Insurance Mandate Would Face Obstacles in California
California lawmakers this year are considering a number of health care bills that aim to reduce the number of uninsured residents, including two bills that are similar to legislation recently passed in Massachusetts that would require people to have health insurance or pay penalties, the Sacramento Bee reports.
However, because of demographic differences between California and Massachusetts it would be challenging to enact such a law in California, according Kim Belshe, Health and Human Services secretary, and Peter Harbage, a health policy expert at the New America Foundation.
For example, the proportion of uninsured Californians -- about one in five residents -- is about double the proportion of uninsured Massachusetts residents. In addition, about 66% of businesses in Massachusetts offer health insurance to workers, compared with 56% of employers in California.
Compared to Massachusetts residents, uninsured residents in California also have higher poverty rates, which likely would require legislation to extend coverage to include government subsidies for a greater proportion of the population, the Sacramento Bee reports.
Bills being considered by the Legislature to reduce the number of uninsured Californians include:
SB 840, by Sen. Sheila Kuehl (D-Los Angeles), which would create a state-run, single-payer health care system;
SB 1414, by Sen. Carole Migden (D-San Francisco), which would require for-profit employers with more than 10,000 workers to spend at least 8% of their payroll costs on health care for employees;
SB 1584 -- by Sens. George Runner (R-Lancaster) and Dick Ackerman (R-Tustin) -- and AB 2010, by Assembly member George Plescia (R-San Diego), which would provide state income tax deductions for health savings accounts;
SB 1672, by Sen. Abel Maldonado (R-San Luis Obispo), which would give a tax break to medical providers who invest in information technology;
AB 1952, by Assembly member Joe Nation (D-San Rafael), which would require all residents to have health insurance and require employers to provide insurance. The bill also would create a state-run purchasing pool for residents to buy low-cost insurance;
AB 2450, by Assembly member Keith Stuart Richman (R-Granada Hills), which would require all state residents to have insurance. The bill also would provide low-cost insurance for state residents not insured by their employers and subsidies to some employers who offer health benefits; and
AB 2737, by Assembly member Alan Nakanishi (R-Lodi), which would provide a tax credit for employers who contribute to workers' high-deductible health plans used in conjunction with HSAs (Benson, Sacramento Bee, 4/10).
Los Angeles Times: "Part of what Massachusetts' experiment shows is that there are no easy solutions to the U.S. health care crisis," a Times editorial says, adding, "Solving it will require a more sober discussion at the state and federal levels" (Los Angeles Times, 4/10).
Modesto Bee: California lawmakers "should take a hard look at the Massachusetts model, once it's operating, to see what it might offer California," according to a Modesto Bee editorial. Although the plan "is not perfect, ... at least the system addresses the issue of providing health care for the uninsured," the Modesto Bee writes (Modesto Bee, 4/10).
- San Jose Mercury News: "If the United States is going to solve its health care crisis, then it is going to need individual states to serve as laboratories for seeking cures," a Mercury News editorial states. It adds, "If a Republican governor in a state with such a prominent liberal constituency can find common ground on the issue, surely California can make progress toward reducing the number of its six million residents without health care coverage" (San Jose Mercury News, 4/10).
- Ronald Brownstein, Los Angeles Times: "At a time when Washington is locked in partisan warfare on almost every front and has done little to reverse the declining access to health insurance nationwide" the Massachusetts bill shows "brilliant political balancing," Brownstein writes in a Times opinion piece. He adds that the "package advances many ideas dear to conservatives ... [but] advances just as many priorities of the left." Brownstein also says that "[m]uch could still go wrong" with the plan, but the plan "has created a structure supple enough to respond to the challenges that emerge if the state's future political leaders show the flexibility demonstrated by Romney and state Democratic leaders" (Brownstein, Los Angeles Times, 4/9).
- Judy Dugan/Jamie Court, Los Angeles Times: While many individuals have praised the Massachusetts plan as a "model for national health insurance ... [i]t's not, and certainly not for California," Dugan and Court of Santa Monica-based Foundation for Taxpayer and Consumer Rights write in a Times opinion piece. Dugan and Court write, "If California wants genuine universal health insurance, it is going to have to do the hard work of restraining the health care system's waste, inefficiency and profiteering. But that would entail angering interest groups that finance politicians' elections. The uninsured and underinsured don't attend fundraisers or make political contributions" (Dugan/Court, Los Angeles Times, 4/8).
Several broadcast programs recently reported on the Massachusetts bill:
- APM's "Marketplace Money": Economics editor Chris Farrell discusses the Massachusetts bill (Farrell, "Marketplace Money," APM, 4/7). The complete segment is available online in RealPlayer.
- KCRW's "To The Point": Guests on the program included Marylou Buyse, physician and president of the Massachusetts Association of Health Plans; Jamie Court, president of the Foundation for Taxpayer and Consumer Rights; John Goodson, associate professor of medicine at Harvard University and co-chair of the Healthcare for Massachusetts Campaign; and Merrill Matthews, resident scholar at the Institute for Policy Innovation (Olney, "To The Point," KCRW, 4/7). The complete segment is available online in RealPlayer.
- NPR's "Weekend Edition Saturday": The segment includes comments from Massachusetts House Speaker Salvatore DiMasi (D); Ed Haislmaier, research fellow in the Center for Health Policy Studies at the Heritage Foundation; and Massachusetts Gov. Mitt Romney (R) (Knox, "Weekend Edition Saturday," NPR, 4/8). A transcript of the segment is available online. The complete segment is available online in RealPlayer. Text of an expanded NPR interview with Romney is available online. Text of an expanded NPR interview with Stuart Altman, health economist and professor of national health policy at the Brandeis University Heller School for Social Policy and Management, is available online.
- NPR's "Weekend Edition Sunday": NPR senior news analyst Daniel Schorr discusses the Massachusetts bill (Schorr, "Weekend Edition Sunday," NPR, 4/9). The complete segment is available online in RealPlayer.