National Health Reform Efforts Focus of Debate After California

The Senate Health Committee's rejection of a health care reform bill (ABX1 1) negotiated by Gov. Arnold Schwarzenegger (R) and Assembly Speaker Fabian Núñez (D-Los Angeles) highlights the need for national reform as state-level efforts are hampered by budgetary restraints, the Washington Post reports (Lee, Washington Post, 1/31).

The Assembly passed the measure in December 2007, but the Senate Health Committee earlier this week voted 7-1 against the bill, with three Democratic members abstaining. The legislation received no support from Republican committee members.

The plan would have required about 3.6 million of the 5.1 million permanently uninsured residents to obtain health care coverage.

Aside from approval from the Legislature and Schwarzenegger, the plan could not have taken effect without voter support of its funding mechanism. A ballot measure was planned for November (California Healthline, 1/29).

Most senators cited concerns over the state's budget deficit in their decision to reject the measure after a report by the Legislative Analyst's Office raised questions about funding for the plan.

Alicia Trost, spokesperson for Senate President Pro Tempore Don Perata (D-Oakland), said the committee's "sole motivation" for defeating the reform bill was the budget deficit and Schwarzenegger's proposed spending cuts to reduce the shortfall.

However, Schwarzenegger and Núñez "seemed to indicate that the LAO report was being used as political cover for senators who voted against the bill," according to Capitol Weekly (York, Capitol Weekly, 1/31).

Paul Ginsburg of the Center for Studying Health System Change said, "The failure of California's plan pushes the focus about expanding coverage even more strongly towards Washington." He added, "I've never believed that states would be able to go very far on their own because of their fiscal limitations."

Karen Davis of the Commonwealth Fund said, "The lack of federal support for state innovations has proved to be a major hurdle to reform." She maintained that federal leadership is necessary because California and other states' plans rely heavily on an expansion of Medicaid and other federally funded programs to extend health care coverage (Washington Post, 1/31).

Nonetheless, some in California expect support to build for a narrower health care coverage expansion, perhaps focusing on children, Capitol Weekly reports.

One possibility is legislation by Assembly member John Laird (D-Santa Cruz) and Sen. Darrel Steinberg (D-Sacramento) that would expand eligibility for Healthy Families -- California's version of the State Children's Health Insurance Program -- and permit higher-income families to buy coverage through the program.

However, that legislation, like the Schwarzenegger-Núñez plan, lacks a funding source (Capitol Weekly, 1/31).

Summaries of an opinion piece and editorials regarding the health care reform debate in California appear below.

• George Skelton, Los Angeles Times: "The governor and [Núñez] deserve credit for trying hard on universal health care," Skelton writes in his "Capitol Journal" column for the Times. "But just because their bill failed doesn't mean that the Legislature did," Skelton writes, adding, "The system succeeded" (Skelton, Los Angeles Times, 1/31).
• Los Angeles Times: "Núñez and Schwarzenegger should keep the focus on comprehensive reform and the notion of shared responsibility" as they rework their overhaul plan, a Times editorial states. "Their great achievement was forging a broad coalition for change," the editorial states, adding, "Their greatest failure would be letting it disintegrate" (Los Angeles Times, 1/31).
• San Diego Union-Tribune: The vote against ABX1 1 "was a welcome repudiation of a massively flawed measure," a Union-Tribune editorial states. However, there "are plenty of ways California health care can be improved," including improving efforts to enroll eligible children in public health care programs and providing tax breaks to small businesses "to encourage them to provide health insurance," according to the editorial (San Diego Union-Tribune, 1/31).