisis when the governor has proposed cutting funds for established health-care programs.

ABC News 10, a California news station that covers Sacramento and the surrounding areas, brings us the view from the Chair as reported by Ayesha Thomas:

Committee Chair Shiela Kuehl said there isn't enough money to fund the program.

"There's insufficient funding there for so called subsidies, there's insufficient money there to cover the expanded Medi-Cal coverage," said Kuehl.

"If the headline is Health Committee kills reform, that's an erroneous headline. But we'll live with it...The right headline is Senate Health Committee does not pass bad bill," Kuehl added.

There's more where that came from. The News 10 article ends with a transcription of Gov. Schwarzenegger's Statement in response to the vote.

Since this is a California issue a visit to Brian Katz's blog is order. As usual Mr. Katz delivers the goods, this time in the form of this quote from Senator Perata explaining his decision:

In a letter to Governor Schwarzenegger and Speaker Nunez, Senator Perata wrote, “This bill – which is before the Senate, and the initiative, which is not – would create the third-largest program in state government, surpassed only by K-12 education and Medi-Cal. Under any circumstances, but especially in light of the state’s $14.5 billion budget shortfall, we have the fiduciary responsibility to approve a health care coverage plan that is both self financing and fiscally sound and a moral responsibility to protect from harm those who already have health care coverage.”

Mr. Katz provides our summation today, as he has stated it so eloquently.

The defeat of ABX1-1 is no cause for celebration. The reality is, while the health care system works well for many in the state, serious problems exist that need to be addressed. With the defeat of ABX1-1, pressure for change will continue to build. Lawmakers may succumb to the pressure to pass anything in order to have passed something.

SOURCE: "Health-Care Bill Fails to Pass" 01/29/08
SOURCE: "Key Committee Rejects Schwarzenegger's Health Reform Effort" 01/29/08
photo courtesy of d_vdm, used under this Creative Commons license

Fear of Big Tobacco in California?

This morning Mike Zapler at the Sacramento Bureau of the Mercury News examines the the new tobacco tax proposed in California as a means of funding health care reform. Two dollars a pack could generate a lot of revenue for expanding coverage to the twenty percent of California residents who lack it, but will it be that easy?

Problem is, it might be the very thing that dooms health care reform.

A new cigarette tax would be tantamount to a declaration of war on Big Tobacco, which last year spent more than $65 million to defeat a $2.60-a-pack tax on the California ballot and just this week easily turned back an attempt in Oregon to raise tobacco taxes.

"You can bet they would aggressively fight it, and I don't think they'd be alone," said Sacramento political consultant Frank Schubert, who advised tobacco companies during last year's ballot campaign.

Any attempt to overhaul health care is bound to invite opposition, given the huge financial stakes in the system. The tobacco tax idea is an example of the difficult balance that Gov. Arnold Schwarzenegger and Democrats are struggling to strike at the negotiating table: achieving meaningful reform without triggering insurmountable opposition.

The challenge is amplified by the fact that any health care proposal is certain to end up on the ballot, where interest groups can spend tens or even hundreds of millions of dollars to defeat it.

He goes on to look at the pros and cons of several aspects of the legislation in its current form, paying particular attention to sections of the law that could be contentious. From Governor Arnold Schwarzenegger's lottery lease plan to the Democratic provision for purchasing drugs in bulk, he provides a concise summary of the options being put forth.

As for tobacco, backers of the proposed cigarette tax - which would be on top of the current 87-cent-a-pack tax - acknowledge the industry's political might. But they say the millions of dollars tobacco companies likely would spend against a health care initiative wouldn't necessarily ensure defeat, given the industry's low standing among the public.

"If you have all of the health care community backing reform, I think it can trump the money spent by tobacco," said Kris Deutschman, a political consultant who advised last year's failed campaign to raise the tobacco tax. "Because all they have is money and self-interest."

SOURCE: "Analysis: Tobacco Tax Could Doom Plan for Health Overhaul" 11/09/07
photo courtesy of curran.kelleher, used under this Creative Commons license

Deadlines Loom for Health Care Legislation

In Washington D.C., where the fiscal year ends on Sunday, September 30, President George W. Bush continues to threaten a veto of the State Children’s Health Insurance Program (SCHIP), while Democrats line up votes. Passage is expected in the U.S. House of Representatives early this week and in the U.S. Senate by the end of the week.

In an article for the Monday The New York Times blog, "The Caucus," journalist Carl Hulse explains why Democrats are not backing away from a showdown with the President:

Democrats like their position on this issue. They believe that the public supports making health insurance more affordable and that many families with middle-class incomes are struggling to provide coverage and care for their children. Some Republicans in both the House and Senate are expected to support the plan.

In California, compromise -- not confrontation -- is the top story. The San Francisco Chronicle reports that Governor Arnold Schwarzenegger is close to a compromise with Democratic leaders on a health care reform bill. Schwarzenegger wants to pass the bill before the end of the special legislative session. In a Sunday article outlining the financial interests of a dozen key players, Chronicle journalist Tom Chorneau comments on the surprising civility of the public debate at this late stage:

Absent from the airwaves are the attack ads from insurance companies and doctor groups that many feared would have materialized by now. Massive protests from labor unions or consumer groups intended to push the talks one direction or another have also been largely put on hold.

This should be an exciting week of twists and turns in the effort to pass health care reform legislation. Do you think the California bill or the federal SCHIP program will pass? Do you think President Bush will really veto SCHIP? Do you think the U.S. Congress will have the votes to override a presidential veto? We'd love to hear your comments.


SOURCE: "Democratic Leaders Close to Deal on Health Care Reform," Tom Chorneau, San Francisco Chronicle, 09/23/07
SOURCE: "Congress Tackles Child Health Care," by Carl Hulse, The Caucus, Political Blogging from The New York Times, 09/24/07
photo courtesy of U.S. White House

Report Card on the Legislative Session

Even though a special session looms in California, the lack of progress on the health care issue has spawned criticism, anxiety and unease across the state.

Steven Harmon at the San Jose Mercury News examines the situation:

"They had the stars and the moon properly aligned, with the governor re-elected, and there were no election worries for the Legislature," said Tony Quinn, a GOP political analyst. "This was the year to do something. I expected to see more substantive stuff. But the governor didn't use the large mandate he got. It just petered out."

Left on the cutting room floor were hot-button issues such as health care reform, sentencing and parole reform, assisted suicide, water storage and redistricting reform.

[Gov. Arnold] Schwarzenegger has called lawmakers into special session in hopes of accomplishing what couldn't be done in the regular session: health care reform, and water storage and flood protection legislation.

But not everyone is optimistic, especially given the partisan divide that dominated a session that produced mostly tweaks to state laws, not memorable change.

A common thread in many articles is the idea that the seven-week long budget standoff was a primary factor in health care issues remaining unresolved.

Ted Lempert, former California State Assembly member and President of Children Now, comments in the Capitol Weekly:

California's recent budget battle did more than just heighten political friction. The two-month-long stalemate monopolized precious time needed to fix California's desperately broken health-care system, which leaves millions of Californians uninsured--including over 760,000 children. Uninsured children often miss the preventive care that decreases health-care costs borne by the public over time.

Now, with just a few weeks left on the legislative calendar, Democrats and Republicans alike have a responsibility to address their unfinished business--namely health-care reform. This is not a problem that can wait until the next legislative year. California, which always has prided itself on leading the nation in social and economic issues, today ranks 43rd among states in the percent of insured children. As families, businesses and the rest of the public are demanding immediate action, it is not hyperbole to say that health care reform is a life or death issue.

SOURCE: "Hopes for Major Achievement Dashed as California Legislature Wraps Up- 2007 Session in Review" 09/13/07
SOURCE: "Children's Health Care: Unfinished Business" 09/13/07
photo courtesy of A. Belani on Flickr remixed and used under this Creative Commons license

Votes and Vetos: AB8 Passes

All eyes in California are focused on Sacramento.

From the San Francisco Chronicle:

The state Legislature approved an overhaul of California's health care system Monday, but even before the votes were tallied Gov. Arnold Schwarzenegger vowed to veto the bill and call lawmakers into a special session after the current session ends this week.

Schwarzenegger said he would reject AB8, by Speaker Fabian Núñez, D-Los Angeles, because it puts too great a financial burden on employers and does not address the needs of 2.8 million of California's estimated 6.8 million uninsured residents.

Despite the vote's outcome, there is still a long road ahead for reformers. Schwarzenegger's veto will bring a return to the ongoing debate, while the special session will keep it in the public eye.

Jordan Rau at the Los Angeles Times speculates on the content of possible resolutions:

An agreement would be likely to include a requirement that employers provide health coverage for workers or pay a fee to the state, which would then arrange for insurance for those workers. That proposal forms the heart of the Democratic bill.

The deal probably would also incorporate a tax on hospitals that would help California capture an extra $2 billion in federal aid. The California Hospital Assn. endorsed such a tax last week after Schwarzenegger lobbied hospital executives.

SOURCE: "Health Care Bill Passes Legislature, But Governor Says He'll Veto It" 09/11/07
SOURCE: "Governor Plans Health Care Veto, Talks" 09/11/07
photo courtesy of Fronco Folini on Flickr remixed and used under this Creative Commons license

Universal Concerns About Universal Health Care

In California, the legislative calendar is coming to an end, and still the debate on health care reform seems far from resolution. As competing plans are dissected and debated on the floor, citizens and business groups are stepping up to make their feelings known. Health providers and small businesses are putting out press releases to make their stance on the issue a matter of public record, and the one constant throughout is the sense of urgency that is felt on the subject.

Among others making their position known, the California Association of Physicians Groups stresses the lack of attention to preventative services in any of the current legislation:

California's network of 150 medical groups applauds the leadership in producing their pending health care reform proposals, but a critical factor necessary for these to succeed is glaringly missing -- namely, an express requirement for an affordable, coordinated benefit plan that emphasizes prevention, disease management, and increased access to healthcare.

Small businesses overwhelmingly support universal coverage according to the San Diego Business Journal:

Eighty percent of those surveyed also believe that businesses should provide their employees with health care, according to the survey released Aug. 24 by Small Business for Affordable Healthcare, a coalition of the Small Business Majority, a progressive nonprofit organization based in Sausalito.

The California Primary Care Association joins the bandwagon, invoking the "year of health care reform," which draws to and end soon:

The California Primary Care Association (CPCA), which represents over 650 community clinics and health centers throughout the state, today delivered a letter to Governor Schwarzenegger and legislative leaders calling on them to move now to enact meaningful, comprehensive health care reform that fixes California's malfunctioning system of health care. With just days remaining in the legislative session, the window of opportunity is closing fast on what was proclaimed to be the year of health care reform in California.

SOURCE: "Media Statement From Don Crane, President, California Association of Physician Groups" 09/10/07
SOURCE: "Despite High Cost, Small Business Says It Supports Universal Health Care" 09/10/07
SOURCE: "Act Now to Fix Our Broken Health Care System" 09/07/07

photo courtesy of HeyPaul on Flickr remixed and used under this Creative Commons license

California Health Care Battle

In a much watched battle Republicans and Democrats in California are squaring off on the subject of universal coverage for the state's residents.

Governor Arnold Schwarzenegger's plan would impose new fees on employers and medical providers while making coverage mandatory, although subsidized for the poorest. The Democrats, who control both houses of the Legislature, have proposed an alternative that would require an employer contribution almost double that of the governor's proposal.

Via Forbes:

"The governor and the Legislature are inches apart, but neither side wants to give that final inch," said Larry Levitt, a vice president with the Kaiser Family Foundation.

SOURCE: "Schwarzenegger Tries To Save Health Plan" 08/29/07
photo courtesy of Benjamin Earwicker

posted on behalf of George Williams

Economic Impact of California Reform

UC Berkeley News shares results of a report by university researchers about the economic impact of the two major statewide health care reform plans under consideration in California.

Their study concludes that neither plan will mean job losses in California, and it forecasts that most firms will experience little or no net change in business operating costs after a short adjustment period. Increased operating costs related to increased health care provisions are likely to be absorbed through increased productivity, modest price hikes for consumers and delayed wage increases for workers earning more than minimum wage, the report says.

The article summarizes findings in the report, "Health Coverage Proposals in California: Impact on Businesses." The report was authored by researchers at the University of California at Berkeley's Center for Labor Research and Education, and it analyzes Gov. Arnold Schwarzenegger's health care reform proposal and Assembly Bill 8 (AB 8).

The story also includes a link to the full report.

SOURCE: "Study Predicts Positive Net Economic Impacts of Key Health Reform Plans" 07/11/07