HEALTH CARE REFORM HEADS WEST. If the Libby pardon has you down, here's a bit of good news. George Skelton reports in the LA Times that "the stars are in rare alignment this summer" for health care reform in California. Democrats in the state legislature have an ambitious plan (PDF) that would expand access to care, though without an individual mandate. Governor Schwarzenegger has his own, slightly more modest proposal, but he hasn't managed to even find anyone to introduce it in the legislature. Without his own plan, he is expected to support the Democratic proposal in order to keep his approval ratings high as memory of his recent global warming legislation fades (legislation he also was barely involved in crafting). The Democratic plan is a big step towards universal health care access in a state that contains one out of eight Americans. The plan requires insures to offer coverage to all individuals without preconditions and sets out a series of subsidies and employer mandates intended to expand coverage:
- Employers would be required to spend 7.5% of their payroll on workers' health care. Schwarzenegger had proposed 4%, but also wanted to sock doctors 2% of their income, and hospitals 4%.
- Insurers would have to spend at least 85% of premiums on medical care. That's borrowed from Schwarzenegger's proposal.
- The state would subsidize insurance for the poor, including children.
- Insurers would subsidize state coverage for people whose "preconditions" prevent them from getting private insurance.
This certainly isn't ideal and the employer mandate in particular is problematic, but it's also encouraging. California has a long history, for better or worse, of setting trends that other state follow -- from ballot initiatives to customized license plates.
Unfortunately, a maddening feature of the California Constitution may kill the legislation even though it has majority support in both chambers of the legislature. In California, raising "taxes" requires two-thirds of the legislature while raising "fees" requires only a simple majority. Democrats and the Governor insist that funds for this proposal will come from "fees" while Republicans in the state legislature claim that any levy on private health plans amounts to a tax. The courts will decide who wins this particular fight, but the the reforms are very popular (PDF, scroll down to page 7) and the mood in Sacramento suggests some kind of reform is likely.