Tuesday, December 28th, 2004


  • Continuing advocacy needed over health impact of budget cuts, Medi-Cal redesign, CPR
  • Multiple proposals on health coverage expansion expected next year
  • Renewed efforts on single-payer, employer responsibility, and children’s health programs
  • New interest on individual mandates for health coverage

The new year brings new political debates over health care programs and policies, that bring both promise and peril to California health care consumers, the insured and the uninsured.

BUDGET CUTS COMING: Governor Arnold Schwarzenegger is expected to give his State of the State address on Wednesday, January 5th, and then release his budget on Monday, January 10th. There have been unconfirmed rumours that the budget might be released earlier. With a continuing deficit projected to be over $8 billion, the proposed budget will be painful, and Administration officials in the Health and Human Services department have warned of serious cuts.

The Governor was to announce his plans for “Medi-Cal redesign” and his proposals under the “California Performace Review (CPR)” as part of the budget. However, recent statements have suggested that the Governor will not directly incorporate these proposals into his budget announcement for January 10th, but that they will be released soon afterwards. Finance Director Tom Campbell and others indicated that the Governor may announce some details of the proposals, but that their financial impact would not be incorporated into the proposed January budget. Health advocates have been very concerned about the Medi-Cal redesign’s attempt to place additional costs on Medi-Cal patients, and shift seniors and people with disabilities into managed care. The continuing delay has been around another area of significant concern, on hospital financing. Consumer advocates also had specific concerns about many of the policy and restructuring proposals in the CPR. While the budget cuts, Medi-Cal redesign, and CPR are all related in that they are the Administration’s attempts to seek to save mone–often by restricting access to care, these proposals seem to be proceeding along parallel tracks at this time.

HEALTH COVERAGE EXPANSION: For advocates who support expanding health coverage to the uninsured, there might be an opportunity to move the debate forward, building on the conversation from SB2/Proposition 72 and other efforts in the past few years.

For 2005-06, the policy conversation in Sacramento seems to resemble that of two years ago, with multiple proposals by different legislators and various interest groups. We may very well have five or six major proposals to expand health coverage in the legislature, and one or two may go to the ballot.

However, as opposed to general concepts of two years ago, the policy discussion will be more specific and sophisticated. As advocates and other interested parties have been through this discussion once, we all know what questions to ask, and a better sense of what our basic principles are. The continuing health care crisis, with more people uninsured and high-profile hospital closures up and down the state, as well as the closeness of the Prop 72 vote, will add urgency to this debate. On a cautionary note, the overall political environment means there will be more conservative proposals, advanced by the President, the Governor, and other sources. Consumer health advocates will be forced to spend more time raising concerns, about mandatory catastrophic or high deductible coverage.

But at this point, we know:

  • Supporters of SB 2 and Proposition 72, after seeing the closeness of the vote, are exploring re-introducing a similar measure to set a level playing field for employer responsibility to the health of their workers, that sets a basic standard for on-the-job health benefits. This could be either as legislation or a future ballot measure.
  • Senator Sheila Kuehl will re-submit her ambitious proposal for universal, single-payer health coverage for all Californians, which got considerable enthusiasm from many grassroots organizations in the last two years as SB921. The new version will include more details on not only health care quality, but the financing mechanism for the system.
  • A major effort seeks to expand coverage for all children, led by the 100% Campaign and PICO California, building on the county initiatives that have a proven track record and have already-developed constituencies.
  • There still is the pending Healthy Families parent waiver, which needs a relatively small amount of funding in order to extend coverage to up to 300,000 parents. Some groups are actively looking to re-propose this, as well as expand the income threshold for children in the Healthy Families program.
  • Speaker Fabian Nunez has decided to make health care a major priority of his caucus, both in the budget, and in policy. He is likely to be active on the issue of hospital closures in Los Angeles and statewide, and in looking for ways to maintain and strengthen the safety net, as well as ways to expand coverage.
  • Other policymakers and elected leaders are convening meetings to generate ideas and come up with proposals, including Insurance Commissioner John Garamendi, Senator Jackie Speier, and Assemblyman Dario Frommer. Others who will be active in the debate are the chairs of the health policy committees, Senator Deborah Ortiz and Assemblywoman Wilma Chan.
  • Several proposals may introduce the notion of mandating individuals to get coverage. The California Medical Association has floated one proposal; Assemblymen Keith Richman and Joe Nation have talked about the concept and plan to introduce legislation in town halls; and Governor Schwarzenegger has mentioned publicly, two or three times now, the notion that if people have to buy car insurance, they should also be require to carry health insurance.

INTEREST IN INDIVIDUAL MANDATES: Having been conspicuously silent to date on his ideas for health reform as hospitals close and the situation gets worse, Governor Schwarzenegger is said to be looking at possible solutions, including supporting tax credits, a Healthy Families expansion, and/or some form of individual mandate. Members of his Administration are looking at a policy proposal by the New American Foundation, a Washington, D.C., think tank, around “universal responsibility.” The executive summary of this proposal is at their website, at:

The vast majority of uninsured are not offered health coverage on the job, and find individually-purchased health insurance either unavailable or affordable. An individual mandate thus seems to solve the wrong problem. The individual mandate does not address the barriers of affordability and accessibility in the individual insurance market, and any proposal would need to include significant regulatory oversight and new consumer protections, and substantial subsidies in order to work. Health Access California and other consumer groups would be opposed to any proposal that would serve to criminalize the act of getting care, which would seem to be the only way to enforce such an individual mandate. In contrast, health advocates have not opposed requiring individual participation in social insurance system, like Medicare. For a two-page brief on Health Access California’s concerns with individual mandates, go to our website at:

WHAT WORKS IN HEALTH: The debate on health reform is alive and well. Health consumer groups will once again have the opportunity to support multiple proposals to expand coverage, with the advocacy for each proposal hopefully complementing and supporting the efforts behind other worthy proposals. At the same time, there will be a new challenge in opposing other proposals that would be ineffective in expanding coverage or violate key principles. Fundamentally, the health policy approaches that work are those that pool people together to share risk, either in a community or at the worksite, rather than those proposals that encourage people to risk it alone in the marketplace. Of 35 million Californians, over 18 million get coverage through an employer; over 10 million get coverage through a public insurance program. Alternatively, less than 2 million get coverage in the individual insurance market. We want to expand on the solutions that work, not the ones that don’t.

For more background, link to this Los Angeles Times story last week that began to describe this upcoming debate in California:,1,4355249.story

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