Kristen Gerenche: What California's history means for nation's health-reform efforts
[Kristen Gerencher is a San Francisco-based reporter covering personal finance issues. She also writes the Vital Signs column. She previously worked in the KGO-TV’s consumer unit and holds a master's degree from the University of California at Berkeley's Graduate School of Journalism.]
Two years ago, California was where the nation finds itself today: Very close to passing sweeping health-care reform. Gov. Arnold Schwarzenegger, a Republican, was past the halfway point in the year he set out to accomplish an overhaul. He had achieved some victories — hospitals had agreed to pay new fees, public opinion was favorable, negotiations were ongoing — but big obstacles remained. I recently asked three experts who followed California’s long slog what it portends for the broader U.S. reform effort as it unfolds in the next few months.
“One of the rules is never generalize from California,” jokes Jonathan Oberlander, associate professor of health policy at the University of North Carolina-Chapel Hill. But of all the states that have tried their own versions, California is perhaps the most reliable predictor of the hurdles the nationwide effort will face in the home stretch, he argues.
Why? Because unlike Massachusetts, which enacted its statewide reform in 2006, California started with a large uninsured population, didn’t have a pool of federal money with which to tinker and has a much more diverse political environment to contend with than the liberal Bay state.
Closing gaps
When it comes to covering the uninsured, “Massachusetts had to close a gap; California had to jump a chasm,” says Anthony Wright, executive director of Health Access, a consumer advocacy group in Sacramento. Despite the political land mines that lay ahead, the Golden State mustered up the gumption to confront its health-care problems in 2007, including what to do about its 6.7 million uninsured.
“Even though it was hard, the urgency was there and we had a moment of political will,” he says.
Like the bills under consideration in Washington, California’s approach called for a health-insurance exchange and new requirements for individuals and employers to have or provide coverage. But some Democrats were holding out for a single-payer plan, insisting that real reform couldn’t happen without it. That was a deal-breaker for Republicans, who also opposed employer mandates, making it tough to find middle ground.
“The California experience shows you should never underestimate how difficult this is to do, and you should also not overestimate how much support you’re going to get from Republicans for a large-scale expansion of government’s role in health [care],” Oberlander says.
“There are genuine ideology cleavages between the parties in the role of government and the market in the health system.”
On top of that, the state’s process for approving legislation on issues of taxes and revenue calls for a supermajority of two thirds or else letting voters decide. But putting the question to voters involved a time table that Schwarzenegger proved unable to meet.
“Getting two-thirds of both houses or going to the ballot is a much higher bar to getting health reform than even the very tough job of getting 60 votes in the U.S. Senate” in order to bypass a filibuster, Wright says.
“There was a certain point where Schwarzenegger had to realize that if he wanted health reform he was going to have to do it without Republican votes,” he says. “Unfortunately, Schwarzenegger came to that realization several months too late so he didn’t have enough time to get it done.”...
...“The lesson from California in my mind is that there’s a window of opportunity for health reform, and that you’ve got to take advantage of that window of opportunity.
“If [national reform] doesn’t happen in the next six to nine months, we’ll continue to muddle through and tens of millions of Americans will continue to suffer,” Kominski says. “If five out of six Americans are insured, five out of six will say ‘OK, this isn’t the best system but at least I’ve got mine.’ That is a system we’ve had too long. This is an opportunity to address that.”
Read entire article at The Wall Street Journal (Marketwatch)
Two years ago, California was where the nation finds itself today: Very close to passing sweeping health-care reform. Gov. Arnold Schwarzenegger, a Republican, was past the halfway point in the year he set out to accomplish an overhaul. He had achieved some victories — hospitals had agreed to pay new fees, public opinion was favorable, negotiations were ongoing — but big obstacles remained. I recently asked three experts who followed California’s long slog what it portends for the broader U.S. reform effort as it unfolds in the next few months.
“One of the rules is never generalize from California,” jokes Jonathan Oberlander, associate professor of health policy at the University of North Carolina-Chapel Hill. But of all the states that have tried their own versions, California is perhaps the most reliable predictor of the hurdles the nationwide effort will face in the home stretch, he argues.
Why? Because unlike Massachusetts, which enacted its statewide reform in 2006, California started with a large uninsured population, didn’t have a pool of federal money with which to tinker and has a much more diverse political environment to contend with than the liberal Bay state.
Closing gaps
When it comes to covering the uninsured, “Massachusetts had to close a gap; California had to jump a chasm,” says Anthony Wright, executive director of Health Access, a consumer advocacy group in Sacramento. Despite the political land mines that lay ahead, the Golden State mustered up the gumption to confront its health-care problems in 2007, including what to do about its 6.7 million uninsured.
“Even though it was hard, the urgency was there and we had a moment of political will,” he says.
Like the bills under consideration in Washington, California’s approach called for a health-insurance exchange and new requirements for individuals and employers to have or provide coverage. But some Democrats were holding out for a single-payer plan, insisting that real reform couldn’t happen without it. That was a deal-breaker for Republicans, who also opposed employer mandates, making it tough to find middle ground.
“The California experience shows you should never underestimate how difficult this is to do, and you should also not overestimate how much support you’re going to get from Republicans for a large-scale expansion of government’s role in health [care],” Oberlander says.
“There are genuine ideology cleavages between the parties in the role of government and the market in the health system.”
On top of that, the state’s process for approving legislation on issues of taxes and revenue calls for a supermajority of two thirds or else letting voters decide. But putting the question to voters involved a time table that Schwarzenegger proved unable to meet.
“Getting two-thirds of both houses or going to the ballot is a much higher bar to getting health reform than even the very tough job of getting 60 votes in the U.S. Senate” in order to bypass a filibuster, Wright says.
“There was a certain point where Schwarzenegger had to realize that if he wanted health reform he was going to have to do it without Republican votes,” he says. “Unfortunately, Schwarzenegger came to that realization several months too late so he didn’t have enough time to get it done.”...
...“The lesson from California in my mind is that there’s a window of opportunity for health reform, and that you’ve got to take advantage of that window of opportunity.
“If [national reform] doesn’t happen in the next six to nine months, we’ll continue to muddle through and tens of millions of Americans will continue to suffer,” Kominski says. “If five out of six Americans are insured, five out of six will say ‘OK, this isn’t the best system but at least I’ve got mine.’ That is a system we’ve had too long. This is an opportunity to address that.”