The Fateful Vote

Tuesday, January 29th, 2008

* Sen. Perata withdraws support for AB x1 1; Senators cite budget shortfall, LAO report
* Sen. Mark Ridley-Thomas casts the only “aye” vote in committee for ABx1 1
* Speaker, lawmakers urge efforts on health reform to continue
* ACTION ALERT: Call your Senator to express dismay at health reform failure!

New on the Health Access WeBlog: Much More on Senate Health Committee Vote, Commentary on California’s Impact on Other States; Editorial Boards on AB x1 1; Mailers by Tobacco and Big Business; Health Wonk Review; Single-Payer Supporters for Strategic Steps

The Senate Health Committee on Monday failed to pass ABx1 1, which garnered one “aye’’ vote and seven “no’’ votes. Three Democrats abstained while three voted against the measure. Speaker Fabian Nunez declined to have the bill reconsidered saying he “got the message,’’ but issued a challenge to his colleagues:

“I would challenge members of the Senate to come up with a plan that stands up to the same kind of scrutiny and analysis, is doable, and is going to respond to the needs of those families that don’t have health care today,” he said.

The only yes vote for ABx1 1 on Senate Health Committee came from Sen. Mark Ridley-Thomas, who said, “I remain persuaded there is something to be embraced here, by the range of advocates and sponsors who are diverse in their own rights. This doesn’t suggest there isn’t more work to do.’’

ALERT: Call Your Senator TODAY to express your disappointment at the Senate’s failure to come to agreement on health reform; and to urge them to take leadership on health reforms and expansions.

The phone numbers for Senator’s Sacramento offices are available on the California Senate website, at:

THE BILL: ABx1 1 would have expanded health coverage to approximately 3.6 million Californians who currently do not have health insurance. All told 95 percent of Californians would have had health coverage through the bill, which would have also required businesses to contribute to worker health care, required most Californians to have coverage, and made various reforms to the insurance market – including a prohibition on the practice of denying enrollees based on “pre-existing conditions.’’

It would have raised nearly $15 billion in tobacco taxes, employer contributions, hospital fees and federal funds to pay for it. (Follow the links to read Health Access’ Fact Sheet and analysis of Who Gets Help through AB x1 1.)

The failure of AB x1 1 leads Sacramento policymakers into a second year of the Year of Health Reform, which will likely be overshadowed – if not eclipsed – by the state’s staggering $14.5 billion budget deficit and cash flow problems.


In 45 minutes, senators gave wide ranging reasons for why they could not support ABx1 1, including some statements that proponents believed were misrepresentations of the bill. The Sacramento Bee’s Capitol Alert has the most detailed reporting of the Senators’ statements at the hearing. Beneath the commentary and criticism were common themes.:

The economy and budget situation: A worsening economy, combined with the state budget deficit of $14 billion, would make passage of the bill seem imprudent. In the wake of the Legislative Analyst’s Office’s report outlining the potential risk of shortfalls in the program in later years, senators said they felt uncomfortable approving legislation that could put the state’s budget further at risk.

Question marks and readiness: Some questions regarding the health reform plan’s implementation were unanswerable at this moment – from the cost of premiums, to federal matching funds, to the makeup of the minimum credible coverage. Lawmakers saw those question marks as too risky to proceed.

Process and timing: Other senators felt pressured to act on deadline, and felt restrained by the November 2008 ballot initiative that was tied to ABx1 1 – as is. That meant making amendments to the bill, which senators thought were important, were impossible.

The Senate’s concerns about ABx1 1 are outlined in this letter sent by Senate President Perata to Gov. Schwarzenegger and Speaker Nunez.


Sen. Darrell Steinberg, and two others elected to abstain on the measure, rather than vote against Ab x1 1. Steinberg, said, in spite of ABx1 1 incompleteness, “It’s not deserving of outright rejection …We should continue to work on it.’’

No matter their stance on ABx1 1, the bill’s failure on Monday many lawmakers and advocates insisted that it did not mean the death of health reform at large, echoing the sentiments of Senate President Perata, who said “More is yet to come, no one has lost heart,’’ who spoke at a press conference after the vote.

Perata, for his part, said he would not call the bill’s “a failure,’’ saying it took nearly a decade to get significantly less complicated reform–such as motorcycle helmet laws–passed. “I believe we got as far as we could get this year.’’

Even though the Year of Health Reform had captured the attention of political leaders in 2007, this was not the first year of health reform. In the past five years, other major expansions of health coverage have stalled, but efforts have continued:

* In 2003, then-Gov. Gray Davis signed SB2, a pay-or-play required employer contribution, which was subsequently repealed in a narrow 2004 vote (Prop.72).
* In 2005, AB772 (Chan), which would have guaranteed all California children coverage, but was vetoed by Governor Schwarzenegger. A similar measure was part of the tobacco tax in Prop 86 in 2006, which was narrowly defeated.
* In 2006, Gov. Schwarzenegger vetoed SB840 (Kuehl), which would have created the framework (but without the financing) for a universal single-payer system.
* In 2007, AB8 (Nunez/Perata) passsed the legislature. Governor Schwazenegger vetoed it, but negotiated with Speaker Nunez, and eventually supported a new version, AB x1 1 in 2008 (Nunez).

Perata said he hoped lawmakers would continue to work on elements of ABx1 1 that were “small but important,’’ and “yielded’’ health reform discussions to Speaker Nunez. While advocates expressed their commitment to continued efforts at health reform, the prospects are tough.

Many of the elements of health reform, including any expansion of coverage, would require new revenues, especially in light of the budget crisis. The action of the Senate effectively ended the effort around the ballot measure, that would have raised the bulk of $15 billion for coverage expansions. Instead, there is $0 of new dollars, in a budget-cutting environment.

Senate President Pro Tem Perata was clear that his attention was moving on to this year’s budget crisis, which looks to be more dire than those in years past, as Perata presaged. “I believe our attention will soon be turned to see how the state does not go insolvent in March and how we forestall serious problems if we do not pass a budget by July,’’ he said.

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