Health Care and Economy Top Domestic Issues in 2008 Presidential Election

Iraq remains the single most important issue for voters in deciding whom to back for president in 2008, but close behind is health care reform and the economy. This according to the just released Kaiser Family Foundation Health Tracking Poll: Election 2008.

When asked, “What is the single most important issue in your choice for president?” and pushed to give two answers, 29 percent of the respondents said Iraq, but health care and the economy were close behind, each mentioned 21 percent of the time. There were modest differences based on party affiliation. Republicans ranked the economy slightly ahead of health care (18 percent to 16 percent). So did Independents (22 percent versus 20 percent). Democratic voters, however, indicated health care was a more important issue for them than the economy in general (28 percent to 23 percent).

The survey approached the question in two ways. Half of those surveyed by the Kaiser Foundation were asked the “single most important issue” question in the previous paragraph. The other half were asked, “What do you think is the most important problem for the President and Congress to address?” Again, respondents were pushed for two answers. The top six responses for all respondents were:

  1. Iraq (46%)
  2. Health Care (24%)
  3. Economic Issues (22%)
  4. Immigration (15%)
  5. Gas Prices/Energy (8%)
  6. Terrorism/National Security (7%)

Iraq was the top response for respondents of all parties. When phrased this way, however, Immigration was the second highest ranking issue for Republicans with 23 percent followed by health care with 21 percent. Independents put health care second with 23 percent, followed by immigration at 19 percent. For Democrats health care was the number two issue (30 percent) followed by economic issues(26 percent).

Interestingly, Iraq and health care as an issue lost some ground to economic concerns since the Kaiser Foundation’s October survey. Then, the top six issues to the “what do you think is the most important problem for the President and Congress to address” question were:

  1. Iraq (54%)
  2. Health Care (29%)
  3. Economic Issues (16%)
  4. Immigration (12%)
  5. Frustration with government (6%)
  6. Terrorism/National Security (5%)

While the number of respondents mentioning health care declined somewhat, voters remain interested in hearing presidential candidates talk about the issue. Not surprisingly, the specific health care reform issues they want to hear about vary by party affiliation.  The Kaiser survey found that Republican and Independent respondents wanted to hear the candidates speak about reducing the costs of health care and health insurance (47 percent of Republicans; 43 percent of Independents). 35 percent of the Democrats said this was an important topic for conversation, but more wanted to hear candidates discuss expanding health insurance coverage for the uninsured (42 percent).  Expansion of coverage was the second most mentioned issue by Republicans and independents (19 percent and 29 percent, respectively).

In considering these survey results, it’s important to keep in mind that voters don’t always make their decision based on the issues. In fact, the Kaiser survey found that only 46 percent of the voters would decide who to vote for based on the candidates’ stands on the issues. An equal number (45 percent) say they’ll base their vote on their perception of the candidats’ leadership abilities, character, values and experience. Ten percent aren’t sure how they’ll base their voting decision.

So health care reform will be an important issue in the 2008 presidential primaries, but the specific positions taken by the candidates won’t be the whole story. What also matters is what their positions say about the candidates character, values and leadership.

Polls are fun to look at, but they have limited value. The true test comes when people actually cast ballots. With the Iowa caucuses less than two weeks away and the New Hampshire primary less than a week after that, the first test results are near at hand.

Another California Health Care Reform Round-up

A couple of days ago I provided links to documents, articles and web sites describing the Health Care Security and Cost Reduction Act passed by the Assembly on December 17th. Those were predominately focused on the facts surrounding ABX1-1. Now that folks have had a few days to look things over, opinions about the compromise health care reform package pulled together by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez are emerging. Here’s a round-up of some of the more interesting ones:

Los Angeles Times columnist George Skelton writes about the need for policy makers to heed the forthcoming review of the financial impact ABX1-1 will have on the state’s finances being prepared by the Legislative Analyst, Elizabeth Hill, and her staff.

Anthony York, over at the Capitol Weekly web site dissects some of the politics behind the Assembly’s mostly party-line vote on ABX1-1. Not to give away the ending, but he suspects the motivation might have something to do with an issue that rhymes with “germ inhibits.” The nature of political give-and-take is further examined in a Los Angeles Timesarticle written by Michael Rothfeld. It seems some last minute amendments to the health care reform package benefited unions which, in a coincidence of timing, poured $1 million into the “Yes” on Proposition 93, the germ inhibits — I mean, term limits — initiative.

Sacramento Bee columnist Daniel Weintraub wrote an interesting piece on how the Governor and others are insisting the Health Care Security and Cost Reduction Act is in keeping with Republican Party principles. He even offers polling to support the claim. GOP Assemblyman Chuck DeVore, writing in the Orange County Register, would, I believe, beg to differ (Note: this article was cited in the previous California Health Care Reform Round-up).

The San Jose Mercury News editorial board likes much of what they’re reading in ABX1-1, but thinks Senate President Pro Temp Don Perata is right to make sure the state can afford the plan. The Contra Costa Times editorial board agrees and is willing to have the financing initiative targeted for the November 2008 ballot if that’s what it takes to assure the Health Care Security and Cost Reduction Act won’t break the state’s piggy bank.

As I wrote about earlier today, the Los Angeles Times editorial board’s endorsement of ABX1-1 would make Alfred E. Neuman proud. The editorial board at the Los Angeles Daily News concludes ABX1-1 is the best comprehensive health care reform package California is going to see for awhile, so they’re hoping it moves forward.

I’m sure there will be more opinion pieces worth reading, but hopefully this is a helpful start.

Enjoy.

The Alfred E. Neuman Approach to Health Care Reform

The Los Angeles Times ran a surprising editorial in support of the health care reform package cobbled together by California Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez. That the Times is supporting the reform package isn’t the surprise, it’s the reasoning.

The editorial, published on Wednesday and entitled simply “California’s healthcare plan” accurately noted that there is much to like in Assembly Bill X1-1, the Health Care Security and Cost Reduction Act. And they assume Governor Schwarzenegger will make “a reasonable case that there will be adequate funding [for the reform package] — and that there’s a backup plan in place should finances fall short ….”

So, there’s some good things in the bill. The Governor is bound to make a “reasonable” case it won’t bankrupt the state. That’s enough for an Alfred E. Neuman worthy endorsement by the Times: “Why not give it a chance?”

Well, gee. Let’s think.

First, the history of state health care reform is littered with the wreckage from “What, me worry? reforms. As described in one of yesterday’s post, Washington State and Tennessee had to roll back their reforms. New York and New Jersey consumers pay on average twice what Californians do for individual health insurance thanks to their reforms. In fact, there’s no example of state health care reform inspiring confidence that the challenges facing our health care system can be resolved at the state level.

Second, while there’s a lot to applaud about the compromise legislation, it may contain serious flaws, too.* The reality is the Health Care Security and Cost Reduction Act has not been thoroughly vetted. The bill that passed out of the Assembly Health Committee was far different than that put before the Assembly Appropriations Committee. And what the Appropriations Committee and the full Assembly passed was made available to them the day of the vote. There was no way this complex, 200+ page bill was thoroughly reviewed before its passage. The staffs of the Governor and the Speaker are very good. They are very well intentioned. And they are very human. The odds of the bill being ready for prime time are small.

Senate President Pro Temp Don Perata is to be commended for slowing down the reform juggernaut until the Legislative Analyst’s office can estimate the impact of ABX1-1 on the state’s rapidly worsening budget. The Senate should also use this time to thoroughly review details of the bill and fix what’s flawed.

Even Alfred E. Neuman should be worried about the impact of a defective health care reform package on California.

* Note: In the original post I outlined one such serious flaw, the lack of enforcement of the mandate for residents to have coverage. Mike Russo at CALPIRG posted a comment leeting me know I missed a provision that allows carriers to exclude coverage on existing health conditions for up to 12 months on “late enrollees.” In the interest of accuracy, and out of fear I missed something else, I deleted that discussion from this blog. As pennance for missing this major element of the bill the first time, I’m going to re-read the bill again to see what else I might have missed the first time. My thanks to Mike for the correction.
Alan – December 20th, noon.

A Long 10 Months

It could be a long 10 months. If California enacts ABX1-1, the health care reform compromise worked out by Governor Arnold Schwarzenegger and Speaker Fabian Nunez, we’re in for a public relations war that will start out nasty and get worse from there.

ABX1-1, the Health Care Security and Cost Reduction Act, is a framework for health care reform, bereft of funding. It will take effect only if voters approve a financing initiative supporters will seek to qualify for the November 2008 ballot. When it comes to health care reform, passions run deep. Many participants in the debate have a near religious belief in the rightness of their cause. And health care itself is an emotional issue. Taken together, these factors will tempt partisans on both sides to make bold, dramatic and emotional attacks on their opponents.

In fact, it’s already started. Daniel Weintraub, posted a story on the Sacramento Bee’s CapitolAlert web site concerning the California Nurses Association plans to march on offices of Cigna in protest of the company’s denial of a liver transplant for a critically ill 17 year old. The nurses see this as proof that ABX1-1 is fatally flawed as it fails to address the problem of denial of care. However, after being challenged for claiming the denial was made based on the cost of the transplant, the Nurses Association now admits the transplant was denied because Cigna considered it experimental and, consequently, not covered. (Cigna’s conclusion will be examined under the state’s independent medical review system.)

What’s hypocritical about the California Nurses Association protest is that their preferred solution, a state-run single payer health care system would be no better. Instead of an administrator who works for a health plan deciding whether the treatment is experimental, the decision would be made by an administrator working for the government. As Mr. Weintraub notes, “It’s misleading for the nurses to imply that their plan somehow would give every patient every treatment they requested. It wouldn’t.”

The plight of this teenager is sad. Manipulating her situation to support misleading attacks proved too tempting for the California Nurses Association to resist. That’s sad, too. Unfortunately, while they were the first to succumb to this enticement, they won’t be the last.

Note added December 21, 2007: A few hours after Cigna agreed to cover the transplant, the teenager passed away. While Cigna normally does not cover experimental treatment, the company made an exception in this case. Doctors at UCLA, where she was being treated, said patients in situations similar to Nataline’s who undergo transplants have a six-month survival rate of about 65 percent. My condolences and sympathy to her family.
 

States’ Health Care Reform Efforts Doomed to Fail?

I almost hate to bring this up. After all, everyone is so excited (not necessarily supportive, but excited) about Assembly Bill ABX1-1 (Nunez) making it through the California Assembly on Monday. For those not paying attention, ABX1-1 is the compromise health care reform legislation put forward by Speaker Fabian Nunez and Governor Arnold Schwarzenegger. It faces a very uncertain future in the State Senate, where it will be considered in early January. And it is contingent on passage of a financing measure supporters hope to qualify for the November 2008 ballot.

So I feel like the Grinch at the office holiday party, but a strong case can be made that the states are not the place for health care reform. In fact, Ezra Klein, a staff writer at the self-proclaimed liberal American Prospect, has made a strong case states tend to fail at health care reform.  The title of his piece, published in the August/September 2007 edition of the Washington Monthly, sums up his point: “Over Stated: Why the ‘laboratories of democracy’ can’t achieve universal health care.

Mr. Klein describes providing health care for all citizens as being “one of those tasks, like national defense, that the states are simply unequipped to manage on their own.” He then sets out the several failures states have already experienced. Washington State’s “Clintonian-style” program, recent challenges faced by Hawaii, Tennessee’s fiasco called TennCare, and Oregon’s troubled attempt “to do the one thing that really needs doing: controlling costs.” He also points out why Massachusetts’ health plan is unlikely to work in other, more diverse and poorer states. Mr. Klein concludes that the “results are pretty clear: states are no good at delivering universal health care.”

Mr. Klein’s message is that the federal government should implement universal coverage and relieve the states of their impossible quests. He appears to support a government-run system, but that’s not the focus of the article.

Nor should it be the focus of Californians contemplating our own health care reform effort. We have to deal with the issues on the table and there’s substantial momentum now for a state solution. But as California moves forward, we should heed the warning from Washington, Hawaii, Tennessee and Oregon. Budget projections often miss the mark (just look at the surprised look on the faces of California lawmakers learning the state’s budget is $14 billion out-of-whack). Assumptions that make sense on paper don’t always play out the way we expect in the real world. Administrations and policy priorites change.

In other words, the road to state health care reform, paved as it is with good intentions, often leads to unpleasant results.

A California Health Care Reform Round-up

Health care reform took a giant step forward yesterday with the Assembly’s passage of ABX1-1 (Nunez), the compromise package ironed out by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez. As my previous post pointed out, enacted of reform is still very much up-in-the-air. I’ve been getting lots of questions about what happened and what’s going to happen. So I thought readers might benefit from a list of sites and documents they can use to get caught up. As I discover new material I’ll add them to this post.

Governor Arnold Schwarzenegger’s web site has a video of his press conference lauding the Assembly’s passage of ABX101.

Governor Schwarzenegger’s office even prepared a Summary of ABX1-1, The Health Care Security and Cost Reduction Act (Governor’s version). Needless to say it glosses over a few problem areas, but it’s useful to see how the Governor sees the compromise.

It takes two to compromise: here’s Speaker Nunez’s press release concerning the Assembly’s passage of ABX1-1.

And it takes three to have a troika: here’s Senate President Pro Tem Don Perata’s press release and letter to the Legislative Analyst asking for a review of the impact of ABX1-1 on the state’s finances. There will be a lot of pressure on Senator Perata to move quickly to get the Senate to move the health care reform proposal forward. However, during a story on San Jose’s CBS affiliate, Channel 5, on Monday Senator Perata described the bill as “DOA.” The statement is made about 3:15 into the clip. After CapitolAlert posted these comments, Senator Perata’s spokeswoman Alicia Trost clarified the Senator’s position: “We need to know the details of the financing plans as well as the details of the budget before the Senate takes it up. We remain committed to passing health care reform and getting it done right, but we only get one shot at doing this correctly.

If you’d like to read the bill for yourself, here’s the place to get the full text of ABX1-1. This page also provides information concerning the vote on ABX1-1 (46 ayes, 31 nays). For those looking for a short cut to learning what’s in the bill (good training for becoming a legislator) here’s the official Bill Analysis of ABX1-1 delivered to Members prior to the vote.

The California Health Care Foundation FAQ on ABX1-1 and what comes next is worth reviewing. They also have updated a summary of the compromise health care reform bill on their site.

The folks over at Health Access have a post providing a blow-by-blow account of the Assembly Appropriations Committee vote on ABX1-1. They also offer a summary of the bill. (Their blog doesn’t have a search feature, so if there’s a lot of new posts, you’ll want to find the ones dated December 18th).

Health Access has a “support if amended position on ABX1-1. The California Nurses Association are in outright opposition (This link is to a press release published before ABX1-1 was amended on December 17th. However, I doubt any of the changes appeased the Nurses Association which is adamant the only solution is a single-payer solution).  Senator Sheila Keuhl take a similar view of the Governor and Speaker’s compromise

For perspectives from the right on the compromise health care reform package, take a look at this post by Joel Fox, president of the Small Business Action Committee (written before the vote, but still relevant) and this op-ed piece published in the Orange County Register by Assemblyman Chuck DeVore of Irvine.

Happy reading.

California Assembly Passes Health Care Reform, But Fate Still Unclear

The California State Assembly passed Assembly Bill X1-1 on Monday, a comprehensive health care reform package negotiated between Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez. (OK, much of the heavy lifting was done by their able staffs, but they’re paid not to take credit, so I don’t want to get them in trouble). Considering the challenges they faced — both policy-related and political — this is an amazing political accomplishment. One that is worthy of the celebratory press conference they held after the vote.

That vote, by the way, was largely along party lines (some papers are reporting it as 45 in favor; others report 46 voting “aye,” but all agree there were 31 “no” votes). The vote came just hours after publication of a spate of amendments, more than a few quite substantive. I would never suggest that Assembly Members voted on a bill of such complexity and import without thoroughly studying the legislation. But, in reality, Assembly members voted on a bill of such complexity and import without having much of a chance to thoroughly study the bill before casting their vote.

Lining up 45 or 46 “aye” votes in the Assembly was (relatively speaking) the easy part. Now it gets hard: proving the legislation is worthy of passage by the State Senate. Broadly stated, the Governor and the Speaker will need to convince Senate President Pro Tem Don Perata (and, to be fair, others in the Senate, but especially Senator Perata) that their health care reform package: 1) will not negatively impact California’s snowballing fiscal crisis; and 2) does more good than harm to the health and financial security of California residents.

Then it gets even harder: convincing California voters of the same two points. Because what the Assembly passed is only a framework for reform. It takes effect only if voters approve a ballot measure, expected to be qualified for the November 2008 ballot. (Even qualifying the financing is initiative will be challenging. Speaker Nunez has publicly stated drafting of the initiative needs to start on December 21st to make next year’s November ballot. In reality, the deadline is probably some time in January, but either way, it’s coming up fast. As discussed below, the Senate is unlikely to take up the measure, let alone pass it, until next month. This means drafting the initiative will need to be done quickly, and hasty drafting usually leads to flawed measures).

Senator Perata isn’t waiting for the Governor and Speaker to make the case on the financial issues. On Monday he asked the non-partisan Legislative Analyst’s office to report on the impact ABX1-1 will likely have on California’s budget. And by announcing the Senate will not convene prior to the start of the regular session on January 7th, he is providing the Legislative Analyst’s office time to conduct a meaningful investigation.

Then there’s the substance of the bill. The legislation is greatly improved over earlier versions — including what was passed (again on a party line vote) by the Assembly Health Committee just last month. For the record, one amendment added today of special interest to agent readers of this blog is a change recommended by the California Association of Health Underwriters and several carriers. It permits, but does not require, carriers to contract with agents and brokers to provide “marketing and servicing” of coverage offered through the purchasing pool.

Yet serious problems remain. Over the next several days there will be dozens of folks critiquing the package from the left and the right (and the diversity of opponents will be pointed to by supporters as proof that their compromise is fair). Some of the problems they’ll be identifying are extremely disconcerting. Take, for example, the enforcement of the requirement that all California residents obtain health care coverage — or the lack of enforcement, to be more precise. The enforcement mechanism seems to be limited to forced enrollment in a health care plan offering minimum coverage. This “penalty” is so weak, many Californians are likely to conclude it’s in their financial interest to wait until they need coverage before obtaining it. This, in turn, creates a New York-type health care system. And residents of New York pay, on average, individual medical premiums twice as high as do Californians.

It’s uncertain whether the State Senate will even considers ABX1-1. If it does, it’s uncertain whether they’ll seek to amend the bill. If they do make changes, it’s unclear whether those amendments will destroy the fragile compromise forged by Governor Schwarzenegger and Speaker Nunez. So it’s unclear whether comprehensive health care reform will pass the California legislature in a form that the Governor would sign. Even then it’s unclear whether voters will approve the initiative financing the bill, without which most of its provisions will never become law. And as previously posted, even if voters do approve the the ballot measure, it’s unclear whether federal health care reform will preempt the state’s effort before it can be enacted.

That’s a lot unclearness. But today is a time for Governor Schwarzenegger and Speaker Nunez — and their staffs — to celebrate a very real victory. The process of creating clarity can wait a few more hours.

Your State Government at Work

Update: December 17th, 10:00 am — New amendments to ABX1-1 are due any hour now. Word has it they’re fairly extensive. Whether these changes mean the hearings and votes will be delayed or not is unclear.  

The Assembly Appropriations Committee needs to vote on the health care reform compromise package hammered out by Assembly Speaker Fabian Nunez and Governor Arnold Schwarzenegger before Assembly Bill X1-1 (Nunez) goes to the full Assembly. So they’re scheduled to meet and “consider” the legislation at 11:00 am today.

At around 1:00 the legislators will meet in party caucuses. Assembly Minority Leader Mike Villines has already pledged his party’s opposition to new taxes or a “government run healthcare scheme.” So they’ll be working on how to muster their opposition.

In the Democrat caucus members will hear an explanation as to why they should support the package. (It would be interesting to know how many will have read it by this afternoon — probably more than we expect, but less than we hope). As mentioned in my previous post, the California Labor Federation’s president has asked for a delay on the vote for a few days until they can study the bill. The Speaker’s office is moving forward, however, and announced the support of two unions for ABX1-1: the California State Council of Laborers; and California Conference of Carpenters.

Meanwhile, back to the voting: once the caucuses are finished the full Assembly will convene. Spirited debate will follow and, sometime this afternoon, ABX1-1 will be passed by the Assembly on a party line vote. It will be interesting to see how many, if any, Democrats vote against the bill or, if not willing to go that far, are “absent” for the vote. It will be irrelevant, but it may well be one of the few interesting things going on. When you already know the end of the story you’ve got to pay attention to something to stay engaged.

For those wanting to listen in to all of this scurrying around, click on over to the California State Assembly web site. I’m not sure what room the Appropriations Committee will be using, but it shouldn’t be hard to determine if it’s being broadcast.

Once the celebration ends in the Assembly chamber, all attention will turn to the Senate side of the Capitol. Senate President Pro Tem Don Perata has said it’s irresponsible to enact health care reform in the face of a $14 billion state deficit. He’s even signaled the Senate will not be convening before the new year. However, the pressure on him to pass ABX1-1 will be tremendous. My guess is he’ll make a definitive statement soon — no later than Wednesday.

Ramming Health Care Reform Through the California Assembly

Assembly Speaker Fabian Nunez insists the full Assembly will vote on the compromise health care reform compromise he hammered out with Governor Arnold Schwarzenegger. Never mind that members and others will have had little time to review the complicated legislation. The deal is the deal and Democratic members are expected to fall into line.

This doesn’t sit well with the California Labor Federation, the trade group representing the state’s unions. According to the Los Angeles Times, the Federation’s leader, Art Pulaski, is urging Assembly members to postpone the Monday vote. Apparently, the unions would like a chance to actually read the legislation and understand it before taking a position on it.

In a letter obtained by the Times Mr. Pulaski sent to Assembly members he writes, “We feel cheated of the opportunity to take a position on a bill that will impact the lives of every working family in California.” Steve Maviglio, a spokesman for Speaker Nunez, says the Labor Federation has been involved in drafting the bill “from Day One until the last meeting.”

What Mr. Maviglio doesn’t say is that that there’s a lot that goes on between the handshake at the table and the drafting of the specific language. And the language was released only on Friday.  So is the Speaker’s office chiding Labor’s leadership for being slow readers?

Meanwhile, the new leadership at the Service employees International Union, which represents healthcare workers, among others, has endorsed the bill (presumably they’re speed readers). You may recall that on December 4th the SEIU leadership council replaced its president. The former president was skeptical of the compromise being negotiated by the Governor and the Speaker. The new president is more supportive.

The Health Access web site has a couple of posts that attempt to summarize the bill. I’m sure there are others out there, too. There’s so many interlocking pieces it can be tough to catch everything. Further complicating things is that the funding initiative isn’t available for review yet.

So, on Monday afternoon the California Assembly will vote on is a framework for health care reform which was released on Friday. They will not vote on how to finance the package. Assuming it passes the next test will be in the Senate. As noted in my last point, this puts health care reform in the hands of Senate President Pro Tem Don Perata. He’s on record as claiming the legislature should deal with the state’s budget deficit before enacting the bill. But that was Thursday. A that was then. And Speaker Nunez and Governor Schwarzenegger are in a hurry.

Senator Perata the Key to California Health Care Reform Now

A lot of interesting developments in the past couple of days as California continues its long journey toward comprehensive health care reform. Here’s some of the highlights. Details will follow in the next few days — or become totally irrelevant.

  1. There’s now a new, improved ABX1-1 (Nunez).  According to a story by Laura Kurtzman of the Associated Press, the package requires all residents to obtain health care coverage, implements a one-to-six percent payroll tax on employers, and raises the cigarette tax. (One of the few remaining issues left to resolve is whether the tobacco tax will be raised by $1.50 or $2.00 per pack). The “affordability exemption” demanded by Labor and others is gone, but households earning up to 400 percent of the Federal Poverty Level would receive tax subsidies if premiums exceed 5.5 percent of their income; and for those earning up to 700 percent of the FPL tax credits would kick in if their premiums exceeded 10 percent of their income. As is apparent, negotiators made a lot of changes to the ABX1-1 passed by the Assembly Health Committee last month.  Understanding the package will require a thorough review. 
  2. Assembly Members don’t have much time for that review. Speaker Nunez has announced a vote on the compromise by the full Assembly on Monday, December 21st. Or, of course, they could skip reading the bill and simply vote the way their party leaders tell them. In either event, the result is likely to be the same: expect the Assembly to pass ABX1-1 on a party line vote.
  3. Senate President Pro Tem Don Perata called passage of health care reform legislation before Sacramento addresses the state’s looming budget crisis “imprudent and impolitic.” He told Senate colleagues not to expect to meet before the end of 2007. (This is significant because, depending on who you talk to, work on the initiative to finance ABX1-1 needs to begin next week or early-January if the measure is to be on the November 2008 ballot).
  4. Governor Arnold Schwarzenegger and Speaker Nunez have already begun positioning their compromise as being a financial boon for the state. According to a statement issued by the Governor’s office, health care reform would “bring billions of dollars of badly needed money to our healthcare system and ensure that future Governors will not have to make the decisions we are being forced to make today.”  Central to this argument is the relief ABX1-1 provides the General Fund in connection with MediCal financing. By using a tax on hospitals to raise the reimbursement rate, California providers will benefit from increased federal matching funds.

There’s a whole lot to digest here. It’s a complicated package and with lots of nooks and crannies for devils to hide in.  Whether understanding the bill will be worth the effort depends a great deal on Senator Perata.

It will be difficult for him to claim that what was “imprudent and impolitic” on Thursday is sound public policy on Monday. But both the Governor and Speaker are working hard to position their health care reform package as good for the state’s economy and budget. If their argument gains traction with the media and the public Senator Perata would have the coverage he would need to reverse course and push the compromise through the Senate. If that’s what he wants to do.

That’s unclear, however. He’s made very complimentary statements about the compromise, calling it better than he thought would emerge from the long and arduous negotiations. But he also seems genuinely focused on dealing with what could be a $14 billion budget deficit.

Over the next few days, it will be important to keep an eye on how various stakeholders respond to ABX1-1. Has it crossed the line in the sand Labor and its allies drew during the November 14th Assembly Health Committee hearing? Or has that line shifted to the right in the past month? Will the business community consider the reform package a benefit to their bottom lines or a drag on it? What do doctors think about the package? The carriers? Agents? Editorial boards?

If keeping track of how all these folks respond to the compromise seems too daunting a task, it’s easy to simply things: just watch for what Senator Perata. Because the fate of health care reform is largely in his hands now.