Editorial, Opinion Pieces

Summaries of an editorial and two opinion pieces regarding health care reform in California appear below.

• San Diego Union-Tribune: "Unfortunately, instead of considering the likely result of the governor's and the speaker's health proposals, most of the Legislature (and the media) have kept busy applauding their good intentions," a Union-Tribune editorial states. "[W]e welcome Perata's call to have the [LAO] examine whether" the health care reform plan "is truly revenue neutral," according to the editorial. "Here's hoping Perata's burst of common sense finally gives California the full health reform debate it has needed all along," the editorial concludes (San Diego Union-Tribune, 12/18).
• Daniel Weintraub, Sacramento Bee: The ballot measure asking voters to approve a financing plan for health care reform would "attract significant opposition" from Blue Cross of California, the tobacco and pharmaceutical industries, and the California Nurses Association, Weintraub writes in his Bee column. "Together, those interest groups could spend $100 million or more in November in an effort to persuade voters to reject the measure," Weintraub concludes (Weintraub, Sacramento Bee, 12/18).
• Daniel Walters, Sacramento Bee: Schwarzenegger and Núñez are pushing "an incomplete, unclear and legally questionable" health care reform plan that is, "at best, a work-in-progress that has generated as much opposition as it has support," Walters writes in his Bee column. "It's a lousy way to make public policy that could affect the lives of millions of Californians," according to Walters, adding, "the good news is that the Senate ... is moving more deliberately and has delayed any action until next year" (Walters, Sacramento Bee, 12/18).

Broadcast Coverage

Several broadcast programs reported on the Assembly vote and related issues. Summaries appear below.

• Capital Public Radio's "KXJZ News": The segment includes comments from Núñez and Assembly Minority Leader Mike Villines (R-Clovis) (Russ, "KXJZ News," Capital Public Radio, 12/18). A transcript and audio of the segment are available online.
• KPBS' "KPBS News": The segment includes comments from Chuck Idelson of the California Nurses Association (Goldberg, "KPBS News," KPBS, 12/17). A transcript and audio of the segment are available online.
• KPCC's "AirTalk": The program on Monday included a discussion with Andy Stern, president of the Service Employees International Union, and Daniel Zingale, senior adviser to Schwarzenegger, about the agreement between Schwarzenegger and Núñez (Mantle, "AirTalk," KPCC, 12/17). Audio of the segment is available online.
• KPCC's "Patt Morrison": The program on Monday included a discussion with Weintraub about the compromise plan (Morrison, "Patt Morrison," KPCC, 12/17). Audio of the segment is available online.

Who Is Covered?

Under the plan, most residents would be required to have health insurance. The state also would set up a program for low-income residents and increase Medi-Cal rates for physicians and hospitals (Ainsworth, San Diego Union-Tribune, 12/18).

The plan would extend coverage to 3.7 million of the 5.1 million California residents who are considered permanently uninsured, according to Núñez's office (Young, AP/Los Angeles Daily News, 12/17).

Insurers would be required to provide coverage to all applicants, regardless of age or pre-existing medical conditions. The plan would require insurers to spend no more than 15% of premiums on administrative costs and profits (Herdt, Ventura County Star, 12/18).

Children whose families have annual incomes up to 300% of the federal poverty level will be eligible for coverage (San Diego Union-Tribune info box, 12/18).

About one million uninsured undocumented immigrants would be excluded from the plan, as well as an additional 500,000 low-income residents who do not enroll in coverage or cannot prove they are documented residents (Zapler, San Jose Mercury News, 12/18).

Levels of Coverage

The bill would assign a state board to determine the minimum level of coverage that applicable residents would have to obtain.

The most limited and low-cost policies would cover preventive care and routine physician visits but include a $2,500 deductible for other services, according to Núñez's office (Rau/McGreevey, Los Angeles Times, 12/18).

Tax Credits

The plan would provide tax credits for purchasing coverage to:

• Residents who spend more than 5.5% of their incomes on health insurance as long as their incomes do not exceed 400% of the federal poverty level; and
• Residents who spend more than 10% of their incomes on health insurance if their incomes do not exceed 700% of the poverty level (California Healthline, 12/17).

Employer Contributions

The plan would require all businesses to provide health care coverage or contribute toward a state pool for purchasing insurance (Chorneau, San Francisco Chronicle, 12/18). Employers that do not provide coverage and have payrolls:

• Up to $250,000 would contribute 1% of payroll toward coverage;
• From $250,000 to $1 million would contribute 4% toward coverage;
• From $1 million to $15 million would contribute 6%; and
• Above $15 million would contribute 6.5% (California Healthline, 12/17).

Other Funding

The plan also would be funded through:

• A tobacco tax increase of $1.50 to $2 (San Jose Mercury News, 12/18);
• A 4% tax on hospital revenue in an effort to secure matching federal funds and boost Medicaid reimbursements for services; and
• About $5 billion in anticipated new federal funding, including for Medi-Cal (California Healthline, 12/17).

Wellness, Information Technology

The plan also would offer programs for smoking cessation, diabetes management and other issues, as well as encourage the use of electronic health records (Los Angeles Times info box, 12/18).

Senate Vote Unlikely This Year

Despite the Assembly's approval of the plan, Senate President Pro Tempore Don Perata (D-Oakland) said he will not call Senate lawmakers back until the 2008 session begins on Jan. 7 (Sack, New York Times, 12/18).

Perata has asked Legislative Analyst Elizabeth Hill to determine how the health care reform plan could affect the state's projected $14 billion budget deficit (Sacramento Bee, 12/18).

Hill's report will not be available until mid-January, at the earliest, because Perata wants it to account for the governor's proposed fiscal year 2008-2009 spending plan (Sacramento Bee, 12/18). Schwarzenegger will outline his budget proposal on Jan. 10 (California Healthline, 12/14).

Schwarzenegger maintains that the health care overhaul will not affect the state's general fund (San Diego Union-Tribune, 12/18).

If the Senate delays a vote until January, 1.2 million signatures must be collected in fewer than 50 days in order to qualify the plan's financing mechanism for the November 2008 ballot, which would be a "near-record pace," according to the County Star (Ventura County Star, 12/18).

The financing mechanism for the plan was omitted from the bill because it lacks the two-thirds support from the Legislature that is necessary for tax increases (Los Angeles Times, 12/18).

There is a debate among health care insiders on whether the Assembly's approval is enough to begin drafting the ballot initiative now rather than wait for the Senate to vote.

Perata believes the LAO report will not impede the chances of qualifying the funding mechanism for the November ballot because other initiatives have qualified in less time, according to Alicia Trost, Perata's spokesperson (Myers, KQED, "Capitol Notes," 12/17).

Schwarzenegger said, "I am confident the Senate will follow up and quickly move the finish line even closer because I know [Perata] is a big big believer in making sure everyone has medical insurance" (Sacramento Bee, 12/18).

The governor's Web site features video footage of the governor's speech in reaction to the Assembly vote (Office of the Governor release, 12/17).

Republican Opposition

Assembly Republicans assailed the bill as the "largest tax increase in California history." The caucus has proposed less comprehensive alternatives, such as expanding local clinic services and tax credits for health care costs (San Francisco Chronicle, 12/18). According to the Bee, no Republicans voted for the plan (Sacramento Bee, 12/18).