Thank You and Happy New Year

My thanks to all of you who took the time to read this blog in 2007. It’s been a lot of fun creating it and I’m delighted, appreciative and, to be honest, surprised at how many folks stop by to visit.

Health care reform is an issue that generates tremendous passion — and it should. We’re not talking about what the next flavor of Ben & Jerry’s ice cream should be. This debate is about something that impacts everyone’s lives, health and financial well being. 

There’s a natural tension in debates over issues like health care reform. Reasonable people can agree to disagree on how to fix what’s wrong and how to preserve what’s working in the current system. Passionate people can lose patience with the discussion, the seemingly endless negotiations and disagreement. What’s impressed me most about the feedback I’ve received on and about this blog is how readers have engaged in civil discourse without diminishing their passion. Yes, there’s been a few comments that descended to name calling and self-righteousness, but the overwhelming majority have been as thoughtful as they were fervent.

I hope all of you keep your passion and commitment alive in the year ahead. And that you all have a healthy and happy new year.
Alan

California Health Care Reform Debate: Lesson for the Nation?

California enjoy their image of national trendsetters. Advocates on all sides of the health care reform debate in California are fond of claiming that what happens here will set in motion a reform movement that will alter the course of the presidential primaries and health care of the country.

I’m not so sure the specific elements of the health care reform package, passed by the assembly and to be taken up by the State Senate, is really going to alter the debate. Heck, I’m not sure it will even pass the State Senate. Assuming it does, what’s the lesson of Assembly Bill X1-1? That purchasing pools are the solution? They’ve been around, and failing, for over a decade. That $1.75 is the appropriate amount for a cigarette tax increase? That carriers must accept all applicants? That too has been around, and increasing premiums, for years. Tying guarantee issue of products to a requirement that all residents have coverage might be the element of ABX1-1 that most qualifies it as a model for the rest of the nation.  But I think the lesson California has to offer is more one of process than specifics. And the lesson is the need for a less partisan approach to the effort.

Health care touches everyone. It’s more than a political issue, it’s a deeply personal one. At the same time it has a tremendous impact on the big picture. It’s over 15 percent of the nation’s economy. It affects the fiscal stability of government, the competitiveness of businesses, and the financial security of families. There are few issues that influences both society and everyday lives as much as health care. Consequently, there are few issues with so many stakeholders as health care.

Getting buy-in for a health care reform package is, not surprisingly, a challenge. Policy makers have two choices: ram a partisan “solution” down the throats of the opposition or engage in a dialogue with them.

The former is tempting. In many ways it’s easier because it’s more about politics than public policy. Which elements of your constituency needs what provisions? Cobble them all together and slam the package through.

A nonpartisan approach is much more painful. There’s still a heavy dose of politics involved, but the resulting package needs to be able to stand up to the rigors of questioning and debate from a broad spectrum. The package –in total — needs to have a good chance of actually working. And it’s more likely to because it reflects ideas and input from a variety of viewpoints. It’s a slower process than a partisan effort. It’s a frustrating process. But in the end, the results are usually better.

The California’s health care reform debate illustrate this point.

To the extent ABX1-1, the Health Care Security and Cost Reduction Act, has any chance of passing, it’s because technically it is a bi-partisan bill. Governor Arnold Schwarzenegger is, after all,  a Republican. Senate President Pro Tem Don Perata and Assembly Speaker Fabian Nunez are Democrats. If the Democratic Legislative Leaders had a soul mate in the Governor’s office, the bill would have looked far different. The views of the business community and others would probably not have been ignored, but they would have been much further from the center of the debate. If the result wasn’t a single-payer solution it probably would have looked a lot more like Assembly Bill 8, the reform package passed by the legislature last year during the regular session, than ABX1-1. And regardless of whether one supports ABX1-1 or not, it’s a much better piece of legislation than either AB 8 or Senate Bill 840, the single-payer bill.

So California serves as evidence of the benefits of a bi-partisan approach.

However, ABX1-1 is only technically bi-partisan. Republicans in the legislature have been totally absent from the deliberations. To a large extent, this was their own choice. By refusing to accept any new taxes they made themselves irrelevant to the process, except as an obstacle to a purely legislative solution. Without the two-thirds votes necessary to create new taxes the Governor and the Democratic Leadership are turning to the ballot to fund the $14 billion health care reform plan.

Leaving Governor Schwarzenegger as the only Republican in the room is not a good way to insert the perspective of the Republican party into the debate. Even he refers to himself as being “post-partisan” and few would suggest he speaks for the core beliefs of the GOP. As a result, key elements of the bill did not get the full benefit of a truly bi-partisan debate. Would this have eliminated problem areas in the bill, such as the unlevel playing field created in favor of the purchasing pool? That’s a question California “nearly non-partisan” process can’t answer.

The partisan versus non-partisan approach to health care reform is already a part of the presidential campaign debate, at least on the Democratic side. Senator Barack Obama believes in the wisdom of bi-partisanship. According to the Boston Globe,“To Obama, Democrats have been unable to make progress on core concerns like universal healthcare because of a selfish Beltway political culture that puts partisanship ahead of the national interest; electing Clinton, he said, would perpetuate the existing ‘Washington game with the same Washington players.’

“‘You know that we can’t afford four more years of the same divisive food fight in Washington that’s about scoring political points instead of solving problems – that’s about tearing your opponents down instead of lifting this country up,’ Obama said last week.”

Former-Senator John Edwards, however, champions a more partisan approach. “‘You better send a fighter [to Washington]’, he told voters Friday night in Davenport. But politicians are not his main targets: Special interests are the force that must be quelled.

“‘Corporate greed has infiltrated everything that is happening in this country,’ Edwards said.” Hardly an invitation for all sides to participate in the discussion.

This is where the California experience can educate the national debate — even if ABX1-1 never makes it past the Senate. It shows that even a “nearly bi-partisan” approach resulted in a better bill, one that had the best chance of any of the available alternatives to become law.

California Health Care Reform Initiative Filed

The next chapter in California’s long saga of comprehensive health care reform started on Friday, even as the current chapter continues to play itself out. Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez filed an initiative with the Attorney General to finance the reforms embodied in Assembly Bill X1-1. That legislation, passed by the Assembly and waiting on Senate approval, provides a framework for reform. However, the entire bill is contingent on passage of the financing initiative. If the initiative fails, the bill’s provision vanish as if they never existed and everything reverts to the status quo. Well, a status quo full of frustrated staffers who worked extremely hard to enact comprehensive health care reform, but the status quo nonetheless. 

At this stage, the campaign to enact the financing initiative, known for now as the Secure and Affordable Health Care Act of 2008, is all about timing and signatures. (The Sacramento Bee’s CapitolAlert site has a useful post by Shane Goldmacher on initiative timing).  

By filing their initiative on December 28th the Governor and Speaker started a countdown for the Attorney General . The Attorney General drafts the title and a summary of the initiative and asks the Department of Finance and the Joint Legislative Budget Committee for a fiscal analysis. The finance folks have 25 working days to get their results in. The Attorney General’s office has seven weeks in total to complete its assignment, in this case, until February 15th.

Once past these hurdles, signature gathering can begin. It takes just shy of 695,000 valid signatures to qualify an initiative. The rule of thumb is, to get 695,000 valid ones, initiative sponsors need to submit roughly 1.2 million signatures. To provide time for the appropriate county agencies to review, validate and count the signatures in time to qualify an initiative for the November 2008 ballot, the Secretary of State is recommending sponsors submit their petitions to the appropriate county office by April 21st.

Doing the math: if the Attorney General and Department of Finance take the full seven weeks they’re allowed, sponsors would have less than 10 weeks to get 1.2 million signatures submitted before the April 21st deadline. But it’s unlikely the Attorney General and Department of Finance will take the full seven weeks. Attorney General Jerry Brown has every incentive — and more than enough capacity — to do his part quickly. And as the Department of Finance is part of his administration, it’s safe to assume that Governor Schwarzenegger can get this initiative moved to the top of the Department’s in-box. And can sign off on any overtime that might be needed (budget deficit not withstanding). So it’s more likely supporters of the initiative will have closer to 12-14 weeks to get a sufficient number of valid John Hancocks on their petitions. As for the Joint Legislative Budget Committee, well, its membership is appointed by Speaker Nunez and Senate President Pro Tem Don Perata. ‘Nuff said.

Ten weeks is not a lot of time, but it’s enough. All it takes is money. Lots of money. Most of those folks you see in front of supermarkets get paid on a per-signature basis. With enough money you can hire enough clipboards to get the job done. Backers of the health care initiative will be able to supplement paid signature seekers with volunteers from their union and consumer group allies. And how hard will it be to get people to sign? “Excuse me. Will you help Governor Schwarzenegger fix California’s broken health care system? It’ll only take a minute.” The task is eminently doable.

By filing the initiative even before the bill makes it through the Senate (still an open question), the Governor and Speaker secured valuable time time for their signature gathering process. They also put pressure on Senator Perata to have his house pass the legislation pretty much as written. If the Senate modifies the bill in ways that impacts the cost of the package, the initiative would need to be rewritten. Any such changes would need to be pretty important to justify starting the filing process all over. Because while a refiling starts the seven weeks given the Attorney General, it doesn’t change the April 21st deadline. So the delay reduces the time available to get signatures.

This doesn’t mean the Senate can’t put it’s stamp on the legislation. There’s plenty of elements of ABX1-1 that don’t impact the funding. Changing those provisions is fair game — and in some places, a very good idea. And there’s still a fair chance the legislation won’t pass the Senate. If the Legislative Analyst report Senator Perata requested shows it will make fixing the state’s budget problems harder, the initiative may never see the light of day.

But it was smart politics for the Governor and Speaker to file their initiative now. After all, Election Day, November 4, 2008, is only 10 months away.

California Health Care Reform and the Inevitable ERISA Challenge

Few were surprised when a Federal Court struck down San Francisco’s Health Security Ordinance on ERISA grounds. There were elements of the city’s ordinance that seemed to invite a suit and to have been drafted on shaky legal grounds. What’s interesting is whether the Health Care Security and Cost Reduction Act (Assembly Bill X1-1), passed earlier this month by the state Assembly and scheduled for a Senate Health Committee hearing on January 16th, will fare any better. University of Mississippi law professor Paul Secunda, writing in the Workplace Prof Blog and Anthony Wright in a December 27th posting on the Health Access blog think it will. Chris Reed of the Union-Tribune and Daniel Weintraub at the Sacramento Bee think it won’t.

The reality is, no one knows what a court will decide until a court decides. (Those three years at law school weren’t a total waste!)  The District Court ruling,  Golden Gate Restaurant Association v City and County of San Francisco, will be appealed to the Ninth Circuit Court of Appeals. And anything could happen there. 

What’s important to keep in mind is that previous ERISA decisions by Circuit Courts, such as that of the Fourth Circuit when it overturned a Maryland law aimed at Walmart, are not controlling in California. A decision from the Ninth Circuit will be. That’s just the way Federal Appeals Court decisions work — they’re only controlling in Federal Courts in the states comprising that circuit.

ERISA has been the bane of state and local health care reform efforts for years and is one of the reasons national health care reform is likely to be required. While the authors of ABX1-1 have taken great care to avoid running afoul of ERISA, that’s a far from easy task. Just ask the San Francisco Board of Supervisors. Better still, ask the Ninth Circuit Court of Appeals.

Progressives Accepting of Half a Health Care Reform Loaf?

Assembly Speaker Fabian Nunez has long supported a single payer health care system for California and prefers that solution to his own health care reform plan, Assembly Bill X1-1, passed by the Assembly earlier this month and awaiting consideration by the State Senate on January 16th.

Yet, he takes Governor Arnold Schwarzenegger at his word that he will not sign a single payer bill and notes that the Governor previously vetoed such legislation, Senate Bill 840. Consequently, he encourages progressives to recognize this reality and line up behind ABX1-1, health care reform that can be enacted.

The Speaker made this plea explicit in posts on several liberal blogs (that’s one, here’s another and another) last week. In his post, Speaker Nunez warned  progressives that “it would be a shame if disappointment over the chances of single payer (and I’m a supporter of single payer)  detracted from the opportunity we have to do a strong measure of good for the millions of Californians who don’t have, or are having trouble affording, health care.”

His plea for liberals to line up behind ABX1-1 seems to be having an effect. Consumers Union is on board. Several labor organizations, including the Service Employees International Union (SEIU), are backing the bill. They, and others, are finding ABX1-1 to be a very satisfactory partial health care reform loaf.

Mike Russo, Health Care Advocate and Staff Attorney for the California Public Interest Research Group (CalPIRG), does an excellent job in parsing the legislation and pointing out the reason progressives should support it: “ABX1-1 sets out an entirely new framework for health care in this state, and it’s critical to focus on making that framework the best it can be, rather than rejecting it for an unsustainable, intolerable status quo.” Whether you agree or not with his politics, his post is insightful and well worth reading.

The Left is far from united on ABX1-1. Senator Sheila Kuehl, the author of SB 840, remains opposed. So is the California Nurses Association. But the fact that proponents of a single payer scheme for California are not united against ABX1-1 is a major victory for Speaker Nunez and Governor Schwarzenegger.

And it puts pressure on Senate President Pro Tem Don Perata to push the legislation through his house. Senator Perata, however, has placed the future of the bill in the hands of the Legislative Analyst’s office. He has asked them for an analysis of the legislation’s impact on the state’s finances. If the result is a report showing the state can’t afford ABX1-1, it would be hard for Senator Perata to bring the bill forward. If the analysis shows the health care reform package would help the state’s finances, he’s pretty much pledged to get the bill passed.

But what if the Legislative Analyst calculates a budget neutral impact or even that the impact is impossible to determine? In other words, what if it’s a “tie?” In that case, having a substantial portion of the liberal community advocating for the bill is to result in Senator Perata pushing ABX1-1 through the Senate. In other words, the support of liberals breaks the tie in favor of the legislation passing. 

Whether ABX1-1 should pass the Senate is still an open question for many of us. What’s interesting about the dynamic taking place in the progressive universe, however, is how it runs counter to business as usual.. 

True believes on either end of the political spectrum often take a “purist’s” approach to issues. It’s all or nothing. In their willingness to accept what they see as a partial victory, liberals have increased the odds California will pass comprehensive health care reform legislation next month. That’s hardly business as usual.

Health Care Reform, Polls and Presidential Politics

Bill Robinson, a Palm Springs insurance agent and voracious researcher on health care reform issues, recently circulated a gem of an article concerning a seeming contradiction in how Americans view the health care system. The gist of the article,  posted in November by The Century Foundation and written by Maggie Mahar, is that Americans consistently denigrate the health care system while simultaneously claiming, by huge majorities, that it works just fine for them, thank you.

Comparing results from several polls, Ms. Mahar identifies this apparent discrepancy as resulting from Americans’ satisfaction with their own current health care coverage, but insecurity about how long they’ll be able to maintain it. With premiums rising, coverage contingent on sometimes precarious employment and, if I can add to Ms. Mahar’s list, politicians constantly claiming the system is broken beyond repair, widespread insecurity is not surprising.

At the same time, there are plenty of polls showing that people don’t have a lot of confidence in how Washington runs things, either. This creates an interesting quandary for presidential candidates. Most voters feel the system needs substantive changes, yet they don’t trust the government to make things better.

It’s no surprise then, that none of the major Democratic presidential candidates have called for a government-run single payer system. Instead they call for plans that expand the size and scope of public programs to varying degrees, but preserves the private system. There are differences between the plans: Senator Barack Obama focuses on affordability, Senator Hillary Clinton, former-Senator John Edwards and Governor Bill Richardson place more emphasis on universal coverage, with Governor Richardson distinguishing himself by avoiding the creation of any new bureaucracies.

What’s significant, however, is that the second most oft used phrase by the candidates is that “no one will have to give up their current insurance if they don’t want to.” (Still holding strong in first place is “The system is broken.”) The Democratic candidates, consequently, get to have it both ways, to a degree. They get to say they’re going to fix the current system with new regulations and public programs, but they’re going to preserve private sector involvement. This may play well in the general election, but it’s not likely to excite many of the more strident constituents of the Democratic party who will accept nothing less than a single-payer system (cue the California Nurses Association).

Republican candidates face a different challenge. They have an aversion to new taxes (or cutting back on existing tax cuts). And they don’t like turning private sector services over to the government. So they focus more on affordability with few, if any, new public programs. This addresses the “my coverage is fine” dynamic the polls identified, but it doesn’t face up to the demand for change. The result is the inverse of the Democrats’ dillema: the Republican candidates’ positions will get them through the primary season all right, but it’s going to look weak after the conventions.

As the Kaiser Family Foundation surveys and other polls have shown, health care is one of the most important issues voters expect presidential candidates to address. And as Ms. Mahar points out, the polls also indicate a nuanced understanding of the issue by voters. Since the candidate’s messages must be equally nuanced, their positions tend to clump together, with obvious differences between the parties. Consequently, the specifics of the candidates’ health care proposals are not likely to be decisive in garnering support, at least not early in the primary season. What will be more important than specifics is how their proposals reinforce their core messages.

Senator Edwards, for instance, needs to show that his plan will help the poor and middle class. Which is why he emphasizes universal coverage. Senator Clinton’s program needs to underscore her claim of competency and experience, which she does by highlighting the differences between this plan and the one she pushed in her husband’s administration. Senator Obama represents a break with the past, which means his opponents do him a favor by attacking his plan. And Governor Richardson brings to the campaign broad government experience at the state and federal level. His plan underscores this by redeploying and expanding existing public programs, not creating new ones.

The importance of the health care reform issue, and of the candidates plans, will change over time. For now, however, they are mirrors of the candidates’ themes.  Which, given the seeming contradictions in the polls, is no doubt the wisest political strategy.

California Health Care Reform Initiative Timing

The Health Care Security and Cost Containment Act, ABX1-1, can become effective only if voters approve a ballot measure providing financing for the health care reform package. Supporters of ABX1-1 are hoping to place that funding initiative on the November 2008 ballot. As posted earlier, a Field Poll released Friday shows strong support for the measure, although the survey failed to probe for reactions to arguments likely to be made by opponents.

Contrary to the impression folks might have from the large number of initiatives California voters face every year, qualifying a ballot measure takes time, money and perseverance. While every aspect of the qualification process is challenging, the biggest obstacle facing supporters of the Health Care Security and Cost Containment Act is time.

That’s why Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez are pushing so hard on Senate President Pro Tem Don Perata to have his house consider the legislation sooner rather than later. The Senate can — and should — make changes to ABX1-1. Without knowing what these changes are, drafting the initiative is challenging.

If the Governor and Speaker had their way, the Senate would convene this week and pass the bill as is. Senator Perata says he won’t call the Senate into session until January 7th. And he won’t bring ABX1-1 up for consideration until the Legislative Analyst has had a chance to evaluate it’s impact on California’s budget. Realistically, that means a vote is unlikely before January 15.

Will that leave enough time for the qualification process to begin?

According to an excellent post on the Sacramento Bee’s CapitolAlert web site by Shane Goldmacher, the answer is “probably not.” This is a post well worth reading.  Go there, I’ll wait.

For those looking for solely the bottom line …

It is virtually impossible to gather enough signatures to qualify a ballot measure in less than 30 days. That’s the key stat. Before the signature gathering can start, however, the Attorney General has to do some paperwork. That can take weeks. If the Senate takes until January 15th to pass the legislation and the Governor and Speaker wait until then to submit the initiative to the Attorney General, there will be virtually no chance to meet the deadlines for the November ballot. It’s not impossible, but the chances are slim. We’re talking really, really slim here.

To get the full story, check out Mr. Goldmacher’s post. And I suggest you read it before time runs out.

Field Poll Shows Voters Like the Upside of Health Care Reform

California voters like the core benefits of the health care reform compromise pulled together by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez. According to a California Field Poll released December 21st, voters favor the package by nearly a two-to-one margin. What’s impressive is the breadth of the support. The reform package is supported regardless of political party, age, gender, ethnicity, income or  geography, albeit by varying majorities.

This demonstrates the importance of health care coverage to Californians, the real problems that exist in the current system, and the impact of nearly a year debating health care reform in which the most frequently used phrase is “the current system is broken.” In fact, of voters who say they are inclined to favor the proposal, the second most frequently cited reason (at 19 percent) is that the system is broken, or words to that effect. The most common response falls into the category the Field Poll describes as “Everyone needs insurance/you could get wiped out without insurance” with 38 percent.  In a time of substantial economic uncertainty, this result is not surprising.

Whether voters get to actually cast ballots on the reform package will depend on what happens in the State Senate. The Assembly on December 17th passed ABX1-1, also known as the Health Care Security and Cost Reduction Act. Senate President Pro Tem is holding off deliberation and a vote on the bill until the Legislative Analyst’s office has a chance to determine the impact ABX1-1 will have on the state’s finances.

What’s significant is that while ABX1-1 creates a “framework” for health care reform, none of it takes effect unless voters approve a ballot measure to finance that framework. Supporters hope to qualify that initiative for the November 2008 ballot.

The Field Poll is good news for backers of the Health Care Security and Cost Reduction Act. Starting off with 30 percent of voters saying they strongly favor the package and another 34 percent indicating they somewhat favor the plan is a great starting point for any campaign on any topic.

But that doesn’t mean the campaign is in the bag. The survey, it seems, failed to probe for the impact of arguments detractors are likely to make. Here’s the question that was asked:

“The broad outlines of the reforms being proposed call for making changes within the framework of the current health insurance system. Those who currently have insurance could retain their same coverage. Those who do not have insurance would be required to obtain a minimum level of coverage from either an employer, government agency, or by paying for it themselves. The state would subsidize the costs of insurance for low income people. Middle income families would receive tax credits if they need to buy their insurance in the open market. Insurance companies would be required to offer coverage to anyone without regard to health condition. most employers would be required to offer health insurance to their employees or pay into a state fund.”

Sounds good. Since most Americans, even rich ones, consider themselves “middle class,” those tax credits sound especially good.

But opponents of the bill are going to hammer away at the size of the taxes, the amount of government involvement and control over the health care system, the risk of health insurance premiums skyrocketing, the impact on the state’s already shaky budget, etc. There are a lot of voter hot buttons and opponents will press them all to try to defeat the initiative.

Does the fact that opponents will have ammunition doom the initiative? No. But then, this poll doesn’t mean it’s sure to pass either. Think of this Field Poll as a good benchmark. If the Senate passes ABX1-1, this poll will be a valuable tool for measuring the impact of the claims both sides will make during a very long campaign.

California Health Care Reform Needs a Better Name

OK. I know a rose by any other name would smell as sweet. And that a rose is a rose is a rose.

I get it. Names aren’t everything. The debate should focus on a piece of legislation’s substance.

Fine. But after nearly a year of debate and negotiations, couldn’t someone have come up with a better name for California’s comprehensive health care reform package than the “Health Care Security and Cost Reduction Act?” 

What were they thinking? Don’t they realize that every name over three syllables gets reduced to an acronym? When Congress the Health Insurance Portability and Accountability Act in 1996 they gave us HIPAA (“Hip Ahh”). That’s an acronym that works. When they passed the Consolidated Omnibus Budget Reconciliation Act of 1985, they result was “COBRA.” An A+ acronym. And the list goes on.

The Health Care Security and Cost Reduction Act? No one is going to take the twenty five minutes required to say all that. It cries out for an acronym. But come on, “HCSCRA?” How do we pronounce that? “Hick Scraw?” “H C Scray?” “Hic Sic Ra?” Anyway you work it, it sounds like an insult. There’ll be fist fights in the parking lot over this one.

While waiting for the Legislative Analyst to determine if ABX1-1 insults the state’s budget, negotiators need to meet around the clock until they come up with a better name for the legislation. If necessary, they should head down to Hollywood. There’s a lot of good writers there with time on their hands. Maybe they could come up with something that works.

But I don’t think they need outside help. The folks working on California’s health care reform plan are smart. They’re creative. They’re talented. Surely they can come up with something that doesn’t sound like a slur.

Senator Perata Says California Health Care Reform Will Move Forward

I’m getting whiplash. Following comprehensive health care reform through the legislative process in California has been a roller coaster ride this year. But now the twists and turns are coming faster than ever.

On Monday, the day the California Assembly passed the Health Care Security and Cost Reduction Act (ABX1-1), Senate President Pro Tem Don Perata tells a San Jose television station health care reform is dead on arrival. That’s the same day he asked Legislative Analyst Elizabeth Hill to investigate and report on the impact the health care reform package will have on California’s hemorrhaging economy.

On  Thursday, however, Senator Perata told the Contra Costa Timesthat he’ confident the ballot measure required to finance the ABX1-1 reforms will be on the November 2008 ballot. (The legislation is contingent on passage of the funding initiative). “A good idea is not going to be stopped by two weeks (delay),” he’s reported as saying. That would seem to pre-judge what Ms. Hill’s team is going to report, something Senator Perata has been careful not to do — until now.

What to make of all this? It seems to be coming down to that Legislative Analyst’s report. If it finds the health care reform package passed by the Assembly will have little or no negative impact on the state’s economy, Senator Perata has indicated he will move the bill forward. (Whether the report will convince voters come November 2008 is another matter).

If, however, Ms. Hill finds ABX1-1 is likely to make the state’s budget crisis even worse Senator Perata has indicated the bill will never leave the Senate. He’ll face tremendous pressure to bring ABX1-1 to a vote, but my guess is he’ll stand up to it.

Either way, I expect my neck won’t start feeling better until sometime around mid-January.