The small group health insurance marketplace was a nasty environment back in the late-1980’s and early-1990’s. Groups were declined coverage because of the nature of their business. Rate increases of 100% or more were not uncommon and were applied selectively on businesses with employees who dared to actually use their coverage. And health plans came into — and out of — the state more frequently than a caffeine addict into a Starbuck’s.
Then Speaker Willie Brown decided to do something about the situation. And in 1991 he introduced AB 350, a “pay or play” bill with a lot in common with several of the proposals being considered by the Legislature today. However, there was no realistic way such a proposal was going to become law. So Speaker Brown and Senate President Pro Tem David Roberti created a conference committee around AB 1672, which until then, I believe, dealt with the medical component of automobile policies.
Speaker Brown and Senator Roberti appointed Burt Margolin to chair the conference committee. Mr. Margolin was highly regarded, smart and very much a liberal (he represented parts of West Los Angeles and Hollywood). But most importantly, he was serious about finding workable solutions to difficult problems. Solutions which were fair, would work and were responsible. He made sure all sides were given an opportunity to speak their peace. More importantly, the committee and its staff listened. They didn’t always agree, but by focusing on policy instead of politics, by being open to all points of view, they fashioned a balanced, effective piece of legislation.
AB 1672 became law in July 1993. While not perfect, it went a long way toward fixing the system without destroying it. No small business could be denied coverage, rates were required to fit within specified bands and rate increases, again within rate bands, were applied equally to all groups in a particular health plan. In short, AB 1672 made the small group marketplace much more fair while creating only a few, manageable unintended consequences.
Comparing the process which led to AB 1672 with what’s happening with AB 8 and with the Governor’s proposal is, at best, disconcerting. The dialogue with stake holders seems perfuntory and almost passive-aggressive. There’s conversations, but it doesn’t seem like anyone’s listening. By meeting with interested parties separately, the drafters are denied the ability to observe and learn from the give-and-take which occurred during the AB 1672 deliberations. And instead of meaningful public policy being the primary focus, it appears that politics and election time tables are front-and-center now.
It seems to me that what today’s process needs is a few more Burt Margolins.
P.S. Incidentally, Burt Margolin is doing fine. He’s president of the Margolin Group, a health policy and lobbying firm which includes among its clients the County of Los Angeles.