POST-ELECTION OUTLOOK ON HEALTH REFORM
- Prop 86 Defeated in Close Vote In Face of Massive Spending by Big Tobacco
- Gov. Schwarzenegger, Commissioner Poizner; Other State Offices Go Dem
- Major Health Debate Expected, With Similar Margins for Dem Legislature
- Dramatic Change Nationally with Democratic Takeover in House & Senate
- Medicare Part D Fixes; Children’s Coverage Funding on National Agenda
- Expanded Health Access Blog for an Expanded Discussion on Health Reform
The 2006 election results dramatically impact the prospects for change in health policy, with many new opportunities, particularly at the national level.
The question on the ballot most directly dealing with the issue of access to health care was Proposition 86, a $2.60 tobacco tax that would have raised significant funding for emergency rooms, expanded children’s coverage, anti-smoking activities, medical research, and other health programs.
CLOSE VOTE: Prop 86 received 48% of the vote, making it the closest statewide contest of the night, despite over $60 million spent by tobacco companies against the measure. On Proposition 86, health advocates can correctly point out that not only did the tobacco companies needed to spend eye-popping amounts in order to beat the measure by such a small margin, but the campaign was waged on issues unrelated to the provisions around expanding access.
The measure started with significant support, particularly as a way to discourage smoking and save lives. The tobacco companies successfully were able to spotlight specific provisions in the initiative included by the hospital industry, and thus reframed the debate as merely one special interest fighting another. A tobacco tax measure was also defeated in Missouri , but another passed in South Dakota.
CHILDREN’S COVERAGE CAMPAIGN CONTINUES: Especially given that the campaign did not focus on universal children’s coverage or the broad issue of access to health care, the result should not change the momentum for those goals. In past years, health advocates have had initiatives on both HMO reform and prescription drug prices go down to defeat on the ballot, only to win those issues subsequently in the legislature. Expanding coverage for all children is likely to appear next year as part of the broad statewide debate on health reform.
Governor Schwarzenegger was opposed to Prop 86, despite his many statements in support of expanding coverage for all children. The passage of Prop 86 would have helped him meet this promise, and yet his position and the outcome now places him in a more difficult position of having to find another way to meet this outstanding commitment.
OTHER MEASURES: Another watched ballot measure on health-related matters, Proposition 85, which would have required parental notification and thus impacted access to abortion for teenagers, also was defeated. This was a victory for Planned Parenthood and several other groups, as it was with last year’s Proposition 73. The campaign finance measure Proposition 89, sponsored by the California Nurses Association, was also defeated. In other state news on initiatives, proposals for a “taxpayer bill of rights” to restrict spending for health and other services were defeated in Maine , Oregon , and Nebraska .
The wide margin for the re-election of Governor Arnold Schwarzenegger was widely predicted, but what was noteworthy about the gubernatorial race was that both major candidates made health care an important part of their platforms, promising major action next year.
HEALTH CARE AS NEXT YEAR’S FOCUS: Governor Schwarzenegger has said that next year will be focused on “health care, health care, health care,” and that he will present a major health reform plan in his January 2006 State of the State. This goal was set during a health care summit that he held this past summer; and was reinforced in his campaign commercials—which placed health care as a top issue, along with education and the environment. The Governor’s campaign commercials even chastised his opponent on health care issues. For a Governor that rarely talked about health issues in the beginning of his term, 2006 was a year that he prioritized the issue.
What the campaign did not reveal was what Governor Schwarzenegger would do on health care. His statements were vague, talking about “affordability, shared responsibility, and the promotion of healthy living,” even while opposing proposals that seemed to meet those goals, such as Senator Kuehl’s SB840 universal health care bill. Future updates will go into more detail about what we might expect from the Governor. While his proposal won’t be the only one, it will be an indication of the parameters of the health care debate California is about to have.
Next year’s health care debate will include many proposals and many players, most notably many members of the newly re-elected Democratic Legislature, led by Speaker Fabian Nunez and Senate President Pro Tem Don Perata. The Democrats maintained strong majorities in the Assembly and Senate, and any health care reform will need to go through the legislative process.
SIMILAR BREAKDOWN, NEW FACES: The partisan breakdown has not changed in the Assembly, with 48 Democrats and 32 Republicans, despite close races in Kern and Imperial counties. However, because of term limits, nearly half—36—of the Assemblymembers will be new to the Assembly, which provides a challenge for health advocates to educate them about the specifics of health policy and work with them on health reform.
The Senate is likely to have a similar breakdown as last session, 25-15, with the possibility of the Republicans picking up one seat. Republican Lynn Daucher is leading Democrat Lou Correa by a handful of votes, with a recount likely. While there are many new Senators as well, many are legislative veterans; Democratic Los Angeles councilman Alex Padilla is the only Senator-elect without Assembly experience.
Some of the most active legislators on health care issues were termed out, such as Assemblymembers Chan, Chu , Cohn, and Frommer, and Senators Ortiz, Speier, and Chesbro, but others remain, such as Assemblymembers Dymally, De La Torre and Laird, and Senators Kuehl and Ducheny.
Governor Schwarzenegger’s landslide victory did not seem to indicate any coattails, as Democrats won tight contests for Secretary of State, Controller, and in particular Lieutenant Governor, which was won by Insurance Commissioner John Garamendi, long-time advocate on health care issues, who is likely to continue to be active in the issue.
NEW INSURANCE COMMISSIONER: Replacing Garamendi will be Steve Poizner, a multi-millionaire businessman and the only other Republican besides the Governor to win statewide. While most Californians are covered under plans regulated by the Department of Managed Health Care rather than the Department of Insurance, the Insurance Commissioner does have authority over some health insurers, and so is relevant in health policy. For example, Garamendi is finishing up regulations on ensuring that certain amount of premiums go to medical care, and that language access to care is provided. Poizner has no previous experience in elected office, and so there is no record to go by to know what to expect of his tenure.
OTHER GOVERNORS: California ’s debate on health care reform will also be informed by what goes on in other states. It was noteworthy that Governors that took on health reform, including Gov. John Baldacci (D) in Maine , and Gov. Rod Blagojevich (D) in Illinois , were re-elected. The much-discussed reform in Massachussetts, which left much to implementation, will have much of that implementation done under a new Governor, Democrat Deval Patrick. This may change the nature of that reform from the characterization by Governor Romney (R), who was not up for re-election. Finally, many new Governors made health care reform a major priority, suggesting that California ’s health care debate will take place with efforts in other states.
The biggest national news is the change of the U.S. House of Representatives and probably the Senate as well in Democratic control, new opportunities open up with regard to the national debate on health care. The most immediate changes in national health policy is likely to be on changes to Medicare Part D, and the reauthorization of the State Child Health Insurance Program, but it has implications for broader reform, and the 2008 presidential election.
NEW DEMOCRATIC MAJORITIES: As of this writing, Democrats are likely to have at least 229 seats in the House of Representatives and maybe as many as 234, more than the 218 needed for a majority. This includes one change in California , with Jerry McNerney (D) defeating Rep. Richard Pombo (R) in Northern California .
In the Senate, Democrats held onto seats in New Jersey , Maryland , Washington , and Minnesota and other states, while picking up seats in Pennsylvania , Ohio , Rhode Island , Montana , Missouri . If Democrats maintain their lead in Virginia , they will have the 51 votes to be in the majority.
NEW CALIFORNIA LEADERS: The new majorities will bring new California Representatives into key positions to impact health reform. First and foremost is Rep. Nancy Pelosi, who is expected to become Speaker of the House, third in line in presidential succession. Longtime leaders on health issues Rep. Pete Stark and Rep. Henry Waxman, both of California, are in line to chair vital committees, and to thus put forward proposals and shape the national conversation on health policy.
HEALTH CARE AS AN ISSUE: After corruption, Iraq , and the economy, health care was in the mix of issues in the national Congressional elections. The controversial structure of Medicare Part D and prescription drug prices was a big part of specific races, such as those that led to the defeat of Reps. Nancy Johnson (R-CT) and Clay Shaw (R-FL).
MEDICARE PART D: In their campaign document “A New Direction for America ,” the Democratic congressional campaign pledged “Six in ‘06”, six measures to pass immediately: one of those plank was: “Affordable Health Care: Life Saving Medicine. Fix the Medicare prescription drug benefit by putting seniors first by negotiating lower drug prices and ending wasteful giveaways to drug companies and HMOs.” Pelosi has stated that changes to the Medicare Part D law, including allowing the government to negotiate for lower prescription drug prices, would be a top priority for passage in the first 100 hours of her Speakership.
CHILDREN’S COVERAGE: Another issue slated to come up is the reauthorization of the State Child Health Insurance Program (SCHIP), which provide around 2/3 of the funding for California ’s Healthy Families program. Health advocates have been concerned if the renewal of SCHIP will provide sufficient funds for the ongoing growth of programs like Healthy Families. This will be a major focus for health advocates nationally, even in the new political environment.
BAD ITEMS TABLED?: The most meaningful change for the new majorities is not what might get passed, but what doesn’t. The margins in the House and Senate are thin, and President Bush would still have the authority to veto proposals. However, the switch in power in Congress makes it less likely to see proposals that were slated to come up, and that were debated in the last few years. This includes proposals to cap, block-grant, or privatize the Medicaid or Medicare programs; tax cuts that would further pressure cuts in the health and other vital services; or legislation to pre-empt state consumer protections, or encourage high-deductible health plans. All these ideas were clearly on the agenda in Congress before the power shift, and their prospects have decreased, even though health advocates need to continue to be vigilant.
SETTING THE 2008 AGENDA: While having a majority in the House and Senate does not automatically translate to passing legislation, it does allow political leaders to help set an agenda, to hold hearings, to develop proposals. While major health reform is not likely for the immediate future, it allows the new party in power to float ideas, in time for the 2008 presidential campaign. After years when major expansions of health coverage were only discussed at the state level, in California and a handful of other states, we can expect that there will be a new conversation nationally on health reform.
This election dramatically sets the landscape for a major discussion of health reform, both statewide and nationally. Health Access California looks forward to the debate. As part of this effort, we are expanding the blog on the Health Access website to include more daily, real-time updates about health reform, in addition to the regular E-mail Health Access Updates that have been archived there for the past several years.
For those who want the latest on the health care debate in Sacramento and around California , visit the Health Access blog at: