I typically write a Year in Review synopsis for Health Access California (see this one for 2006). But even on this last day of 2007, it’s too soon to assess the year.
In one way, this has been a banner year for the longstanding effort to expand coverage and reform.
* In California, “The Year of Health Reform” yielded a wide range of policy conversation on many health reform issues not discussed in over a decade, and the serious engagement of the Governor and legislative leaders–a rare combination.
* At the national level, health care emerged as the top domestic issue in the presidential campaign, with all the leading Democrats putting out ambitious yet credible plans for near-universal coverage expansions.
* The conversation has been broad as well–from the Its Our Healthcare! statewide campaign which helped coordinate a consumer campaign at a new level of activity and effectiveness, to the renewed attention to single-payer solutions through grassroots efforts and media. The policy conversation at the state and federal level yielded its own media, along with Michael Moore’s movie Sicko, renewed scrutiny of insurance company practices, and new reports on the problems with the “broken health care system.”
At the same time, none of this yielded an actual change in policy… yet. The negotiations between the Governor and Speaker yielded a groundbreaking reform proposal, but it still has to pass the Senate and the ballot. And any policy changes out of the presidential campaign won’t start at the earliest until a new President is sworn in in 2009.
At the same time, the changes that were made seems to take steps backward, or at least postpone the positive momentum.
* At the state level, budget cuts undid efforts to enroll eligible children in public coverage programs, and delayed the start of a prescription drug discount programs for the un- and under-insured. A looming budget deficit suggests far worse cuts are expected to be proposed.
* Regulations were finally approved at the Department of Insurance and Department of Managed Health Care on language access to care, but other regulatory proceedings are stalled or going backwards, especially on timely access to care.
* At the federal level, there was a brusing battle over SCHIP, the State Child Health Insurance Program, which did show strong bi-partisan support for the program, but a new polarization that led the President to twice veto a re-authorization bill. A bill was finally signed to extend the program only to March 2009.
So with health reform, the budget, the presidential elections, etc., the issue isn’t with 2007, but the real question is what 2008 will bring.
I think the analogy for health care consumers is a poker player, who doesn’t start off in a strong place, and as the hand continues sees his chips diminish even as the potential of the pot increases.
Next year could be the best of times, with a major health reform passed in California, new revenues supported to make it real and forestall bad budget cuts, and a new President committed to national reform… or the worst of times, with a bad budget deficit forcing bad cuts and choices, with a policy stalemate stopping hope for new revenues, or new reform efforts.