Health Care Players React to Special Election Outcome

Before the dust from last month’s election settled, health care players began lining up for the next go-round in California’s initiative process. Some consider it the best — others say it’s the only — way to get things done in California, where the governor and Legislature don’t see eye-to-eye on many issues.

“It’s not that hard in the rest of the country to get things moving,” Mike Spence, spokesperson for the California Pro-Life Council and president of the California Republican Assembly, said. “In California there’s definitely a feeling of being stalled. The initiative process is one way of getting around that,” Spence — a leader in the campaign for Proposition 73, the parental notification measure defeated last month — said.

It appears voters will get another shot at the same issue next year. A petition was filed last week at the state Attorney General’s office seeking approval to collect signatures to put essentially the same proposal on the ballot again. With the working title “Parental Notification Before Minor’s Abortion,” the new initiative reportedly is being underwritten by San Diego newspaper publisher Jim Holman. who launched Proposition 73 and bankrolled it with $1.1 million.

Proposition 73, which would have required doctors to notify a parent or guardian 48 hours before performing an abortion on an unmarried minor, was defeated by “no” votes from 52.6% of voters The new initiative uses similar language and could be ready for the November 2006 ballot.

Spence, a leader in the campaign for Proposition 73, isn’t sure whether he will be involved in the new campaign.

“It depends on what kind of campaign financing comes through,” he said. “Initiatives are a very expensive way to go. We didn’t have the money you need to get your message across with this last campaign.”

For the November 2005 special election, proponents of the measure raised just over $2 million, about half of it used to gather signatures to qualify the petition for the ballot. Opponents of the measure collected about $5 million.

The $80-Million Question

Money raised for the parental notification proposal was dwarfed by the record $80 million pharmaceutical companies raised to promote Proposition 78 and defeat Proposition 79. Both lost, but health and drug industry leaders say the overall effect was a victory for the drug industry. Proposition 79, if it had passed, could have started a wave reaction in other states trying to address prescription drug prices. Supported by labor and consumer groups, Proposition 79 would have required drug makers to participate in a prescription drug discount program for low-income families or face exclusion from the Medi-Cal formulary in some cases.

Proposition 78, supported by the Pharmaceutical Research and Manufacturers of America, would have established a voluntary prescription drug discount plan for low- and moderate-income Californians.

Many analysts agree it was more important for the pharmaceutical industry to defeat Proposition 79 than to secure passage of Proposition 78 and that’s why most of the $80 million went to defeat Proposition 79.

“If you spend $80 million, there’s a good chance you will kill the thing you want to kill,” David Magnus, director of the Stanford University School of Medicine’s Center for Biomedical Ethics, said.

Implications of Defeated Budget Measures

Anthony Wright, executive director of Health Access California, a statewide consumer advocacy group, was pleased that $80 million wasn’t enough to get Proposition 78 passed, but he said the defeat of a third measure — Proposition 76 — was more important for the future health of California.

Wright said Proposition 76 “would have basically been a suspension of the taxpayer bill of rights. It would have put a stranglehold on publicly financed health care, and that’s the majority of health care in this state.”

Proposition 76, the kingpin of Gov. Arnold Schwarzenegger’s (R) reform package in the November special election, would have limited state spending growth to the average revenue increase in the three previous years. In addition, it would have allowed the governor to make mid-year spending cuts if the budget fell out of balance and the Legislature did not agree on how to balance it.

“Defeating Proposition 76 was a very big deal for us, and while we’re disappointed about 79, it pales in comparison with what could have happened if 76 passed,” Wright said.

78, 79 Proponents Look Ahead

Health Access will pursue drug price reforms, Wright said, but probably through the Legislature rather than another initiative.

“Perhaps in this new political climate we can deal with this issue legislatively,” Wright said. The governor’s failure to pass any of his four reform initiatives is widely perceived as the beginning of a new, perhaps more conciliatory relationship between the Legislature and Schwarzenegger.

PhRMA representatives did not rule out another petition drive in the future but said the organization will pursue some sort of relief for uninsured and low-income Californians having trouble paying for expensive prescription drugs.

“No one knows now what form new legislation would take, but we are committed to being part of the solution to helping the uninsured get the medications they need,” PhRMA CEO Billy Tauzin said.

Turning to Tobacco Taxes

Although it’s often used in California as a sort of end run around stalemated elected officials, the initiative process is not without its own share of political give and take.

Two tobacco tax initiatives in the works for next year are stirring up controversy. In a rare move, four statewide groups usually in favor of taxing tobacco to benefit health care banded together last week to oppose the California Hospital Association petition to raise tobacco taxes by $1.50 a pack. Most of the money would go to help fund hospital emergency departments.

The California Medical Association, Congress of California Seniors, Health Access and Campaign for Tobacco-Free Kids are urging CHA to stop gathering signatures.

“This proposed initiative to raise money through a tax on tobacco could have been designed to unify consumers and all health care constituencies to address some of the biggest health problems California faces,” CMA CEO Jack Lewin said. “Instead, it appears to physicians to mainly benefit hospitals, without addressing the real crisis facing our trauma and emergency care system,” Lewin said.

Meanwhile, another tobacco tax proposal — also calling for a $1.50 surcharge per pack of cigarettes in California — is gathering steam in the wings. Sponsored by the Coalition for a Healthy California, the second initiative is awaiting the Attorney General’s green light to begin collecting signatures.

The coalition’s plan would direct the money — about $1.4 billion a year — toward expanding health coverage for children, tobacco resistance and other health programs. The coalition includes the American Cancer Society, the American Heart Association, American Lung Association, California Primary Care Association, Campaign for Tobacco-Free Kids, Children Now, The Children’s Partnership and PICO California.

Calls to the California Hospital Association were not returned by publication time.

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