HEALTH ACCESS UPDATE
Monday, November 15, 2004
GOVERNOR SCHWARZENEGGER’S FIRST YEAR: REACTION AND INACTION
- Consistent Record Against Health Care Consumer Interests
- Budget Cut Proposals, Legislative Vetoes, Proposition Positions
- Most Glaring Omission: Lack of Proposaled Solutions on Uninsured, ER Closures, Etc.
In his first year in office, Governor Arnold Schwarzenegger has taken a consistent position against health care consumers and their access to health care. This has included proposing severe cuts to limit care and coverage to children and people with disabilities, vetoing health care consumer legislation, and campaigning against important health care propositions. His biggest fault is his lack of any plan or proposal to address the ongoing health care crisis in California. However, voters and legislators are parting ways with Governor Schwarzenegger on health care issues, and this could be a major political liability into the future.
THE CAMPAIGN: When he was first elected to his position a year ago, Governor Schwarzenegger was a complete enigma on health care issues. He never voluntarily raised the issue in his campaign during the recall election, and had no previous record or statements on health issues to figure out his positions.
His one major statement was during the one debate he participated in, where he stated, “we have to make sure that every child in California is insured. That is the most important thing.” He promised to use his salesmanship abilities to help enroll more children in the Healthy Families program. Other than that, he made few other comments on health care, focusing on other issues.
BUDGET: Directly contrary to his debate statement, the Governor’s first budget proposal was to cap enrollment in the Healthy Families program, as well other programs for children and people with disabilities, which would have denied care to hundreds of thousands of Californians. He also proposed major cuts to Medi-Cal provider rates, which would have further reduced access to care. After those proposals were rejected by legislators and analysts, he withdrew the proposals in his May Revision of the budget. These proposals could return in some form, given the continuing size of the budget deficit.
He has proposed a sweeping “redesign” of the Medi-Cal program, intended not to expand coverage but to yield budget savings. Most of the proposals discussed as part of this design would serve to restrict access to care for the over six million children, seniors, and people with disabilities that have Medi-Cal coverage. The proposal’s release was delayed until January, as is the Governor’s consideration of several recommendations from his California Performance Review, which also are of concern to health advocates.
LEGISLATION: The Governor was sent numerous bills on health policy, and he consistently vetoed bills that would assist health care consumers. With his vetoes, he stopped reforms that would prevent bad business practices by various elements of health care industry. The vetoes thus allow drug companies to price-gouge, HMOs to deny maternity coverage, and hospitals to overcharge uninsured families and use aggressive billing and collection techniques. He also vetoed legislation to require community notification in the event of hospital and emergency room closures.
The most high-profile issue was on prescription drugs, where the Governor vetoed four bills that would have facilitated the re-importation of prescription drugs from Canada, to help reduce the cost of these needed treatments for seniors, the uninsured, and others that don’t have pharmaceutical coverage. He opposed these bills, even through elected officials of both political parties had supported them in other states, and the drug companies seemingly rejected his attempts to support a compromise solution.
Ironically, many of the Democratic legislators that he opposed in the campaign used the prescription drug issue to successfully gain voter support, and to successfully counter the Governor’s opposition.
ADMINISTRATIVE OVERSIGHT: When faced with considering a merger that would create the largest health insurer in the nation, the Governor’s Department of Managed Health Care didn’t have an open process. In fact, it was only after protest from the state legislature and consumer groups that the Department even held a public hearing on the merger of Anthem and Wellpoint, which owns Blue Cross of California. When the deadline came, the Department approved the merger, despite concerns about its impact, while independently-elected Insurance Commissioner John Garamendi rejected it. Garamendi eventually gave the green light after further negotiations yielded more consumer protections and benefits for California patients. Despite the fact that he only had authority over a small portion of the deal, Garamendi got a better deal out of the insurers than Schwarzenegger. In another indication of the administration granting the wishes of HMOs, the Department has also approved insurance companies’ requests for high-deductible health plans.
PROPOSITIONS: The Governor campaigned against several health care measures, including a bond for children’s hospitals and two that would generate new revenues to fund mental health services and emergency rooms, respectively. The only health care measure he supported was a bond for stem cell research supported by major biotechnology firms.
In a related issue, he supported Proposition 64, supported by a full range of corporate interests including HMOs, health plans, hospitals, and drug companies. With its passage, Proposition 64 will now restrict the ability of consumer and advocacy groups to sue to enforce public health, environmental, and consumer protections.
Most troublesome was his opposition to Proposition 72, a measure already passed by the legislature to protect the coverage that millions of Californians get on the job, and to ensure that large employers like Wal-Mart and McDonald’s pay for the coverage of their workers, so those health care costs are not burdened on taxpayers or a fragile health system. Voters broke with the Governor to support the millionaire’s tax for mental health services, and on the children’s hospital bond. And despite a $16 million opposition campaign and the Governor’s opposition, over 5 million Californians (49%) voted for Proposition 72.
LACK OF ACTION: Beyond these actions against the interests of health care consumers, Governor Schwarzenegger’s biggest fault has been his general lack of attention or priority to improving access to health care. As hospitals and emergency rooms close up and down the state, as California continues to have one of the worst percentage of uninsured and that number grows, and as the health system seems ready to collapse, the need for health reform is alarming. Yet Governor Schwarzenegger may be the only elected leader in the country without a health care plan or agenda.
In opposing Proposition 72, Governor Schwarzenegger opposed the only solution that was on the ballot, and has yet to propose anything as an alternative, or even pretend to address the problem. To the extent he has proposals that will be unveiled, they would serve to restrict access to care, rather than expand it.
The recent election results of both the state legislature and the initiatives indicate that Governor Schwarzenegger is no longer the “people’s governor” with regard to health care issues. Before his problem on health policy becomes a problem for his political health, the Governor would do well to change direction and support rather than undermine access to health care, by spearheading efforts to expand coverage for children, or for those workers at the malls and restaurants where he frequently campaigns.