Anthony Wright
Executive Director, Health Access California
The California Legislature's Democratic leaders, Speaker Fabian Nunez and Senate President Pro Tem Don Perata, having passed their health reform bills from their respective houses Thursday, are now looking ahead at trying to meld the two ideas together.
REFRESHER
Both passed their respective SB48(Perata) and AB8(Nunez) bills Thursday. Both have similar features, seeking to provide more security so people can get and keep coverage from their employer, through a public program, or by purchasing it as an individual. Both are expected to extend coverage to roughly 70% of the uninsured.
Both bills:
• Would require employers to contribute at least 7.5 percent of payroll to their workers' health coverage, though Nunez does exempt smaller and newer businesses. Employers would either provide private coverage for their workers, or pay such a fee.
• Would create a state-run purchasing pool where workers could get health coverage if their employers don't provide it.
• Would expand existing public programs to cover all children, and move to subsidize coverage for more lower-income adults through this state-run purchasing pool.
• Would draw down new federal funds by bringing in more matching Medicaid money.
• Would also impose some new rules on insurers, including preventing rampant rejection of consumer for "pre-existing'' conditions, and limiting the amount of premium dollars that goes for administration and profit.
One difference between the two plans, though, is that SB48(Perata) would require Californians earning more than 400% of poverty ($40,840 for an individual, $82,600 for a family of four) to have health coverage, with some exemptions.
THE DEBATE: SB48 (PERATA)
Senators got right to business Thursday morning and debated SB48 for about 30 minutes before voting 23-16 on the measure, in a near party-line vote. Sen. Mark Ridley-Thomas, D- Los Angeles, was not on the Senate floor when votes were cast. Sen. Lou Correa, D-Anaheim was the only Democrat to vote against the measure. Correa also voted "no" on Wednesday to SB840, Sen. Sheila Kuehl's universal single-payer health care measure.
Perata said this was the year to get something done. "It will not get any better unless we jump in the pool and get wet,'' he said. "When medical costs are going up five, six, seven times inflation, something is fundamentally wrong,'' Perata said. That will mean making tough choices, including the broaching the idea of denying care, for instance a hip replacement to a 90-year-old.
Sen. Tom McClintock, R-Thousand Oaks, warned that every state that has attempted to reform health care has ended up worse off. McClintock prattled off a litany of states, saying, "Every time and every place this concept has been tried, it has consistently produced massive cost overruns for government, massive increases in premiums for consumers, widespread fraud and abuse, and ultimately a deterioration in health care services and a rationing of what remains.''
He mentioned TennCare in particular, which he said resulted in increased taxes to pay for the state's attempt to provide health care to the sickest and most vulnerable. Some advocates who have looked at the TennCare model, which was undone recently, believe that the issue was that the state failed to negotiate lower costs for with insurers and drug companies. McClintock also attacked nationalized systems in other countries. "What makes you think European socialism is going to work any better than it does in Europe?'' asked McClintock, in the face of statistics that show industrialized nations with national health care systems do have better life expectancies and infant mortality rates than the U.S.
Sen. George Runner, R-Palmdale, also spoke. He led a group of senators earlier this year in proposing a smattering of bills that would have encouraged bare-bones, high-deductible plans, among other ideas. Republicans said they see the health care problem in California being more about access to care.
"There are many people around who are carrying around insurance cards to say they're insured (on Medi-Cal). They can't see a doctor. That is coverage with very bad access,'' Runner said. This is a key point that advocates have made in past years in an attempt to increase Medi-Cal reimbursement rates for providers, a move that Republicans have been reluctant to support in the past because it would require finding new money (ie: raising taxes) to pay for the increased reimbursements. Runner later told Sen. Sheila Kuehl (during her speech) that he would vote in the budget to increase reimbursement rates, though did not say anything about finding the money to do it.
Lastly, Runner cautioned that Perata's bill could lead to "rationing'' of health care. "It opens the door to us deciding who's worthy of health care and who isn't,'' Runner said.
Sen. Sheila Kuehl responded: "We have rationing now. Rationing is not going to be imposed in a new plan. It's Darwinian. You have money. You can buy insurance. You have health care. You don't have money. You don't have insurance. You don't have health care,'' she said.
The author of a bill for a universal single-payer system. Kuehl is also co-authoring Perata's bill, and asked Perata if he could also work provisions into SB48 that would ensure that consumers' obligations to pay for health care were capped, just as they are in businesses at 7.5 percent. This is a key advocacy goal for many consumer and community groups, that there are guarantees for affordability for consumers, both to get coverage (the premiums), and to use coverage (deductibles and other out-of-pocket costs).
THE DEBATE: AB8 (NUNEZ)
The Assembly debate on AB8 (Nunez) was considerably longer than the Senate, though the tenor of the debate was much the same.
Republicans, however, began the discussion by attempting to “amend’’ the legislation, some of which had never been heard in committee, into AB8. Their point was that they had 18 bills that they felt could help fix the health system, but that none were advancing to the Senate.
While it is true that the Republican health reform bills were not advancing to the Senate, and eight were voted down in committee, ten never had a hearing because Republicans did not ask for a hearing. Additionally, four bills were scheduled for hearings, but were cancelled by their Republican authors.
Speaker Nunez said it was a shame that California – one of the largest economies in the world – had children who couldn’t see dentists and people who didn’t have medication. “Millions of Californians, most of whom are working hard to support themselves and their families, live in fear of getting sick and missing work. Many families have high rates of chronic diseases such as diabetes, which can lead to blindness and amputation,’’ he said. “….Health care currently is a privilege. Those that can afford to have it have it. From this point forward, health care will be a right that’s afforded to everyone in the state.’’
Assembly Democrats orchestrated a succession of comments that made the point about how AB8 was a sound solution for this year. Assemblyman Merv Dymally, who has served as an elected official since the 1960s, walked the Assembly through the history of health reform in California and the country.
Assemblyman Ed Hernandez, a physician, told a story of a former patient who he had first diagnosed with diabetes, and whose health slowly deteriorated because he could not afford the medication or doctors visits. The patient eventually died – and spurred Hernandez to begin his life as a lawmaker to change the system.
Assemblyman Mark Leno urged his colleagues to look ahead at one disease: diabetes, which now afflicts one in eight Californians. In 20 years, he said, experts predict it will affect one in three Californians, and by 2050, it will affect one in two people, he said. “Do you know what this will do to our economy?’’ Leno asked. Already, he said about 50% of health care costs are spent on diabetes related diseases – and that’s with just 1/8th of the population affected.
Assemblyman Hector De La Torre said his healthy five-year-old daughter would never be able to get insurance in the current system because when she was an infant, she had infant botulism. Such a “pre-existing’’ condition would preclude her from getting coverage on the individual market, in spite of her good health today.
Finally, Assemblywoman Loni Hancock, a strong supporter and co-author of Kuehl’s single-payer measure, said she still pined for SB840, but “I recognize the governor does not support the measure. AB8 represents our best chance to do something real for the millions of California children, and everyone who does not have access to health care now. This bill will reduce the number of uninsured by 70%. That is an enormous step forward so many people will no longer have to fear injury or serious illness.’’
Several Republicans spoke and many repeated the fact that none of 18 Republicans bills were advancing. But Republicans, by and large, admitted that there was a problem with the current way that health care was delivered, characterizing it as “damaged’’ and saying they’d like to see “better care for Californians.’’ That’s a change from previous debates, such as over SB2 (Burton) in 2003, where Republicans denied that there were significant problems with the large number of uninsured.
A number of Republican Assemblymembers challenged AB8 and its legality – particularly with respect to the federal ERISA law, which does not allow states to dictate how employers provide benefits to their workers. Assemblyman Todd Spitzer said AB8 was the “sister’’ legislation to the Maryland so-called “Walmart” bill, that would have forced Walmart to spend 8 percent of it payroll on health care for workers. The Maryland law, however, is quite different from AB8, in that it only affected one company, Wal-Mart, and did not provide choices to employers. (For further distinctions and discussion on this point, visit the Health Access WeBlog here.)
Assemblywoman Audra Strickland, R-Moorpark, called universal healthcare a “Las Vegas buffet,’’ where “everyone eats for the same price; everyone waits in the same long lines. Some of those more sought after foods, -- some people get them, some people don't. Buffet patrons consume more food. And they waste more food.”
Strickland had a bill, which was rejected, that would have required Medi-Cal patients, the lowest income, to have Health Opportunity Accounts and "shop around’’ for low prices. This is a goal that CalPERS, one of the largest and most sophisticated health buyers in the nation, is having a difficult time negotiating.
In his close, Speaker Nunez directly addressed arguments that Republicans made about allowing the “market’’ to work. He touched upon the need for government rules to be imposed on insurers. Referring to an asthmatic girl who had been denied coverage, Nunez said his message to health plans is, “you’re going to have to do a little bit more to take care of people.’’“If you enter biz of health care, your fundamental responsibility is not how much goes into your back pocket, but to provide adequate health care. We have a responsibility to see that the market works for the people,’’ he said.
AB8 and SB48 will now head to the opposite houses. Sen. Don Perata said it was likely that the bills would, at some point, be combined into one. Frank Russo at the California Progress Report has posted his update of the press conference with both legislative leaders.
Health Access will continue to keep you informed on the status of health reform legislation and debate. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.
YEAR OF HEALTH REFORM CONTINUES
The passage of SB840 on Wednesday and AB8 and SB48 on Thursday was the perfect kickoff to the It’s Our Healthcare coalition’s weekend of house parties. Beginning Thursday night, more than 400 health activists throughout the state are holding “house parties’’ to help inform friends, family and neighbors about the importance of health reform in California. Activists wrote “get well cards’’ to policymakers to urge action.
By Hanh Kim Quach
By Matt Ortega
