Carpe Diem — or at Least Seize the Special Session

There are actually two special sessions in Sacramento right now: one on water; the other on health care reform. For reasons due to the timing of potential initiatives, water is the first focus. And from what I hear it’s not going well.

But that’s legislation under the bridge (sorry). In a few weeks the Legislature will turn it’s attention to health care reform in earnest. There will be tremendous pressure to do something. After the budget fiasco, the failure to address reapportionment, perhaps inaction on water, Governor Arnold Schwarzenegger, Speaker Fabian Nunez and Senate President Pro Tem Don Perata need a victory of some kind to salvage the reputation of the the 2007 Legislative Session. This is especially important for the Legislative Leadership who will be asking voters to approve a change to term limit laws on the February ballot. If the initiative passes Speaker Nunez and Senator Perata will likely remain in their positions for several more years. If it fails ….

So health care reform might be the last lifeline left to our heroes. Which means something is likely to emerge from the special session. What’s not known is what.

Many observers I’ve talked to are increasingly pessimistic that comprehensive reform will move forward. They think some insurance market reforms may pass, specifically the requirement that 85 percent of premiums be spent on health care services. But when it comes to insuring more Californians, they consider expansion of Healthy Families eligibility to cover more children is the only likely accomplishment (this would be ironic since approximately $66 million promised for enhancing Healthy Family and MediCal outreach programs was cut from this year’s budget).

This may sound reassuring to those who are concerned lawmakers, in their great need to pass some health care reform legislation will pass bad health care reform legislation. Certainly there’s a lot to be worried about. The 85 percent heatlh care services mandate, as currently proposed, will likely increase premiums and decrease competition, especially in the individual and small group market segments. A requirement that carriers accept all applicants, regardless of their risk profile passes, without an effective mandate for individuals to purchase coverage before they’re on their way to the emergency room, individual insurance premiums will skyrocket and carriers will flee the state. The purchasing pool could become a black hole, sucking up more of the marketplace than is healthy for the state’s economy or the private marketplace. And that’s just the start. There is plenty to fear from getting health care reform wrong.

There’s also much to fear in doing little, or even worse, nothing. There are real problems in today’s health care system. Insurance reforms are a part of what’s needed. It’s not the only part needing a fix, far more important is the need to deal with escalating health care costs.  Yet politics being what it is, the focus now is on the insurance industry. If not changes emerge from Sacramento, the demand for “doing something to stop the evil insurance companies” will continue unabated. Doing something, if it’s done right, will enable politicians, the media and the public to focus on deeper and more serious problems.

Another reason to do something right now is to deflate the momentum of building behind single payer alternatives like SB 840. There is likely to be an initiative next year to bring a Canadian-style system south to California. It will be much easier to defeat — as it should be for a host of reasons — if voters perceive lawmakers as addressing their health care worries.

Finally, it’s important to do something constructive on health care reform because it’s the right thing to do. In unveiling his reform package, the Governor state, “The status quo can no longer be everyone’s second choice.” He’s right. The issues have been on the table long enough. What we need now is to address those issues and then move on. What will be interesting to watch is whether the way lawmakers seek to address health care reform is aimed at scratching their political itch or in enacting constructive, meaningful public policy. We’ll know in a few weeks.

Budget a Bad Omen for Insuring the Uninsured

As lawmakers prepare for a special session on health care reform and the Governor touts a broad coalition backing universal coverage, the recently enacted budget should serve as a reality check.

Governor Arnold Schwarzenegger and his staff has made clear that any reform package emerging from the special session needs to include an “enforceable” requirement for every Californian to obtain health care coverage. This makes sense. Requiring carriers to issue coverage to all applicants without a corresponding mandate to buy is a formula for disaster. People are logical. If it makes economic sense to simply wait until medical services is needed before buying coverage that’s what they’ll do. Of course, when healthier individuals exit an insurance pool, overall claims increase which leads to higher prices for those remaining. This drives more low cost individuals from the pool and premiums move even higher. Eventually you wind up with New Jersey where the average premium for individual health insurance is 350 percent higher than in California.

So the state’s promise of passing an enforceable mandate to buy coverage along with a mandate for carriers to sell that coverage is critical to the overall health care reform package.

One of the tenants of the California of Health Underwriters’ Healthy Solutions health care reform plan is that the state should demonstrate it can meet its current obligations before making new promises. Unfortunately, to date, the state has failed in this regard. As the Healthy Solutions document notes, as many as a million Californians are eligible for state-run health care programs, yet fail to enroll. According to the California Health Interview Survey, 447,000 children are eligible for, but not enrolled in, state health programs. Healthy Solutions calls on the state to first enroll this group before creating new programs.

It seemed the state was going to do just that. Earlier this year the Governor held a press conference at the Northeast Valley Health Corp clinic in the San Fernando Valley promising additional state funds to support enhanced outreach.  According to the Los Angeles Daily News, the commitment was so firm nonprofit health clinics and local government agencies had already increased staff to bring many of those 447,000 into the state’s Healthy Families and MediCal programs. Yet, as part of the deal to pass a budget, an estimated $66 million was cut, resources which health advocacy groups told the Daily News would have enrolled about 100,000 children during the current fiscal year. The Northeast Valley Health Corp had hired nine people in April for this effort. At least half will now be let go and the others reassigned.

So, here’s what we’re about to witness: Legislative Leaders and the Governor will announce plans to expand eligibility for Healthy Families and MediCal. They’ll promise to enforce a requirement for all Californians to obtain health care coverage and offer premium subsidies to those in households with less than 400 percent of the Federal Poverty Level. At roughly the same time, the Northeast Valley Health Corp will be laying off roughly half of the nine people it hired in April to expand outreach to children and reassigning the rest.

This strikes me as a credibility problem of near Lyndon Johnson-like proportions. As CAHU suggests, the state needs to keep its current promises before making new ones. Yet the budget fiasco of 2007 demonstrates this may be beyond its ability.

At the very least all of this should (but won’t) give advocates of single-payer programs pause. After all, it’s a pretty bad omen when a liberal Legislature and a moderate Governor fail to reach out to 100,000 kids. Imagine what might happen when the pendulum swings to a conservative state government. And the pendulum always swings.

Will Budget Impasse Delay California Health Care Reform?

The California budget for this fiscal year was to have been finalized before July 1st. Senate Republicans are withholding their needed votes, however, until more cuts are made and regulations are changed.  With lawmakers at home for their summer recess until August 20th passage of a budget anytime soon is unlikely. And with the Legislature scheduled to adjourn for the year on September 14th, the window available to pass other legislation is short.

Health care reform, as embodied at the moment in Assembly Bill 8 (Nunez), is just one of several major pieces of legislation held up by the budget impasse. Governor Schwarzenegger has an ambitious proposal concerning California’s water supply while Legislators are passionate about reforming term limits and addressing reapportionment.

So the question is, will the budget fiasco derail passage of health care reform legislation? The Los Angeles Times reports today that, the answer is probably “yes.” Under the headline, “Budget deadlock stalls Schwarzenegger’s agenda” the Times reports, “Everything has been put on the sidelines,” said Senate Leader Don Perata (D-Oakland). “No one would like to have a healthcare bill more than I would. But if we don’t have a budget, nothing else matters.” The article concludes with another quote from Senator Perata, “The only game played in center field here is the budget,” Perata said. “Until the budget is resolved, no one else gets in.”

All this would seem to lead to the conclusion that AB 8 is destined to become a two year bill, right?

I’m not so sure. As I posted earlier, there’s a tremendous amount of political pressure on the Legislative Leadership and the Governor to pass health care reform as soon as possible. Govenor Schwarzenegger wants leverage and visibility in the run-up to the state’s February presidential primary, which means he wants health care reform as soon as possible. The unions, close allies of both Senator Perata and Assembly Speaker Nunez, want health care reform now. Plus Legislators want voters to change the term limit laws on election day in February, and passage of health care reform before then would help cast them in a positive light.

It’s hard, if not impossible, to come up with solid public policy reasons for passing the budget this year. But politics often trumps public policy in capitals across the country. Yet if there’s just a few weeks between passage of the budget and the Legislature’s adjournment, the immutable laws of space-and-time trumps politics, doesn’t they?

Usually. But we have a Governor who has no qualms about making a dramatic gesture. A Governor who relishes acting outside of normal political practice. A Governor, in short, who could easily call for a Special Legislative Session to consider AB 8. As I understand it, all it takes is a stroke of a pen. The press conference is optional, but inevitable.

Calling for a Special Session would emphasize the importance of health care reform to the Governor. And it might be welcomed by Senator Perata and Speaker Nunez as it would enable them to divert attention away from the budget deadlock to substantial public policy. A Special Session would allow both the Governor and the Legislature to achieve their political need of passing health care reform — any health care reform — before the end of the year.

It’s the “any health care reform” that’s the problem. AB 8 needs a lot of work before its anywhere close to ready for implementation. As currently drafted it is likely to cost the state jobs and tax revenue, increase health insurance premiums and the number of uninsured, and devastate an industry that makes up over 15 percent of the state’s economy. Preventing these unintended consequences will require a great deal of discussion, deliberation, hard choices and compromise. In short, AB 8 needs to be a two year bill.

A Special Session might allow for a thoughtful approach to health care reform, but more likely ti will just serve as a forum for political theater. Californians deserve responsible, effective health care reform. There are proposals on the table, like the California Association of Health Underwriter’s Healthy Solutions plan which would deliver on that goal. AB 8 isn’t there yet. The Governor and the Legislature should take the time to get it right. Their constituents deserve no less.