Watched closely by other states, Governor Arnold Schwarzenegger’s proposal to offer near-universal health insurance to Californians at a cost of almost $15 billion was voted down by the state’s Senate Health Committee early this week. Now what?
UI experts Ian Hill, Kim Rueben, Stan Dorn and Steve Zuckerman weigh in.
"The failure of 'big' health care reform in California is a major setback. Looking ahead, however, policymakers might consider taking an incremental step by moving forward with its agenda for universal child coverage.
Contained within several of the state's recent health reform initiatives have been provisions that would have extended health coverage to all children below 300 percent of the federal poverty level, regardless of their immigration status. Essentially, these proposals would fold existing county-based Healthy Kids Programs --shown to be very effective in improving vulnerable children's access to and use of care--into Healthy Families (California's version of the State Children's Health Insurance Program) and provide a stable flow of federal and state funds to support broader coverage of children. To date, however, children's coverage has been subsumed within broader health care reform plans...and gone down to defeat along with these plans.
Now might be a good time to rebound from this defeat and take an incremental step forward, by pursuing universal children's coverage."
Ian Hill, Health Policy Center
"After two days of hearings, a bill that earlier had the support of both the governor and Democratic leadership went down to resounding defeat. Part of this reflects the change in fiscal conditions, with the state going from predicting a budget surplus in July to a $14 billion deficit in January. California will have a hard time raising taxes to pay for current expenditures given supermajority requirements or voter approval for tax increases. The system proposed was complicated to start with and would require voter approval of new taxes.
Most of the political players involved in health care reform were concerned with how all the moving parts would fit together given California’s complicated rules and who would end up paying for the program. Introducing new programs is easier when there are expected surpluses rather than deficits. But, ironically, the need for reform will grow even more if the economy continues to falter."
Kim Rueben, Tax Policy Center
"Policymakers in California just denied health coverage to millions of uninsured residents, most of whom have low incomes. Some of those policymakers care deeply about vulnerable state residents. But the health reform proposal wasn’t good enough, in their view, so they killed it.
We’ve seen this movie before. Unions killed a universal coverage proposal in the 1970s because it wasn’t single-payer health care. Last year, conservatives blocked an SCHIP reauthorization bill that would have limited coverage of higher-income children and adults, because some legislators wanted even tougher limits.
Psychologists have long supported the goal of 'good enough parents.' Children need adequate parents, not perfect parents. 'Good enough health reform' should likewise be our objective, not perfect or even excellent health reform. The problems with American health coverage are so serious that incremental progress – which is not easy to achieve – merits celebration, not excoriation."
Stan Dorn, Health Policy Center
"It seems that the California plan was not taking on the biggest hurdles – getting Senate support and solidifying financing – as it was winding its way along. It also appears that the plan was not ushered through the “dance of legislation” with as much hand holding or broad appeal as occurred in 2006 in Massachusetts, where a similar initiative succeeded.
The decisions to focus on the Assembly without the Senate and to leave the financing for approval in a ballot initiative simply weren’t productive—a lesson for next time or for other states?"
Steve Zuckerman, Health Policy Center
