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Hot Topics 2007 | Universal Health Care in California UC Berkeley | Institute of Governmental Studies Library |
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Universal healthcare is a leading issue in California. In his January 2007 State of the state address, Governor Arnold Schwarzenegger proposed providing medical insurance for all Californians. Citing statistics that find 6.5 million people without healthcare in the state, Schwarzenegger said that the need for a universal health care plan is crucial. The governor released a controversial plan to adminster universal system, which vyed with several other universal health care plans introduced by both liberal and conservative groups in the legislature. The most prominent of these, Fabian Núñez's AB 8 advanced through both houses of the legislature before being vetoed by Gov. Schwarzenegger on Oct. 12th. Schwarzenegger and Nunez were able to compromise and on Nov. 8, 2008, Núñez introduced ABX1 1, a bill which carried elements of both the Governor's plan and AB 8. ABX1 1 passed the state Assembly in Dec. 2007 but met stiff resistance in the Senate because of concerns over long-term costs of the plan. ABX1 1 was supported by a range of consumer and labor groups as well as corporate inteterests but was ultimately voted down by the Senate health committee on Jan. 29, 2008. This website contains information on the 7 California universal healthcare plans widely discussed in 2007. Each plan noted includes a description with key provisions as well as current status. Several bills are considered still active and in limbo in the legislature.
Californians have long debated the merits of proposals to expand health insurance coverage. In 1945 Governor Earl Warren recommended the creation of a compulsory prepaid medical service based on payroll deductions from both employer and employee, a plan that was ultimately defeated by the legislature. In 1992 the California Medical Association (CMA) proposed the California Affordable Basic Health Care Act, requiring all employers in the state to provide health insurance for workers and their families. The proposed legislation, SB 248, passed the Senate but stalled in the Assembly. In the 1992 general election CMA sponsored a similar plan as Proposition 166. It was defeated by a two-to-one margin. In October 1999, Governor Gray Davis signed Senate Bill 480 (introduced by then-State Senator Hilda Solis). This law called upon the California Health and Human Services Agency (CHHS) to examine options for providing health care coverage to Californians. SB 480 also mandated that the legislature act on the CHHS findings by enacting universal health coverage for all California residents by July 1, 2003. After the CHHS study was released, SB 921 was introduced by Senator Sheila Kuehl in February 2003. SB 921 would tax up to 5 percent of an employee's annual income and require businesses to provide matching contributions. This would pay for 35 million Californians to have unlimited visits to doctors and discounts on prescription drugs. An elected official would be responsible for running the program. SB 921 passed the Senate in June 2003. Senator Kuehl shelved the bill till 2005 when she re-introduced it as SB 840 (see 2007 plans below). Senators John Burton and Jackie Speier introduced Senate Bill 2 (SB2), which sought to extend health care to about 1 million uninsured Californians. After intense debate SB2 was passed in the final hours of the 2003 session, and signed by Governor Davis just 48 hours before the special election that resulted in his recall. SB 2 became Proposition 72 on the Nov. 2, 2004 ballot. It was defeated, 50.9% to 49.1%. For detailed table of proposed health plans, see Comparisons of California Health Coverage Expansion Proposals from the California Healthcare Foundation.
In 2007, universal healthcare became a leading subject in California politics. With polls revealing that most Californians believe that some form of health care should be available to all residents, both Governor Schwarzenegger and California legislature released expansive and sometimes controversial proposals on how to organize, fund, and administer healthcare that can cover the 33 million people who live in the state. Democrats in the State Assembly and Senate released several plans which met with stiff resistance from Republican and business interests. Sen. Sheila Kuehl resurrected SB 840, which had previously been vetoed by Gov. Schwarzenegger. This bill would have eliminated insurance companies and established a state run system to administer health care. Assembly Speaker Fabian Núñez released AB 8 in December of 2006. AB 8 would have established a "pay-or-play" system that would be financed through employer and employee contributions with federal matching dollars. Sen. Don Perata introduced a similar proposal. Like AB 8, SB48 would have created a purchasing pool for health coverage. The governor released a sketch of of his plan in January 2007. His proposal spreads the cost of healthcare to employees, employers, insurance companies and the state government. After some significant changes, his formal plan was introduced in Oct. 2007. Schwarzenegger stated his desire for the proposal to make the November 2008 ballot. On January 30, 2007, Senate Republicans released their own universal health plan, Senate Bill 236. Their plan would have redirected tobacco tax dollars toward children's health care. Democrats in Sacramento approvde of the Gov. plan over the GOP proposal. However, there was still opposition to Schwarzenegger's proposal on the grounds that it wouldn't guarantee affordability. On July 22nd, 2007 Fabian Núñez and Don Perata agreed to merge together AB 8 and SB 48 into one bill. The new bill required employers to spend 7.5% of their payroll costs on health care and merged SB 48's affordability and evaluation requirements with AB 8's premium assistance requirements and insurance market reforms, as well as many other settlements. AB 8 was vetoed by Gov. Schwarzenegger on Oct. 12th. SB 840 passed the CA Senate in June 2007. It passed to the Assembly but was stalled in committee. SB 236 was referred to the Senate Rules Committee and has missed the deadline to pass out of its house of origin. After the defeat of AB 8, Fabian Núñez introduced ABX1 1, a bill which carried elements of both the Governor's plan and AB 8. The bill was ammended several times, results of negotiations between the Governor's team and legislators. ABX1 1 passed the state Assembly in Dec. 2007 but was ultimately voted down by the Senate health committee on Jan. 29, 2008.
On January 8, 2007, Governor Schwarzenegger proposed that California provide medical insurance to all residents in the state. Under his plan, illegal aliens would also be included as federal law requires hospitals to not turn away anybody in need of medical assistance. Schwarzenegger said that uninsured citizens and illegal immigrants currently seek emergency care in emergency rooms and when they are unable to pay, California taxpayers must pick up the tab. Schwarzenegger's proposal would alter the health care market by spreading the cost of universal coverage amongst employers, citizens, insurance groups, the government and health care providers. Schwarzenegger's plan's original cost was $12 billion. The governor maintained that he woould not raise taxes to pay for his plan. On Tuesday, Oct. 9, Gov. Schwarzenegger released a new, amended version of the proposal which included some changes from his original plan introduced in January. The governor's ammended plan would involve leasing the state lottery to a private group and using about $2 billion a year of the proceeds to pay for universal health coverage. The funds would be used exclusively for health care and would not divert any lottery funds to be used for education. Education has traditionally received $1.1 billion from the lottery each year. In Schwarzenegger's plan, the private company would pay $37 billion for a 40-year lease on the lottery. The state would use that money to create a $2 billion-a-year fixed payment for health care. At the end of the 15 years, the state would have to find the money elsewhere. Financing for the proposal is subject to approval of a ballot initiative. Gov. Schwarzenegger has said he expects the iniative to appear on the November 2008 ballot. The Governor’s plan was formally introduced as ABX1 2 on September 11th and was ammended on November 8th. The Governor shelved his proposal after reaching a compromise with legislators on ABX1 1. Key Provisions:
Supporters of the plan believe that the plan could slow the rate of *hospital closures. They claim that the plan exempts many small businesses that would be unable to afford the new 4% tax. Furthermore, they argue that the plan will not raise taxes but rather charge fees to employers, physicians and hospitals. Many supporters have hailed the governor's plan as a bold new attempt to confront the unacceptable problem of the uninsured in California. Opposition to the plan comes from several sectors. Some small business owners have spoken out that the plan will be too expensive for them to afford. Many labor unions have opposing the plan because they believe that it will not assure that health plans will be affordable. And nurses' groups have complained that the plan is merely an attempt to boost income for the insurance companies. Finally, many believe that leasing the state lottery to a private company is an unreliable method to fund health care, as lottery funds traditionally grow slowly.
On January 30, Senate Republicans released details of their new plan which would use existing tax dollars to provide health coverage for a lowered number of uninsured Californians. The GOP proposal would not gather money from employers and health care providers to pay for health coverage. Republican backers of the plan claim that statistics quoted by Governor Schwarzenegger and liberal policy makers are inaccurate. They claim that a majority of those uninsured are illegal immigrants who should not be eligible for care. They say that another 2 million residents can afford health coverage but do not choose to buy it. Under the Senate GOP proposal, the Legislature would put a ballot measure before voters in the next statewide election to redirect about $580 million in
tobacco tax dollars toward children's health care. Current tobacco tax revenue is used by the First Five California Commission to promote early child development. Backers of the plan say that these funds have been misused by the commission.
SB 840 (Senator Sheila Kuehl) was introduced in January 2005 and went through a long amendments process before being passed by both the Assembly and the Senate in August, 2006. Gov. Schwarzenegger vetoed the bill on the grounds that it was "socialized medicine" and he could not support it. Kuehl re-introduced the bill on February 14, 2007 and it was referred to the Senate Rules Committee. The bill passed the CA Senate in June 2007. It is currently in the Assembly. Key provisions:
AB 8 was introduced by Assembly speaker Fabian Núñez on December 4, 2006. His bill would have created a state purchasing pool which would buy insurance from private insurance companies. This pool would cover employees and dependents. It would restrict insurance companies from denying coverage to people with pre-existing conditions. On July 22nd, SB 48 was combined with AB 8. AB 8 was vetoed by Gov. Schwarzenegger on Oct. 12th. Key provisions:
SB48 would create a purchasing pool for health coverage. This pool would cover all Californians who are employed and their dependents. On July 22nd, SB 48 was combined with AB 8. Key provisions:
ABX1 1 The plan differs from Schwarzenegger's in several ways. ABX1 1 would require every Californian to have coverage but the bill, unlike the Governor's plan, would make exemptions for those whose health care costs make up more the 6.5 percent of their total income. The Democratic plan would call for a $2 a pack increase on the cigarette tax to raise an additional $1.8 billion. This contrasts with Schwarzenegger's plan to lease the state lottery to a private company to raise additional funds. Finally, ABX1 1 would give partial subsidies to people with incomes up to 4.5 times the federal poverty rate as opposed to the 3.5 times the poverty rate mandated in the Governor's plan.
ABX1 1 passed the state Assembly in Dec. 2007 but was ultimately voted down by the Senate health committee on Jan. 29, 2008. ABX1 8
For detailed table of proposed health plans, see Comparisons of California Health Coverage Expansion Proposals from the California Healthcare Foundation.
Health Care for All The Foundation For Taxpayer & Consumer Rights (FTCR) California Health Reform Health Access California
Large majority favors the health care reform package making its way through the legislature. Support for $2 per pack cigarette tax hike to help pay for it, Field Poll, Release 2254, Dec. 21, 2007. PPIC Statewide Survey: Californians and Their Government, September, 2007. The State of Health Insurance in California: Findings From the 2005 California Health Interview Survey, July 2005. PPIC Statewide Survey: Californians and Their Government, Public Policy Institute, June 2007.
California Statewide Health Care Survey. Ditmar, Inc. Feb. 20, 2007 California Voter Views of the Health Care System (part 1 of 2). Field Poll, Release 2221, Jan. 3, 2007. Proposition 72: voters currently disposed to vote yes on referendum requiring health care coverage for employees working for large and medium-sized employers, Field Poll, Release #2127, August 12, 2004. Voters initially supporting health care coverage requirements referendum," Field Poll, Release #2119, June 8, 2004. Voters favor provisions of SB2, the Health Insurance Act of 2003. If a referendum to repeal SB2 qualifies for the ballot, both sides have potent arguments, Field Poll, Release #2104, January 23, 2004.
Health Care Reform, Jan. 22, 2008. Designing Coverage: Uninsured Californians Weigh the Options, July 2007. Jacobs, Ken; Ronconi, Lucas; Graham-Squire, Dave. The Working Uninsured: An Analysis of Worker Health Coverage Among California Industries, July 2007. Wicks, Elliot. Healthcare On the Ballot: A Historical Overview, May 2007. Comparisons of California Health Coverage Expansion Proposals, March 28, 2007. Health Savings Accounts: No Solution for the Uninsured, January 2007 Yelowitz, Aaron S. The Health Care For All Californians Act: Cost and Economic Impacts BalancedPolitics.org
The following citations include links to full-text articles online, when they are available. Some restrictions on use apply, due to licensing requirements. For more information, see Tips for Finding Full-Text Articles. {Opinion] Hammergren, John."Taking care - and reform - forward," San Francisco Chronicle, Jan. 23, 2008. San Francisco Chronicle [Opinion]. Burd, Steve; Hansen, Joe [Opinion].
"Negotiations are key to health care deal," Sacramento Bee, November 11, 2007. Access World News (UCB) [Opinion]. [Opinion]. Gerber, Alex [Opinion]. Burger, Deborah [Opinion]. [Opinion] [Opinion] Leavenworth, Stuart. [Opinion] Weintraub, Daniel. Bruce, Allison.
"Many factors in play as healthcare costs skyrocket," Ventura County Star, March 2, 2007. Access World News (UCB) Núñez, Fabián. Walters, Dan. Chorneau, Tom. Weintraub, Daniel. Burger, Deborah. Ralston, Richard E.
The following citations include links to full-text articles online, when they are available. Some restrictions on use apply, due to licensing requirements. For more information, see Tips for Finding Full-Text Articles. Fernandez, Elizabeth. Chorneau, Tom. Chorneau, Tom. Chorneau, Tom. "State health reform may be pricey prospect", San Francisco Chronicle, Jan. 23, 2008. Young, Samantha. Rojas, Aurelio.
"Health revamp takes a big step: Bill would extend coverage to most of state's uninsured," Sacramento Bee, Dec. 18, 2007. Access World News (UCB) Herdt, Timm. "Assembly OKs universal healthcare bill," Ventura County Star, Dec. 18, 2007. Access World News (UCB) Weintraub, Daniel. Kurtzman, Laura. Rojas, Aurelio. Chorneau, Tom. Geissinger, Steve. Kurtzman, Laura. Zapler, Mike. Zapler, Mike. Baldassare, Mark. Schultz, E.J. Rojas, Aurelio.
"Lining Up On Health Care: With veto vowed, bill's passage sets stage for special session," Sacramento Bee, September 11, 2007. Access World News (UCB) Rojas, Aurelio. "Hospital group backs fee deal: Move aids governor's health care plan, but doctors still oppose it," Sacramento Bee, Sept. 7, 2007. Access World News (UCB) York, Anthony. Rojas, Aurelio.
"Health care bill hung up on fees: there is no visible change on the issue as the governor holds a summit with top legislators," Sacramento Bee, Aug. 29, 2007. Access World News (UCB) Chorneau, Tom.
Rojas, Aurelio.
"Health insurance gets focus today: Governor to meet with legislators, but Perata not optimistic," Sacramento Bee, Aug. 28, 2007. Access World News (UCB)
Goldmacher, Shane.
"Núñez vows health plan vote: Governor's measure to go before Assembly, he says," Sacramento Bee, Aug.25, 2007. Access World News (UCB) Yamamura, Kevn. Chorneau, Tom. Rojas, Aurelio.
"Health care for kids might pass: tThough no funding plan is in place, universal coverage for children and school clinics are seen as having a chance," Sacramento Bee,
Aug. 20, 2007.
Access World News (UCB) Feder, Barbara; Harmon, Steven. "State Senate panel backs Dems' health reform bill," Oakland Tribune, July 12, 2007. Access World News (UCB) Colliver, Victoria.
"Job-based insurance shrinking," San Francisco Chronicle, July 11, 2007. San Francisco Chronicle Rojas, Aurelio. Weintraub, Daniel. Rojas, Aurelio. "Legislature Approves Democrats' Health Plan," Los Angeles Times, June 7, 2007. Access World News (UCB) Chorneau, Tom. Zapler, Mike. "The Health Care Debate:
Assembly panel approves coverage for uninsured:
Bill provides for 700,000 children, including illegal immigrants,"
Sacramento Bee,
Apr. 25, 2007.
Access World News (UCB) Allen-Taylor, J. Douglass. Zapler, Mike.
"Blue Cross sees threat in universal health plan: huge insurer has much to lose," San Jose Mercury News, Apr. 15, 2007. Access World News (UCB) Macdonald, Heather. "Dellums: Health care faces crisis," Oakland Tribune, Mar. 18, 2007. Access World News (UCB) Weintraub, Daniel. "One health care plan -- Kuehl's -- is really different," Sacramento Bee, Mar. 1, 2007. Access World News (UCB) Zapler, Mike. Weintraub, Daniel. Werner, Erica. Rau, Jordan. Boren, Jim. Geissinger, Steve. Correa, Barbara. Benson, Clea. Lawrence, Steve. Chorneau, Tom. Ostrov, Barbara Deder. Chorneau, Tom. Clark, Cheryl. Alonso-Zaldivar, Ricardo. Chan, Gilbert. Martin, Mark.
Darc, Keith. Chorneau, Tom. Chorneau, Tom; Lucas, Greg. |
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