The Unmentionable Part Of California Health Care Reform

I thought this was the key moment in the Appropriations Committee debate over ABx1 1, which passed the Assembly yesterday.

Republican Assemblywoman Mimi Walters asked Nunez and the Department of Finance whether they were certain financial projections would come through. AB x1 1 relies on $4.5 billion in federal dollars in addition to other revenue sources. Department of Finance staffer Tom Sheehy said one provision in ABx1 1 would not be implemented unless the Director of Finance declared that money to pay for the program was in hand and in state coffers.

Assemblyman Mark Leno, Democrat chairman of the Appropriations committee, followed up with questions about whether the program could be turned off if money did not come in as expected. Nunez’ staff responded that ballot initiative would contain provisions to assure that insufficient funds would trigger a series of events to pull back the program, including the individual mandate and the market reforms. It would first allow the governor and legislature to fix any fiscal imbalances. If lawmakers and the governor did not act, then the pieces of the legislation would be repealed, including the public program expansions and tax credits, returning the state to the status quo.

This is the key because this is what has happened to every single state that has tried to implement universal health care. They pass the bills with a lot of fanfare but are either unable to control costs or keep up with population or their numbers on revenue fall short (nobody EXPECTED the $14 billion dollar budget deficit this year, to use a parallel example), and the program has to be scaled back and eventually scrapped. And there's no massive celebration or gathering on that day, where everyone gets in a room and congratulates each other. But that's what's happened very single time.

The bill has some advances on the health reform front, and is not an ignoble effort. But nobody seems to want to deal with these historical facts. "This is better than nothing" doesn't mean anything when 5-7 years down the road, you're ACTUALLY left with nothing. And I think walling off the funding and claiming that it's revenue neutral makes it more likely that road will be travelled again. The state budget should reflect priorities. We all want every Californian to have access to health care. Paying for it with part gimmick taxes, part wishes and hopes of federal support, et cetera, shows that you really don't value it all that much. And admitting that the program will fall apart unless people continue smoking a lot of cigarettes... well, you see where I'm headed.

UPDATE: Here's another concern. Overhauling health care in a time of a national trend toward major budget deficits at the state level is a problem that shouldn't be dismissed. And we know that the Governor is going to cut all other health care programs to the bone because there's this separate system to provide coverage, which is actually not true. It's a set-up.