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Lots of bills, no accord on health care
(Sacramento Bee, The (CA) (KRT) Via Thomson Dialog NewsEdge) Apr. 10--Massachusetts Gov. Mitt Romney on Wednesday plans to approve a universal health insurance bill so popular with both Republicans and Democrats in his state that he's issuing tickets for the signing ceremony at Boston's historic Faneuil Hall.
It's unclear whether Massachusetts' proposed bipartisan solution to the health care crisis will actually work. It mandates that individuals, employers and government must each shoulder added responsibility so that everyone can have coverage.
But Massachusetts lawmakers are winning applause nationally for moving forward with a plan while states like California remain deadlocked over the best way to solve the problem.
"I think there are some really positive lessons from the Massachusetts experience," said California Health and Human Services Secretary Kim Belshe. "No. 1, politically, Republicans and Democrats can come together and reach consensus around what truly is one of the most complicated and difficult policy issues facing the nation."
California lawmakers this year are considering a long list of health care bills with approaches ranging from creating a government-run, single-payer system to giving people tax breaks on health savings accounts, an individualist approach favored by the Bush administration. Like the Massachusetts plan, two different California bills would require state residents to have health insurance or pay penalties.
So far, there appears to be little common ground.
"Everyone has their own ideas about reform and they're very invested in that idea," said Peter Harbage, a health policy expert at the New America Foundation, a think tank that favors a bipartisan approach like the one enacted in Massachusetts. "Everyone's second choice in terms of reform is the status quo. And that's why you end up with the gridlock in California. You just have to figure out how to crack that code to move forward."
No one in California government disputes that something needs to be done. There are 6.3 million people, about one in five state residents, without health insurance here - a number roughly equal to the entire population of Massachusetts. Health care costs are continuing to rise, and increasingly, leading employers are dropping health benefits.
People without insurance end up seeking medical treatment in hospital emergency rooms, driving up overall health-care costs for everyone else when they can't pay their bills. The state and federal governments also spend billions of dollars a year in subsidies to California hospitals to help offset care for the uninsured.
The Massachusetts legislation would attack the health care problem several ways: State residents who do not get insurance through their jobs will be required to buy insurance if they make more than a certain income level - $60,000 for a family of four. The bill would enact insurance reforms to reduce the cost of insurance for people who are required to buy it. It would expand government programs that cover the poor and people with moderate incomes. And it would charge businesses that don't provide insurance $295 a year for each employee.
Romney, a Republican, said he might veto the last provision.
There are some key differences between Massachusetts and California that present unique challenges here, Belshe and Harbage said.
For one thing, the proportion of the population that's uninsured in California, about one in five, is about double the proportion of the population that's uninsured in Massachusetts. While about 66 percent of private employers provide health insurance in Massachusetts, only about 56 percent offer insurance in California, placing a greater burden on public services.
And California's uninsured have a much higher poverty rate, making it likely that any universal coverage program would have to provide government subsidies for a greater proportion of the population.
Still, some lawmakers are embracing the many-layered approach. Assemblyman Keith Richman, R-Northridge, and Assemblyman Joe Nation, D-San Rafael, introduced a bill last year that would have provided tax credits to employers for private coverage and implemented tax penalties for Californians who didn't have insurance if they could afford it. It died quickly. This year, both members have introduced similar bills.
"Many of the provisions of the Massachusetts reform are very similar to what Joe Nation and I proposed," said Richman, attributing the failure of last year's effort to partisan gridlock. "It's an uphill battle here in the Legislature."
Advocates for mandatory insurance say many of the uninsured can afford it. According to the California Health Care Foundation, about one-third of uninsured state residents have family incomes over $50,000. And about one in 10 workers who is eligible for insurance at work - usually young, healthy people - turns it down because he or she doesn't want to pay the premiums.
Meanwhile, Sen. Sheila Kuehl, D-Santa Monica, and some other Democrats are pushing a single-payer system that would put everyone in a state-run program. A patchwork approach that requires people to buy insurance won't work, said Kuehl, author of Senate Bill 840.
"None of these plans that require people to have insurance do anything to make the insurance affordable," Kuehl said. "If they call something affordable, it's only because it's inadequate. ... They have very high deductibles or they cover very little."
California lawmakers did approve one dramatic health care solution when they passed Senate Bill 2 in 2003, mandating that all large employers in the state provide health insurance. But voters repealed the law a year later by defeating Proposition 72 in a campaign largely financed by restaurant and retail chains.
Kuehl sees her solution as the logical next step after SB 2.
"Every Californian has to pay in (to a single-payer system), but the fact that the state health plan also is a single payer for the services allows us to cut back on the administrative costs by a good $10 billion a year," she said.
Kuehl's plan carries a $100 billion price tag. Republican lawmakers say that's too much. And they oppose the idea of a government program. Instead, a group of Republican lawmakers last week unveiled a list of bills that would make health care more affordable through tax credits and deductions.
Whether the Legislature is able to reach a consensus, the state is taking some incremental steps.
Gov. Arnold Schwarzenegger is seeking to expand the number of insured children in the state by spending about $70 million on efforts to increase enrollment of those who are currently eligible for government programs. A new deal with the federal government will provide funds for expanding the number of people who are eligible for public programs like Medi-Cal.
"The problem of the uninsured is of such magnitude and complexity that it is impossible to think any one equation is going to address the problem," Belshe said. "It can't all be about individual responsibility. It's can't all be about government. And it can't all be about employer obligations."
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Health care bills
Legislation under consideration in the Legislature:
-- Senate Bill 840. Author: Sen. Sheila Kuehl, D-Santa Monica. Would cover all Californians with a health-care system run by the state.
-- Senate Bill 1414. Author: Sen. Carole Migden, D-San Francisco. Aimed at Wal-Mart, would require employers with more than 10,000 employees to spend at least 8 percent of their payroll costs on employee health care.
-- Senate Bill 1584. Authors: Sens. George Runner, R-Lancaster, and Dick Ackerman, R-Irvine. Assembly Bill 2010. Author: Assemblyman George Plescia, R-La Jolla. Both bills would allow the same tax deduction on state income tax returns for a health savings account as is allowed on federal taxes.
-- Senate Bill 1672. Author: Sen. Abel Maldonado, R-Santa Maria. Would give a tax break to medical providers for investments in information technology.
-- Assembly Bill 1952. Author: Assemblyman Joe Nation, D-San Rafael. Would require individuals to have insurance and would require employers to provide insurance. Would create a purchasing pool run by the state through which Californians could purchase low-cost insurance.
-- Assembly Bill 2450. Author: Assemblyman Keith Richman, R-Northridge. State residents would be required to have health care coverage. Would create purchasing exchanges to provide lower-cost insurance to people who don't get benefits through their jobs. Would provide subsidies to help some employers offer health benefits.
-- Assembly Bill 2737. Author: Assemblyman Alan Nakanishi, R-Lodi. Would institute a 15 percent tax credit for employer contributions to high-deductible health plans, which are used in conjunction with health savings accounts.
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