It was appropriate that in the gubernatorial debate in Fresno, where the uninsurance rate is among the highest in the nation, that the candidates were finally asked about health care issues. The differences were clear. Here’s the transcript from the Fresno debate, on both the health care and budget crises:
Maria Elena Salinas: THANK YOU BOTH. AND THE FOLLOWING QUESTION IS ALMOST 30 PERCENT OF HISPANICS IN CALIFORNIA DO NOT HAVE HEALTH INSURANCE. AS GOVERNOR WHAT CAN YOU DO TO FACILITATE ACCESS TO HEALTHCARE FOR MILLIONS OF PEOPLE WHO ARE POTENTIAL BURDEN ON STATE SERVICES. WE’LL BEGIN WITH MR. BROWN.
Jerry Brown: Well first of all I support President Obama’s health plan. I’d like to know if Ms. Whitman does that, because that’s the only game in town right now and while there’s some problems, like for example it needs more cost control, it is a framework to bring in children and to bring in people who have no other way of getting their health insurance. So that’s a very important part; working with the federal government to make that new national health plan work. That’s the path forward.
Secondly, we have a Medi-Cal program that has its own issues. I think we’ve got to save money in that program so we can continue to cover those at the lowest incomes and then finally we have to when we work in the state government as we cut the budget we make sure that we don’t cut the health programs in a way that will help so many families that are working in the public sector. And then finally we have these health exchanges that allow people to purchase health insurance.
And then at the end of the day of course it’s about jobs and it’s not just about jobs, it’s about jobs with good wages and we’ve got to be fair about this. Because in the last 20 years the income has been moving up to the highest sectors, the top one or two percent and those in the middle and much worse those towards the bottom they don’t have enough money even to do the basics which are healthcare. So I’m gonna be a champion for the working people of California and decent wages and good jobs.
Meg Whitman: Well healthcare is an enormous challenge in California and it’s driving up the cost of small business. I think I’ve run into so many small business people who have had to, you know, cut back on their health insurance or it really kept them from hiring more workers because health insurance had gotten so expensive.
The problem is Obamacare is going to make it worse for small businesses not better. There is a requirement for very expensive healthcare insurance on the behalf of small business. It’s going to create, every small business person I’ve talked to says, this is going to create a huge burden. So at a time when we need to make it easier for small businesses, we’re going to make it harder.
The other issue is it could put another $3 billion unfunded liability on California, meaning we’re going to owe $3 billion more when we already have a $20 billion budget deficit. So here’s what I’d do, first is if you want to bring down the cost of things in our society, the way you do it is open up some competition. We should open up California to more insurance competition so there’s more choices for people, more ability to buy plans. Second we should make sure that we eliminate the fraud in Medicare and Medi-Cal. Estimates are $3 billion to $5 billion of fraud in that system and that’s because we don’t use technology to do more with less. The computer system in the state of California belongs in a museum. I come from Silicon Valley and we can do a lot better and then we can use electronic medical records to make sure that we bring down the costs of healthcare for everyone which will allow us to cover more individuals and that’s the ultimate goal. But I don’t think Obamacare is the way to go because it’s going to hurt small business.
Here’s a few fact checks:
* When Attorney General Brown says that “Medi-Cal has its own issues,” one of those is that it currently is 51st in the nation in per patient spending. So it’s hard to see how you can find additional savings while keeping people covered, which he says he wants to do.
* When Meg Whitman says that the new federal health law will place a burden on small business, she’s wrong. In fact, what she calls “Obamacare” actually offers significant subsidies to specified small business with fewer than 50 employees. To the extent there is a requirement on employers afer 2014, it is on larger employers, to either offer a very basic level of coverage, or otherwise pay a contribution to help finance your workers getting subsidies through the new exchanges. But small businesses have no requirement, now or in 2014.
* Meg Whitman suggests health reform will cost the state $3 billion. In fact, it will provide over $100 billion in benefits to California (through Medicaid) and Californians (through the new exchange) to help afford coverage over 10 years. The $3 billion number came from Governor Schwarzenegger about an earlier version of health reform (and one that even then was significantly inflated); it improved and after it passed, Governor Schwarzenegger has embraced it, since he sees the opportunity it provides. What costs might be expected of the state? All the credits and subsidies in the exchange will be federally funded. The Medicaid expansion will be 100% federally funded from 2014-2017, and then would scale down to a still remarkable 90% federal share in 2020 and beyond.
* So the question for a prospective Governor Whitman is, if there is the potential of a cost to the state in 2020–one that would yield a 9-to-1 match from the federal goverment to cover a couple million more Californians–would she turn down the tens of billion of dollars during your tenure and deny millions of Californians coverage as a result? That’s the pending issues right now. Candidate Whitman has in the past suggested supporting lawsuits to repeal the new federal health law.
Would the new Governor implement reforms to maximize the benefits for California? Or will the new Governor seek to block efforts to implement and improve upon the law, and turn away the benefits of reform to Californians?