Health Care Stakeholders Rehash Key Issues in California Health Reform

Four California health care stakeholders discussed the state's recent attempt at statewide health care reform in a series of blog posts and follow-up comments on the Health Affairs Blog.

In January, the Senate Health Committee rejected a compromise health care reform bill (ABX1 1) negotiated by Gov. Arnold Schwarzenegger (R) and Assembly Speaker Fabian Núñez (D-Los Angeles). The Assembly approved the bill in December 2007 (California Healthline, 1/29).

California's health care reform attempt to decrease its number of uninsured residents may "serve as a model for other states and for the nation," according to Curtis.

Similarly, Schwarzenegger's "shared responsibility" approach "provided an important impetus for other states that are pursuing reform," as well as the Democratic presidential candidates' health care platforms (Curtis, Health Affairs Blog, 3/5).

A "lot of heat" has been centered around "the question of whether an individual mandate is a desirable feature of health care financing reform," Kronick, a professor of family and preventive medicine and an adjunct professor of political science at UC-San Diego, writes.

Democratic policy has been "restricted to proposals that build on the employer-sponsored insurance scaffolding," although voters and policymakers need to decide if that will be "a fair, equitable and politically palatable way to" achieve universal coverage, according to Kronick (Kronick, Health Affairs Blog, 3/5).

Kaiser views the failure to implement statewide reform "as a major lost opportunity," Lynch, vice president of state government relations services in Kaiser Permanente's national Legal and Government Relations Department, writes.

The reform bill was important because groups "that rarely work together were willing to moderate their differences and stretch their comfort zones to achieve larger goals," according to Lynch (Lynch, Health Affairs Blog, 3/5).

Gov. Schwarzenegger "had it right: reform must encompass both shared responsibility and shared sacrifice," Wulsin writes.

According to Wulsin, the bill was rejected because of the state budget deficit, problems in the mortgage market and the prospect of a recession, rather than the actual policy implications of the bill. Wulsin maintains that the effort "sets the stage for the next steps in California reform" (Wulsin, Health Affairs Blog, 3/6).

The roundtable participants also were invited to respond to their colleagues' postings. Highlights of those responses appear below.

• Curtis: "With or without an individual mandate, affordable access for higher-risk people requires some allocation of health care costs among" individuals who incur costs, other individuals and the government (Curtis, Health Affairs Blog, 3/10).
• Lynch: The "prohibition on health plans from denying applicants coverage," should not be enacted without an individual insurance mandate (Lynch, Health Affairs Blog, 3/10).
• Wulsin: California policymakers "had and will have no choice but to go to the ballot" for financing expanded health coverage because of the legislative threshold for approving new taxes, state budgeting formulas, and rules on county and local spending (Wulsin, Health Affairs Blog, 3/10).