Budget Vote Will Test Commitment to Health Care Reform

The Senate Budget Committee heard testimony on $1.6 billion in cuts to California’s health care system as part of the legislature’s efforts to overcome the state’s $14.5 billion deficit. Only days earlier, Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez committed to pursuing comprehensive health care reform. Several legislators have also pledged to continue pushing for such reforms. How lawmakers treat health care spending in the budget process will be a strong indication of whether that commitment is for real.

The Senate Budget Committee hearing showed how desperate the state’s financial situation has become. Some of the cuts being considered are counterproductive (cutting back on early medical intervention is no way to reduce overall costs). Some of the cuts were so small as to be rounding errors for the state, but devastating to the recipients of those services. On February 4th the folks at Health Access posted a helpful summary of the Committee hearing on their blog that is well worth reading.

The Administration and the legislature face an extremely difficult task. Finding $14.5 billion in the best of times would not be easy. Now, during the state’s economic troubles and with both chambers facing substantial leadership changes, it will be even more challenging. The solution may require raising taxes, at least temporarily, or at least eliminating some current deductions that don’t make sense. At the very least, Sacramento will need to articulate priorities and then stick to them. That’s a leadership skill state government displays all too rarely.

But the fact is, if they really want to expand health care to more Californians, they’ve got to prove they can deliver health care to those they’ve already promised it to. I don’t envy them the task, but that’s the job they took on when they ran for office in the first place. Now it’s time to deliver.

Will Defeat of Term Limit Initiative Setback Health Care Reform?

Tomorrow, California voters will decide the fate of 42 legislators. Under the state’s current term limits law, these members of the Assembly and State Senate are scheduled to be in the job market at the end of this year. If Proposition 93 were to pass, however, they’d all be able to continue in their current positions — and most (but not all) have indicated they’d do so. If Proposition 93 fails — as it’s almost certain to do — they’ll need to seek out other offices or find something else to do.

There’s a lot of issues swirling around Proposition 93, but this post deals with only with its impact on health care reform. When I first started exploring this my presumption was that the defeat of the term limits initiative would make passing any health care reform measures this year more difficult. Now I’m not so sure.

If Proposition 93 were to pass, most of the lawmakers who had worked on health care reform in the past would be staying put for a few more years. Their accumulated expertise on the issue would, presumably, help them move proposals through the complicated and convoluted policy thicket that is health care reform more quickly than neophytes. They also would not be distracted by the need to campaign for a new office (running for reelection, thanks to the gerrymandered districts California endures, is pretty much a walk in the park for incumbents). This would free them up to deal with making policy.

In theory. In reality, another matter came up that will be a distraction for legislators whether they’re being termed out or not: the state’s ballooning deficit. At last count, the state was $14.5 billion in the hole, but that’s before the over $1.2 billion required to address unfunded retirement health care costs is factored in. And that’s just the start of additional spending and shortfalls that seem to be looming. Addressing this kind of financial disaster will take up most of lawmakers’ time, even if they don’t have to face tough elections.

Whether the current crop of lawmakers is the most capable of passing health care reform is also an open question. It’s similar to the point Senators Barack Obama made in their recent debate to Hillary Clinton’s experience: it’s not enough to be ready on day one, it’s important to be right from day one. An argument could be made that some fresh eyes looking at health care reform could be useful.

Then there’s the reality that nothing the state does on this issue may matter much. If the Democrats take the White House in November, health care reform will be near the top of their agenda. As I’ve written about before, federal reforms could preempt anything California develops. Which diminishes the importance of state lawmakers addressing the problem.

In the end, I think we’ll see a flurry of health care reform proposals being kicked around Sacramento. Most will be incremental reforms. Some would be beneficial to pass; others harmful. The budget deficit will slow their passage through the legislature and most will ultimately fail.

In other words, 2008 is likely to be a typical year as far as health care reform is concerned in California. That’s probably not a good thing, but it is the likely thing.