The number one question I get is whether there will be a deal on health care this legislative session. It has been the focus of big, front-page articles in the San Jose Mercury News and the Sacramento Bee–even the Washington Post, just in case we don’t think that the whole world is watching.
There are two answers. In the world of politics, I see the Governor threatening a veto of the Speaker’s bill; the Speaker threatening to place the Governor’s plan to a vote of almost certain defeat; and the Senate President Pro Tem expressing skepticism. Savvy Sacramento folks all think this is just positioning for final negotiations. What do I know?
In the world of policy, I see two plans that are more similar than different. They both include:
* a major expansion of coverage for more than two-thirds of the state’s uninsured
* a minimum employer contribution toward health care
* a requirement on most individuals to take up health coverage from employers
* major eligibility expansion of public insurance programs for children and parents
* significant streamlining of public insurance programs to maximize enrollment
* significant draw-down of federal Medicaid funds
* new use of federal and state tax breaks, though Section 125 plans, for health coverage
* limits on insurers denying people because of pre-existing conditions
* a minimum requirement on insurers to spend 85% of premium dollars on patient care
* various cost containment efforts, such as on information technology and disease management
In some cases, the proposals are very similar, if not the same. There are differences on some key details. And they matter, a lot. But looking at the policy, it’s hard to come away with the notion that a deal isn’t just possible, it’s likely.
Jon Myers at KQED’s Capitol Notes compares this to other “last-minute” deals, for good or ill, and I would argue that this is differnet–we have been having these health care debates for five years, where issues around expanding employer-based coverage, public insurance programs for children and adults, and other reform have been heavily vetted, in bill form and on the ballot.
The main question isn’t the policy. It’s back to the politics.