Assessing seven years of Schwarzenegger.

As several reporters try to assess the legacy of Governor Arnold Schwarzenegger, it’s time to consider his record on health issues–where he’s been all over the place.

Is he a Governor who vetoed multiple and various efforts at state health care reform, attacked the federal law, eliminated dental, vision and other benefits for millions of Californians, starved our health system of revenues and threatened to further slash the coverage of millions of low-income children and families and fully eliminate our Healthy Families program? Or is he the Governor who signed some key consumer protections, led a bold effort at state health reform, which in turn helped spurred the historic health law that he embraced, and who has laid the foundation for its successful implementation despite opposition from his own party?

Amazingly and surprising, both descriptions are true.

The common headline being used for Schwarzenegger’s tenure is “moderate” or “mixed,” but that simply doesn’t describe it. The words doesn’t been to describe how wildly inconsistent–even iconoclastic–the Governor has been, in proposing the unthinkable, both for good and for bad.

He didn’t come in with a specific agenda on health care. His only mention of health issues in his recall campaign was in his only debate appearance, where he expressed support for the Healthy Families program that covers low-income children. Yet his very first budget proposed to slash the program–something the Democratic legislature rejected, in what became a pattern throughout his tenure.

He said he would not be beholden to special-interest money, yet became the largest recipient of contributions from the pharmaceutical industry, along with other corporate interests. He vetoed several bills opposed by drug companies, but after a $80 million-dollar ballot initiative fight over a prescription drug discount program, he eventually agreed to a compromise program that did accept the notion that the government should be allowed to negotiate for the best possible prices. This was a bill that he highlighted along with global warming and the minimum wage as his new “post-partisan” path when seeking re-election in 2006. Yet the discount program has yet to be implemented due to lack of start-up money because of the budget crisis.

On consumer protections, he has been mixed–we at Health Access California was pleased that he signed key patient protections for the uninsured, limiting what they can be charged by hospitals and emergency room doctors. Yet he has also vetoed many good bills over the years.

For a majority of his term, Governor Schwarzenegger was an obstacle to reform. In 2004, he campaigned against Prop 72, an expansion of employer-based health coverage, and probably was a deciding factor for the initiative, which got 49.2% of the vote, not passing. In 2005, he vetoed AB772(Chan) to provide universal coverage for children. In 2006, he vetoed the framework SB840 (Kuehl) of a single-payer health care system.

To his credit, after saying No, No, No to various reforms, in 2007 he put forward a health reform plan to which he could say “yes.” And to his credit, it was bold, and took ideas from proposals he had previously opposed, including placing regulations on insurers and requirements on employers, who had been key allies of his.

Yet the same disregard for public opinion that gave him the freedom to be a Republican making a major push for health reform also meant that that he was long resistant to compromise in a way that would be acceptable to Democratic legislators–or to address a regular voter’s concerns about affordability. A decent compromise was struck, but not without a split in the coalition for reform, and the budget crisis looming, and the clock ultimately running out.

And the budget is where any assessment of Governor Schwarzenegger’s legacy begins and ends. Under his rule, California eliminated basic benefits for literally millions of Californians–including dental, vision, psychology, and more. While rejected, he proposed far more severe cuts–ones that would have denied coverage altogether for millions of California children and families–and so-called “reforms” that would handcuff our states’ ability to invest in our future.

His solutions didn’t solve the problem: he leaves with a $26 billion hole for the next Governor to address. While faced with a structural deficit to begin with, and later an economic crisis, this Governor actively made the problem worse. His first act as Governor was to cut the “car tax”–the vehicle license fee, which provided billions of dollars a year in revenues to the state. That one act–the reduction of revenues, as well as the resulting debt service–forced additional cuts to health, education, and other vital services that have been made–or that still are to come. To the extent that the Governor reluctantly supported revenues once in 2009, those were temporary, and their expiration leaves the state in another, deeper hole starting next year.

Assessing the state of health care from when he started his tenure to today, it’s hard to conclude things are better off because of the cuts, and the continuing looming budget crisis. The vehicle license fee reduction, and its destabilizing impact on our budget, is the original sin that was never atoned. It colors his health care legacy, and his Governorship, negatively.

To the extent there is optimism in the health care arena in California, it comes from the passage of the federal Affordable Care Act. Governor Schwarzenegger’s earlier push helped create political momentum for reform, and the federal law does mirror the California proposal in several respects. Consistently inconsistent, he both gave statements of support for the push for federal reform, then emerged as a critic earlier this year in his State of the State. But after its passage, he embraced the reform, took credit for many of its ideas, and pledged to implement it successfully in California.

Of the bills on his desk in September to implement and improve upon federal health reform, he signed half of them–7 of 14, and vetoed others–including good bills on standardizing the market, requiring maternity and mental health coverage, and foster a public health insurance option.

But some of his signatures are of nationally significant bills, including the first-in-the-nation legislation to set up an health insurance exchange under federal reform; a bill to ensure insurers to cover children with pre-existing conditions, and to limit how much they are charged; and legislation implementing a Medicaid waiver that allows for early expansion of coverage to low-income adults, as a “bridge to health reform.” While he could have done more, he has put California is a good position to take advantage of the new federal health law, as it starts to roll out in the next several years. His new appointments to the Exchange–Kim Belshe and Susan Kennedy–will mean his record on health has yet to be completed.

In fact, Governor Schwarzenegger’s legacy is in the hands Governor-elect Jerry Brown.

Brown will decide if California makes the most of the opportunities under the new federal health law, building upon the foundation that Governor Schwarzenegger set.

And most of all, our new Governor has the massive undertaking of dealing with our budget crisis, and digging out from the additional hole created by his predecessors. He will see if California makes the cuts that Governor Schwarzenegger set in motion with his budget policies, or if he can win a balanced solution that deals with the deficit while preserving the health system on which we all rely. The stakes are higher than ever.

Health Access California promotes quality, affordable health care for all Californians.

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