The prevailing sentiment across the state following a Senate committee vote against a bipartisan health reform plan appears to be disappointment — even people who voted against it are disappointed.
But it has not resulted in paralysis.
Last week, children’s health advocates filed an initiative to establish a new tobacco tax to help fund health insurance for children in California. The proposal is a recycled version of both Proposition 86, which voters defeated in 2006, and a key element in the now moribund funding plan put forward by Republican Gov. Arnold Schwarzenegger and Democratic Assembly Speaker Fabian Núñez (Los Angeles).
Two leaders of the Proposition 86 campaign and strong supporters of the Schwarzenegger-Núñez plan — PICO California and The Children’s Partnership — are spearheading the new initiative.
The new ballot campaign calls for a 75-cent-per-pack tax on cigarettes. That’s less than half the amount sought in the Schwarzenegger-Núñez plan and less than a third of the tax proposed in Prop. 86 two years ago. It represents a compromise effort to keep as many kids as possible insured in California.
More than 55,000 children enrolled in Children’s Health Initiatives in 25 California counties could lose health coverage this year and next if new funding isn’t developed. The county-based programs were created as a safety net for kids in families that don’t qualify for state and federal programs but can’t afford coverage on their own. Funded by government and private grants as well as money from tobacco lawsuit settlements, Children’s Health Initiative programs cover more than 85,000 kids statewide.
Children’s health advocates got behind the Schwarzenegger-Núñez plan as a way to keep the county programs alive.
“When that plan was voted down, we all looked at each other, said, ‘Okay. None of us expected that. So what happens next?'” says Jim Keddy, president of PICO California, part of a national coalition of faith-based community organizations.
“There is some urgency involved across the state,” Keddy says. “County-based programs are running out of money. The L.A. County health plan alone is faced with dropping as many as 30,000 kids this year.”
Keddy and Wendy Lazarus — founder and co-president of The Children’s Partnership, a national child advocacy organization with offices in Santa Monica and Washington, D.C. — signed the petition filed last week in the state attorney general’s office. They hope to gather enough signatures to place the initiative on the November ballot.
“The timing is kind of tight, and it will take a lot of money, which we’re trying to come up with. But we can’t wait,” Keddy says. “We have to do something now.”
The attempt to push through a tobacco tax, meager compared to the broad changes proposed in the reform package, is one group’s strategy to pick up a piece of the broken reform campaign and run with it.
But it might be hard for other groups to find similar pieces to work with.
Despite a looming shortfall of $14 billion in a state beset with problems, there are a few optimists in Sacramento. They predict newly termed-out legislative leaders and the lame duck governor can roll up their sleeves now and really get to work with little political risk. They can tackle budget cuts, education, taxation, infrastructure repairs and other thorny issues head-on.
Health care reform, however, probably won’t be one of them.
The collapse of the hard-wrought bipartisan reform package last month brought California’s “Year of Health Care Reform” to an ignominious, inconclusive end. Many health care and political players — even the optimists — don’t expect another run at major policy reform until new legislative leaders step up over the next two years and the governor’s term ends in 2010.
“That was definitely the death knell of health care reform for the time being,” says Carmela Castellano-Garcia, president and CEO of the California Primary Care Association, one of many organizations supporting ABX1 1, the plan put forward by Schwarzenegger and Núñez. The Senate Health Committee rejected ABX1 1 last month with a 7-1 vote.
“It was a double blow,” Castellano-Garcia says. “Not only did we lose the chance to make real progress toward getting everybody covered, we lost the opportunity to bring in $14.5 billion in new revenues for health care. Now, with the budget predictions we’re hearing, that’s a much bigger problem.”
The Senate Health Committee’s vote against the reform package surprised many across the state, including Keddy.
“Nobody expected a headline saying ‘Senate Democrats defeat health reform,'” Keddy says. “Who could have predicted that?”
Some see the reform package failure as a sign of increasing polarization in the health care debate.
There is a growing perception that state politics alone cannot bridge the wide divide between the two camps on health care. On one side, business-minded Republicans take the free market, keep-government-out-of-the-doctor’s-office approach. And on the other side, single-payer proponents want to take insurance companies out of the equation and give health care management to the government.
Schwarzenegger, Núñez and the majority of Californians, according to pollsters, wanted to navigate the chasm with tenuous ties to both sides. They ultimately fell without much support from either side.
One of the key votes against the plan was San Francisco Democrat Leland Yee, who expressed regret at having to vote against reform.
“This bill does not move us closer to the promise of universal health care,” says Yee, co-author of SB 840, which would set up a single-payer health care system in the state. “Californians should be extremely skeptical of a law which requires them to purchase insurance but allows insurance companies to charge any amount for the policy. This is not a step in the right direction but a huge jump backwards for California’s working families without insurance,” says Yee, who joined Senate Health Committee Chair Sheila Kuehl (D-Santa Monica) in opposing AB X1 1.
Kuehl, lead author of SB 840 and a champion of the single-payer system, said the Schwarzenegger-Núñez plan’s individual mandate did not protect “working class and middle-class Californians against unaffordable premiums and escalating out-of-pocket expenses.”
Republicans said California could not afford a health care “experiment” with the state facing a shortfall of more than $14 billion and with the state’s economy expected to slow.
“There are some who would wish we could click our heels, or wiggle our nose, to create a perfect health delivery system,” said Sen. Dave Cox (R-Fair Oaks). “This bill is based on fairy tale assumptions.”
Republican Assembly leader Michael Villines of Fresno welcomed the plan’s demise, calling it “a massive government-run health care scheme.”
Staged in the nation’s most populous and often most influential state, California’s plan was projected as a catalyst to make health reform a more prominent issue in the national debate, especially in the presidential campaigns. The plan’s fall to earth may have the opposite effect.
“It’s fine to debate the big picture and hope that sometime in our lifetime we get to a single-payer system,” Keddy says. “But we don’t have the luxury right now of waiting to see where health care reform goes from here.”
“We have to do something now and in November,” Keddy says.