Crunch Time for Health Care In California

Dan Weintraub notes that legislative leaders are meeting today with the governor about the future of healthcare reform. Here's his thumbnail sketch:

The Republican lawmakers have been pretty clear about their opposition to mandates and taxes, which both the Democrats and the governor have as the centerpiece of their plans. But if you leave the Republicans out, then a pay-or-play employer mandate appears to be the only option that can pass on a majority vote, and the governor says he opposes that narrow approach. It looks as if they are going to have to regroup and think about taking the issue to the ballot with a different tax structure, no employer mandate and a broad coalition of support...

We know that Sen. Perata has been subdued about the chances for anything happening this year. And we know that anything resembling a fee will be written off by the no-new-taxes Republicans, even when the governor is attempting to rally support for a fee structure that allows hospitals to get federal money for every dollar they put into an insurance pool. The other major stumbling block is the fact that Republicans and business interests will almost certainly sue the state over whatever proposal is passed into law, either for violating the ERISA statute that prevents states from regulating employer-based plans, or for imposing fees on businesses that would require a 2/3 vote in the legislature. That will happen no matter what gets passed, and yet nobody talks about it.

(To me that's a good thing; employer-based healthcare ought to be severed in favor of something more flexible and more portable. Otherwise more of the problems will exist with people not feeling able to leave jobs because they need to keep their insurance. You also get this annoying tactic of resisting a truly universal system by arguing "If my employer doesn't give me dental care, nobody should have it." Employers may need to pay into a system, but it should not be employer-based; that's a relic of a system from the 1940s, and it's bad for employees and competitiveness.)

It's clear that the eyes of the nation are upon California as they attempt to deal with the healthcare crisis. At precisely the right time, the Census Bureau reported a major increase in the nation's uninsured, to 47 million, including 600,000 new children. As I've said for a while, if the governor really wants to pass something this year he needs to speak up about the effort to cripple any effort at S-CHIP expansion, which is something his health care proposal relies upon heavily. Today New York Governor Eliot Spitzer came out strongly against this morally misguided blockage by the Bush Administration to insure all children; Schwarzenegger has had little to say on this since June, when he called it one of his top federal priorities.

The prospects for a legislative solution are very up in the air right now, so anyone that believes reforming the system must begin now might want to apply some pressure on their represenatives in Sacramento.