SACRAMENTO, Calif.With just three weeks left in the California legislative session, the prospect of meaningful change to the states healthcare system may seem unlikelybut an eleventh-hour deal could happen, some in the states capital said.
The state Senate spent the past two months consumed with one of the longest budget stalemates in recent memory, which was finally broken last week. And Gov. Arnold Schwarzeneggers healthcare proposal, unveiled with much fanfare in January, hasnt been introduced in bill form.
But a flurry of activity before the legislative session ends Sept. 14, and another bill that incorporates some of the governors ideas, could put the Golden State on the path toward covering its 6.5 million uninsured. We continue to be optimistic we can get something done this year, said Anthony Wright, executive director of Health Access California, a statewide consumer advocacy group. Its going to be a roller-coaster ride in the next few weeks.
Schwarzenegger may call a special legislative session on healthcare later this fall if a deal isnt reached in the next few weeks; a ballot initiative is not out of the question, either. Hes not ruling out any means of getting there, said gubernatorial spokesman Aaron McLear.
A reform bill winding its way through the Legislature has some momentum. The bill takes a multipronged approach: It extends eligibility for Californias Medicaid and State Childrens Health Insurance Program endeavors (called Medi-Cal and Healthy Families) to up to 300% of the federal poverty level, which would be $61,950 for a family of four in 2007. It has a play or pay component, requiring employers who dont spend at least 7.5% of Social Security wages for health coverage for workers to pay an equivalent to a purchasing pool. And it requires insurers to spend 85% of premiums on healthcare services, while barring them from varying rates or denying individual coverage based on pre-existing conditions.
The bill would cover 69% of the states uninsured and cost some $4.66 billion, offset by about $5 billion in the employer assessment, according to the California HealthCare Foundation, a not-for profit, nonpartisan organization that aims to help improve healthcare delivery in the state. It passed the Assembly and is expected to pass the Senate Appropriations Committee by Aug. 31.
Schwarzeneggers plan also includes play-or-pay and insurer-spending rules but requires every resident to carry health insurance, and imposes fees on physicians and hospitals. His plan would cover nearly all uninsured, including illegal immigrants, and cost $12.1 billion. He has repeatedly said that shared cost responsibility must be central to any reform, and he has pushed hard for an individual mandate.
State Republican lawmakers, who submitted a now-dead plan to offer tax incentives to expand care, oppose the current bill, but the Democratic-controlled Legislature may not need their vote. Thats because the bills employer mandate has been interpreted by the state Legislative Counsel to be a fee, not a new tax, thus bypassing a state requirement that new taxes be approved by two-thirds of both houses. The governors plan likely would need two-thirds majority because of its broader-based provider and employer assessments.
Still, the bill faces fierce opposition. The California Association of Health Plans said that it would increase premiums and drive healthy consumers out of the market, while hindering investment in technology. The California Chamber of Commerce is also opposed.
Without bipartisan support and buy-in from stakeholders, true reform is unlikely, said Marian Mulkey, senior program officer at the California HealthCare Foundation. Mulkey noted that an employer mandate was signed into California law in 2003, only to be overturned by a ballot initiative a year later. Theres a good chance there would be a lot of work to be done in the form of legal challenges or ballot initiatives without broad support, Mulkey said.