California Gov. Arnold Schwarzenegger's recent order to halt all pending state regulations has thrown into question the future of several healthcare-related laws, including first-in-the-nation mandates governing nurse-staffing levels and mandatory insurance coverage.
On his first day in office Nov. 17, Schwarzenegger issued an executive order suspending implementation of all proposed state regulations for 180 days until his administration has a chance to assess their impact on business. He also called for a review of all laws enacted by former Gov. Gray Davis over the past five years.
Certain business and healthcare interests have seized on the moratorium as an opportunity to push for the delay, revision or repeal of several sweeping healthcare-related changes set to take effect in coming years.
The California Healthcare Association and its local affiliates, for example, are lobbying the governor to delay and retool the state's landmark nurse-staffing law, set to go into effect Jan. 1, 2004.
The legislation, signed by Davis in 1999, is designed to improve patient safety by requiring hospitals to beef up their nurse-to-patient ratios. But hospitals, which fought bitterly against the final regulations, say the bill's $480 billion annual price tag coupled with a nationwide nursing shortage has made it nearly impossible for them to comply.
"Some of the regulations are particularly onerous, while others are simply unworkable," said Jim Lott, executive vice president of the Hospital Association of Southern California. "We've asked for the regulations to be repaired before they go into effect. We're saying, `Let's fix them before the system suffers.' "
The Los Angeles County Board of Supervisors is also urging Schwarzenegger to exempt public hospitals from penalties if they are unable to meet the mandated ratios. The concern is that hospitals will be forced to close units they can't adequately staff, said Carol Gunter, acting director of the county's Emergency Medical Services Agency.
"It's not a bad law. There simply aren't enough nurses," said Gunter, adding that the county's five public hospitals will be short on nurses by about 25% on Jan. 1. "The only option hospitals would have if they're unable to fill these positions is to close beds. ... That could back up our entire emergency medical system."
The California Nurses Association, however, has called on Schwarzenegger, who had open-heart surgery in 1997, to support the staffing law in its current form. CNA spokesman Chuck Idelson argues that, in the four years since the bill was signed, the state Department of Health Services held several public hearings, took written testimony from all parties involved and conducted its own study to draft the final regulations.
"This law has probably undergone more scrutiny than any other law in the state's recent history," Idelson said. "The hospitals have had ample time to air their concerns; their points of view have been thoroughly considered and rejected. We don't think it's necessary or appropriate to make changes (to the law) at this point."
Vince Sollitto, a spokesman for Schwarzenegger, said the governor has not yet taken a position on the ratios.
Some industry observers, however, suggest that Schwarzenegger's recent staff appointments could signal where he will ultimately land. The governor's new secretary of health and human services, S. Kimberly Belshe, ran the state health department under former Gov. Pete Wilson, who vetoed an earlier version of the nurse-staffing law in 1998. And his new chief of staff, HMO executive Patricia Clarey, served as Wilson's deputy chief of staff.
"The dominance of the Wilson team ... raises serious questions about the future of HMO reform and the (state's) patients' bill of rights, including the continued enforcement of these important consumer protections," said Anthony Wright, executive director of Health Access, a Sacramento, Calif.-based consumer advocacy group.
Meanwhile, critics of another hotly debated healthcare bill aren't waiting for the governor to make the final call.
The California Chamber of Commerce is pursuing a referendum to repeal SB 2, a first-of-its-kind law that requires large and midsize businesses to provide heath benefits to workers and their families or pay into a state-run fund to cover them. Supporters say the law, signed by Davis two days before his recall, would cover 1 million of the state's 6.3 million uninsured. But critics argue it would overburden businesses and drive jobs out of state.
Last week, the chamber submitted 620,000 petition signatures to election officials to put the repeal initiative on the March 2, 2004, ballot. The referendum needs 373,816 valid voter signatures to qualify.
Schwarzenegger has said publicly that he "absolutely" opposes the law, calling it "another tax" on business but has not revealed how active a role he will play in trying to overturn it. "This type of legislation is simply too expensive for businesses, especially at a time when we're trying to bring jobs back to the state," Sollitto said.
Since taking office, the governor already has repealed two Davis-signed laws that he opposed-one that tripled the state's vehicle license fee and another that allowed undocumented immigrants to receive driver's licenses. But the sensitive issue of the uninsured could make SB 2 a much more difficult bill for the governor and the Democrat-led Legislature to kill.
"We felt that, because there's such widespread opposition to the law, we should take it to the voters," said Sara Lee, spokeswoman for the Sacramento-based chamber.
Meanwhile, a state Senate committee has taken the first step toward scuttling another major healthcare-related law-one that the new governor does not want repealed.
The Labor and Industrial Relations Committee voted 5-1 last month to overturn a sweeping workers' compensation reform package passed in September. Schwarzenegger had angered Democrats during his election campaign by criticizing the reforms for not going far enough.
Among other things, the bill limits visits to chiropractors and physical therapists, adds cost controls for outpatient surgery centers and pharmacies, and rolls back doctors' fees for treating injured workers. The bill is now before the Appropriations Committee, the last stop before the Senate floor.