Mike Zapler of San Jose Mercury News has a downer of an article about the hurdles of winning health care reform on the ballot. He writes about the odds of any ballot measure, especially those with a funded opposition. The history on health reform isn’t pretty either. In the early 1990s, two such measures, Prop 166 and Prop 186, got 32% and 27% of the vote, respectively.
THE CASE WE CAN WIN: But as my colleague Beth Capell says in the article, we’ve been through a lot of campaigns since then, and we’ve learned a lot. The two most recent ballot measures that would have expanded health coverage were much, much closer. Prop 72 in 2004, to expand on-the-job coverage, got 49.2% of the vote–so health reform went from double-digit trouncings to a less than one percent gap. Prop 86 in 2006, a tobacco tax that partially went to expand children’s coverage, got 48.2%–a similarly narrow margin. The public has seemed much more willing to support health reform, even with heavy spending against these measures, and is seeming more inclined by the moment. While these weren’t victories, the trends are in the right direction.
And Steve Maviglio at the California Majority Report notes, after recounting the potentially significant opposition, what might take a health reform measure over-the-top: A broad-based coalition that includes unlikely allies and broad constituencies, and that includes Governor Schwarzenegger. Governor Schwarzenegger was against both Prop 72 and 86–he campaigned against Prop 72 and was featured the attack ads. If you believe that the Governor has an influence on more than 2% of the electorate, then you can see how health reform can be put over the top.
ONLY WITH US: But the Governor can help, he can’t do it alone. His failed special election effort showed that. In order for this to work, it needs to be a proposal that a broad constituency can get behind, which includes the over 100 consumer, community, and labor groups that have been active in the Its Our Healthcare! campaign this year, and that are that traditional base of health reform.
Essential to the passage of any ballot measure is something that our members, and the voters in general, can support. That includes strong assurances on affordability, which is one of the biggest differences between Governor Schwarzenegger’s proposal and the Democratic leadership.
When the Governor decided to veto AB8 and any proposal confined to what was possible with a majority vote in the legislature, he forced not just the financing but the full proposal to be part of this ballot strategy. That gave the drafters of a compromise some more flexibility with some additional funding–and, in fact, AB x1 1 is a better policy as result, providing more help to more people. But it raises the odds.
But that also raised the bar in terms of what is needed to come to a deal. For the various constituencies, the question is no longer what is tolerable in a health care package, but what package can excite and turn out voters, and mobilize organizations to actively campaign for it. The issue is no longer just what is good policy, but what is good politics with the voters. For example, in the course of legislation, it is typical to leave some questions up to regulators. In the case of the ballot, any measure will need to give some specific answers to voters.
This has empowered those representing consumer interests, because the questions and issues that voters will have are the same that consumer and labor groups have been raising all year, on affordability, cost containment, and access to care. The question is whether we can finance such a package while maintaining a broader coalition, that includes providers, health insdustry, employers, and yes, the Governor.
It’s not worth putting together a deal that not going to win on the ballot. On the other hand, what is worth the effort is putting together a package that does right by voters and patients, that has the support of major stakeholders including consumer groups and labor, that is good policy that pencils out, and that has a good shot of winning. That’s a lots of needles to thread, but that’s the challenge of the moment.