State and federal law mandates that emergency care be provided to any person, regardless of their ability to pay. Clinics, hospitals, and physicians providing emergency care are often uncompensated, although the amount of the shortfall is not known. Proposition 67, the Emergency Medical Services Initiative, seeks to fund uncompensated emergency care from new and existing revenue sources.
Proposition 67 would generate over $500 million in new revenue for emergency care by expanding the current tax on in-state telephone calls (presently up to .075% of a customer's monthly bill) by an additional 3%, with the funds being directed to a new 911 Emergency Trauma Care Fund. The added 3% surcharge on telephone use would be capped at $0.50 per month for residential service, but the cap would not apply to business and cell phone lines. The Legislative Analyst's Office estimates an initial $500 million in new state revenues from the measure.
Proposition 67 would also redistribute some existing revenue and change the way that revenue is administered. Under present law, each county in California is allowed to create a Maddy Emergency Medical Services Fund using revenues from criminal fines and penalties. Monies from Maddy funds must be disbursed according to a specified formula to physicians, hospitals and emergency medical services programs. Proposition 67 would require all counties to establish Maddy funds. Administration of the funds would be shifted to the state although individual counties could request permission from the state to administer specific Maddy fund accounts.
Presently, California allocates about $32 million in revenue from Proposition 99 cigarette taxes to pay for uncompensated medical care. Proposition 67 would lock in the Proposition 99 allocation at the current $32 million level. Over time, this would have the effect of reducing Proposition 99 revenue for other state programs, since Proposition 99 revenue is declining.
Proposition 67 proponents contend that California is facing a crisis in emergency care. They note that dozens of emergency rooms and trauma centers have closed across the state in the past decade, and that more will close unless new funding is made available. Inaction, they say, means increasingly longer trips to crowded and understaffed emergency rooms. They view the added tax on phone service as modest and note that low income phone customers are protected by the $0.50/month cap on new surcharges for residential phones and by the total exemption of lifeline rates from the tax increase.
Proposition 67 opponents contend that a $500+ million tax increase is not modest and point out that there are no caps or exemptions for cell phones or business lines. In the Official Voter Information Guide opponents argue that "90% of the funds [would] go to large health care corporations and other special interests," with no guarantee that new emergency rooms would be provided or emergency response times reduced.
Official Voter Information
League of Women Voters
Ballot propositions: Analysis of the November propositions by California Journal editors in their October issue.
HealthVote2004.org provides voters with facts and non-partisan analysis, as well as easy access to information on who supports and opposes the measures, who is paying for the campaigns, how much is being spent, results of statewide polls, and the latest news. HealthVote2004.org is a collaboration between two non-partisan, non-profit organizations-the California HealthCare Foundation and The Center for Governmental Studies.
"Health-Related Propositions: Support for Prop. 71, Stem Cell Research Bond, continues to grow. Voters moving to the No side on Prop. 72, Health Insurance Requirements," Field Poll, Release #2147, October 31, 2004.
"Los Angeles Times Poll Excerpts," Los Angeles Times Poll, Oct. 20, 2004.
Responses to questions on Propositions 63, 66, 67, and 71.
Los Angeles Times Poll
"Health-Related Propositions: Prop. 72 (health coverage) ahead by 16 points. Prop. 61 and 63 also lead, but Prop. 67 trails," Field Poll, Release #2140, October 12, 2004.
"Voters sharply divided on stem cell research bond measure: favor two other health-related propositions but oppose a fourth," Field Poll, Release #2130, August 15, 2004.
In this poll, conducted July 30-August 8, 2004, likely voters opposed Proposition 67 47% to 37%.