Speaker Nunez to Put Single Payer Under ABX1-1 Microscope

Few pieces of major legislation in recent years have been subjected to the scrutiny Assembly Bill X1-1 received last week. ABX1-1, the compromise health care reform bill proposed by Governor Arnold Schwarzenegger and Speaker Fabian Nunez, was the topic of an 11 hour hearing by the Senate Health Committee on January 23rd and a thorough analysis of its finances by the Legislative Analyst’s Office. Indeed, it was the LAO report that opponents on the committee cited most in justifying their position.

Now other health care reform proposals are about to go under the same microscope. Speaker Nunez has promised nothing less. And first in line is likely to be the single-payer legislation, Senate Bill 840, championed by Senate Health Committee Chair Sheila Kuehl.

Supporters of ABX1-1 held a press conference on Tuesday to affirm their commitment to enacting comprehensive health care reform for California. During his turn at the microphone, Speaker Nunez referred to ABX1-1 as a “road map to getting the right type of health care that we need, to be a bridge between those who want government run health to those who want the private market to dictate the pace of how health care is delivered.” He pledged to continue to pursue this type of reform.

At the same time, he made clear his intent to hold proponents of competing systems — and specifically single-payer proposals — to the high degree of scrutiny to which ABX1-1 was subjected. It’s worth noting that among ABX1-1’s most vehement opponents was the California Nurses Association. They insist the only health care reform worth enacting is one that eliminates the health insurance industry and turns health care over to the government.

“I think it’s time … to have an honest conversation about single payer,” the Speaker said. “We cannot create the false sense of hope that we can do something better if it hasn’t been tested, vetted and put through the same type of scrutiny that our effort has been put through. And I intend to put each and every proposal that seeks to cover health care for everybody through that same process, because I think it’s only fair. And because I also believe that we need to be comparing any proposal not to some wishful thinking of what we might be able to do two decades from now, but to the world we live in today.”

In the past Speaker Nunez has supported SB 840. In introducing his own reform package early last year, Assembly Bill 8, he commented that while he preferred a single-payer solution he accepted Governor Schwarzenegger’s promise to veto it. Yet now he seems intent on demonstrating that SB 840 presents an even greater financial risk for the state than did ABX1-1. And that shouldn’t be hard to do.

Sacramento Bee columnist Daniel Weintraub recently commented on similarities in the risks posed by SB 840 and ABX1-1.  “[T]he single payer plan, to be financed primarily by a 12 percent payroll tax, would have run up a deficit unless its managers could have slowed the growth in health care costs to below the level of the growth in wages — an extremely unlikely prospect. To control those deficits, the commission to be put in charge of health care would have been empowered to cut benefits and levy co-payments on consumers. Hardly a risk-free undertaking.”

ABX1-1 was subjected to extraordinary scrutiny. What’s surprising is that such vetting is extraordinary. Major legislative initiatives — especially on issues that touch the lives of Californians as profoundly as health care reform — should be put under an ABX1-1-like microscope. This kind of detailed evaluation is, after all, what legislators are supposed to do. If some popular proposals are found to offer nothing more than a false sense of hope, so be it. Better to learn that now than after it’s enacted.

More significantly, it’s this approach that will help lawmakers find responsible ways to address challenging and complex issues. Ways that few might consider perfect, but that the majority can conclude with confidence, is an improvement to the status quo.

Let the scrutiny begin.

ABX1-1 Earns Eclectic Mix of Opponents

People are known by the friends they keep. Public policy is often characterized by its opponents. “If so-and-so opposes this,” a supporter will say, “it must be good.” Assembly Bill AX1-1, the California health care reform compromise worked out by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez, must be one eclectic bit of legislation. It’s opponents are folks you might expect to be loath to remain in the same room together, let alone sit on the same side of a table.

The California Nurses Association opposes ABX1-1 because it permits insurance companies to remain in existence. They prefer a government-run, single-payer system. Blue Cross of California, the state’s largest health plan, opposes ABX1-1 for, among other reasons, it gives government too large a role in the health insurance market.

The California Chamber of Commerce, the National Federation of Independent Business, and the California Manufacturers and Technology Association are among a dozen business groups opposing ABX1-1 because they consider it bad for, well, business. And the United Food and Commercial Workers opposes it because they think it harms workers.

Whether this makes them an eclectic crew or just a motley one says more about you than them, I suppose.

Of course, for every opponent, there’s an opposite and equal proponent. The California Hospital Association, a health plan or two, a business coalition led by Safeway CEO Steve Burd and the Service Employees International Union have already lined up behind ABX1-1 or are likely to soon.

Whether ABX1-1 will ever take effect is uncertain. Passed by the Assembly, it awaits consideration by the State Senate. If it gains legislative approval, it’s implementation is contingent upon passage of a funding initiative supporters are seeking to qualify for the November 2008 ballot.

In the meantime, rumor has it some of these opponents of the health care reform package are already talking about forming an alliance to defeat the funding measure. As one rumor monger, who asked for anonymity noted, “The California Nurses Association and the tobacco industry teaming up. You have to wonder what they’re smoking.”

You also have to wonder about what will happen to the space-time continuum if nurses start asking Californians to vote “No” on the health care reform initiative in commercials paid for by tobacco companies. Where’s Rod Serling when you need him?

Sheila Kuehl on ABX1-1

Assembly Bill X1-1, the California health care reform package worked out by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez, will receive its first Senate hearing on January 16th before the Senate Health Committee. (Update as of January 14, 2008: It appears the Senate Health Committee will take up ABX1-1 on January 23rd, not the 16th). This hearing will focus more on the policy issues underlying the legislation. While the financing scheme underpinning the bill will no doubt be debated, that topic is more in the purview of the Senate Appropriations Committee, which will hear the bill later, assuming the Health Committee moves it forward.

Which it is nearly certain to do. However, that doesn’t mean the Health Committee hearing will likely be an easy time for sponsors of ABX1-1. That’s because Senator Sheila Kuehl chairs the Health Committee.

Senator Kuehl is intelligent and politically savvy, a potent combination. She won’t frustrate Senator President Pro Tem Don Perata’s plans for ABX1-1. If he insists the bill move out of her Committee, it’s will in all likelihood move out of her Committee. But that doesn’t mean Senator Kuehl will give the bill a free ride. Expect tough questions and an insistence on thorough answers.

In anticipation of the January 16th hearing, I thought it would be interesting to explore Senator Kuehl’s views on ABX1-1, the Health Care Security and Cost Containment Act as it is officially known. To get straight to the bottom line: she doesn’t like it.

Senator Kuehl has written extensively over the past year on the Governor’s health care reform efforts. As the most ardent advocate of a government-run, single-payer system, Senator Kuehl was predisposed against the public-private sector approach advocated by the Governor to begin with. And she approves of little of what’s contained in the bill that emerged, or in the way ABX1-1 was fashioned.

Process: Back when it looked like the legislative leaders and the Governor might produce a bill before the regular legislative session ended in mid-September, Senator Kuehl posted a statement on her web site warning “[t]he prospect of legislative staff, sitting behind closed doors, hastily crafting a 100-page health reform ‘compromise’, to be pushed through the legislature with little or no public input over the course of the next 14 days, is deeply irresponsible.  Frankly, given the example of the energy deregulation bill, we ought to know better. ”

As it turns out, it took a special session and several more months of negotiations to work out the compromise that became ABX1-1. And while there was extensive consultation with the public and stakeholders, it was only avialable in printed form hours before the Assembly passed the legislation on December 17th.

No one can seriously claim the bill was thoroughly vetted by Assembly Members prior to that vote. Given her previous statements, it’s clear Senator Kuehl will want to make sure it receives the review legislation this complex — and this important — deserves.

Policy: The vetting will no doubt be thorough. There’s not a lot in ABX1-1 Senator Kuehl likes. In an essay posted on her site shortly after the Assembly vote, Senator Kuehl makes it clear she’s underwhelmed with the bill’s scope and unhappy with its approach to addressing health care in California. “The press has described the bill in breathless prose as a ‘giant leap’ for health coverage.  Unfortunately, this is not quite the case, depending on who you are and how and where you work…. [S]ome of the provisions of the bill [are] actually harmful to regular, working-class and middle-class families.  And it provides less help than advertised for poor families, as well.”

She objects to the characterization of the bill as “providing” health care coverage to residents, noting that it’s more accurate to say “Californians would be required to buy insurance with no caps on premiums, no regulation of the cost of insurance or medical expense, no maximum deductibles, and no floor on how little coverage you can buy and satisfy the legal requirement.”

She laments the failure of the bill to define the minimum coverage Californians must have. And how the bill deals with recission of policies by carriers. And how insurers would still be able to maintain provider networks. And how medical assistants working in retail clinics would be subject to less supervision by Nurse Practitioners and Physician’s Assistants.

In short, she finds a lot not to like in the bill.

Senator Kuehl supports creation of a single payer system for California not out of political calculation, but from deeply held beliefs that it’s the right approach for the state and the nation. She knows that if ABX1-1 becomes law it will make it harder to pass her bill, introduced in the past two legislative sessions as Senate Bill 840, to succeed.

As I’ve noted previously, many progressives who support SB 840 seem willing to accept ABX1-1 as a partial victory. Senator Kuehl and a significant number of her strongest supporters are not. Senator Kuehl was one of the few Democrats in the State Senate to vote against AB 8 last September, the health care reform plan sponsored by Speaker Nunez and Senator Perata. Based on her writing, she’s doesn’t think ABX1-1 is much of an improvement.

Meanwhile, her allies, the California Nurses Association are actively campaigning against the bill. They’ve gone so far as to include snippets of a speech by Senator Barack Obama — without his or his campaign’s permission — in radio ads opposing ABX1-1.

None of this means ABX1-1 won’t make it through the Senate Health Committee. It is all but certain to do so. What it does mean is that, at long last, ABX1-1 will have a thorough, rigorous and comprehensive vetting. Whether you support or oppose the bill, that can only be a good thing.

(Note: A January 14th editorial in the San Diego Union provides more insights into Senator Kuehl’s concerns about ABX-1-1. My thanks to agent Bill Robinson for pointing this out).

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.

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.

Principals Deny California Health Care Reform Deal Imminent

So, who to believe? Those who oppose the current health care reform proposals on the table in Sacramento because they don’t go far enough? Or the principals actually involved in the negotiations?

According to the Sacramento Bee’s CapitolAlert (which has added this blog to it’s list of top blogs, incidentally), the Foundation for Taxpayer and Consumer Rights (FTCR) and the California Nurses Association are claiming California Governor Arnold Schwarzenegger, Speaker Fabian Nunez and Senate President Pro Tem Don Perata are close to striking a deal on comprehensive health care reform with the blessings of the California Labor Federation, AFL-CIO.

Not so says Senator Perata. Not so say spokes-folk for Speaker Nunez and the Governor. Not so says the Labor Federation. 

CapitolAlert says the deal rumors stemmed from a release by the FTCR headlined “California Labor Poised to Sell out Consumers with Unaffordable Mandate.” In the words of Steve Maviglio, Speaker Nunez’s spokesman, the FTCR and CNA are “tragically and deliberately misrepresenting the discussions taking place in Sacramento.” While the principals remain optimistic an agreement will be reached, there’s no deal imminent according to Mr. Maviglio.

Usually when there’s a lack of real news on a topic, the importance of rumors is elevated. It’s also not uncommon for opponents of a possible deal to launch a preemptive strike to remind negotiators that they’re being watched. That might be what’s going on here.

It’s also possible, however, that the FTCR and CNA are upset the single-payer apporach they advocate has been completely marginalized. They may have felt it was time to make some noise to remain relevant. The FTCR especially seems to need — and seek out — press attention nearly as much as too thin celebrities-for-being-celebrities do. Under this theory, the attack on Labor and lawmakers is the political equivalent of posing for the paparazzi.

In the meantime, talks go on, the principals profess optimism but give no progress reports, the budget deficit grows and time is running out. That’s all we really know.