Update: Speaker Nunez’s Proposal…



  • “Pay-or-play’’ model, with employer and employee buy-in required
  • Focus on covering *all* children; affordability for workers
  • Individual market oversight and reforms; benefit package uniformity and cost containment

New on the Health Access blog: New Senate chairs; Defending the young; New studies, etc.

It may be the holiday season for most of California, but Sacramento is working away on the health care debate. Governor Arnold Schwarzenegger had press events on Monday and Wednesday to discuss health care issues, not revealing anything about his plans but setting the stage for his State of the State on January 9th. The video of these events are available at the Governor’s website, at:

Today, Assembly Speaker Fabian Nunez unveiled an outline for his health care proposal. The proposal, called “Fair Share Health Care,’’ views our health care system as “a three-legged stool,” with employers, workers and government all supporting the load.

While the language still has not been drafted, health advocates appreciated the framework proposed, including:

  • Building on the existing system of employer-based coverage;
  • Insisting on affordability for working families;
  • Expanding public programs, including a focus on covering *all* children;
  • Reforming the insurance market, which would make it harder for insurers to deny coverage based minor pre-existing conditions.

Nunez’s announcement comes a week after Senate President Pro Tem Don Perata unveiled broad concepts for his plan. There are some common elements, most notably the requirement on employers to provide coverage for their workers, or pay into a purchasing pool. Workers would be required to participate in the employer’s plan, but there is no overall individual mandate, enforced through the tax code–a major difference with Perata’s approach. “I don’t like the concept of an individual mandate, I want a fair share approach. Everyone has an obligation, a responsibility to be a part,” said Nunez.

While his plan isn’t the single-payer approach, which Sen. Sheila Kuehl is expected to reintroduce this year, Nunez referenced he supported the bill this past year. But the reality, he said, is that most Californians receive insurance through their workplace and don’t want to disturb that. “You cannot overlook the fact that 71 percent of employers already offer health insurance to their employees…” He also cited the politics. “Clearly, single-payer is something that Governor Schwarzenegger will never support.”

Instead, Nunez said, he preferred to focus on pieces that are broken – the high cost , and the uninsured population–“bringing them into the system.”


What Nunez emphasized most in his Thursday morning press conference to Capitol reporters that covering all children was his top priority, saying “When it comes to children, the only document I care about is a clean bill of health.’’ By July 1, 2008, Nunez’ plan calls for covering all children in families at or below 300% FPL ($60,000 for a family of four.) “Diseases don’t discriminate, and neither should we.”
While Nunez has not spoken with Gov. Arnold Schwarzenegger directly about his plan, he believes “we are moving in the right direction. We have a lot of common ground,’’ including, the desire to cover all children.
“That’s one thing I’m not walking away from,’’ said Nunez. he also outlined a broader commitment to expand public programs to parents and adults without children at home.


Health Access is still reviewing the proposal to provide analysis in the coming week. There are many elements that the consumer, health and community groups have supported in the past – including an employer mandate, limits on health costs for workers and universal children’s coverage.

It’s unclear, at this point, how much Nunez’ plan would cost. The speaker did not have an estimate, but argued that various elements could save general fund dollars.

Here’s the outline of his plan, to be dropped into his reform bill AB8(Nunez):

PAY-OR-PLAY: Employer Mandate

  • Employer mandate. Pay for coverage or pay a fee, based on a “fair share” percentage of payroll. Exemption for small businesses with fewer than two workers and less than a $100,000 payroll.
  • Worker responsibility to accept health insurance when it’s offered – as long as it does not exceed a “reasonable percentage’’ of their income. (This would catch 87,000 of California ’s 6.6 million uninsured — making more than $60,000 for a family of four – who are declining coverage that they’re offered. The rest are either not offered, not eligible or too poor to get benefits.)
  • State purchasing pool. Creation of a California Cooperative Health Insurance Purchasing Program (Cal-CHIPP) through MRMIB to negotiate and purchase health insurance for businesses and employees who want to buy into this system.
  • Expansion of Medi-Cal and Healthy Families for those below 300% of poverty ($60,000 a year for a family of four.)


  • Standardizing applicant screening and placing oversight into what pre-existing conditions are used to deny people coverage.
  • A surcharge on health insurance premiums to provide coverage for people who are denied based on pre-existing conditions.
  • Uniform benefits making it easier for everyone to make apples-to-apples comparisons when shopping for coverage.


  • Ensuring coverage of preventive care and disease management
  • Moving toward electronic personal health record
  • Promotion of healthy lifestyles
Health Access California promotes quality, affordable health care for all Californians.
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