ALLIANCE FOR HEALTH REFORM, STATE COVERAGE INITIATIVES BRIEFING, WASHINGTON, D.C., OCTOBER 26, 2007.
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Transcript of ALLIANCE FOR HEALTH REFORM, STATE COVERAGE INITIATIVES BRIEFING, WASHINGTON, D.C., OCTOBER 26, 2007.
ALLIANCE FOR HEALTH REFORM, STATE COVERAGE INITIATIVES BRIEFING, WASHINGTON, D.C.,
OCTOBER 26, 2007.
NEW AMERICA FOUNDATION AND CA HEALTH CARE REFORM
D.C. and California-based nonprofit and nonpartisan
think tank
Met with and advised Governor Arnold Schwarzenegger and
his staff from outset
Concepts and research on individual mandate, “hidden tax”
on the insured (Len Nichols and Peter Harbage), and shared
responsibility used by administration and credited to NAF.
UNIVERSAL COVERAGE: CALIFORNIA’S ADVANTAGES
Strong citizen support for health care reform (77% concerned
they can’t pay for cost of major illness; 70% percent think system
needs major change; 72% back Governor’s plan; 61% in favor of
Democrats’ pay-or-play bill (A.B. 8/ Nunez-Perata)
Support or interest in comprehensive reform from labor, big business (Silicon Valley Leadership Group), small business (67% of owners polled feel employers should contribute), insurers, and hospitals (CA Hospital Assn. supports Governor’s plan)
High-profile and activist governor negotiating with powerful
unions and health advocacy groups
UNIVERSAL COVERAGE:CALIFORNIA’S CHALLENGES
High rates of uninsured; relatively low rates of existing employer-based coverage4.9 million without insurance; 6.5 million, or over 20% of population, without coverage
during year; CA employer coverage dropped from 64 to 54% from 1987 to 2005.
Political structure: undemocratic and archaic two-thirds rule needed for legislature to pass budget and any bills that raise taxes. 52-day Republican holdout over passing budget stalled momentum for health reform
Additional federal funding needed to finance reform, rather than MA “use it or lose it”; ERISA issues
Friction between Governor, G.O.P. minority in legislature, and labor over different health care proposals, notably affordability and business contribution
AFFORDABILITY IS CRITICAL
PROPORTION OF TOTAL FAMILY INCOME SPENT ON PREMIUM AND OUT-OF POCKET COSTS, NON-EMPLOYMENT BASED, 2007.
For middle income, affordability involves both what one “can” and “should” pay
“Health Care Expansion in California: What Can Consumers Afford to Spend?” U.C. Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research, September 2007
THE MISUNDERSTOOD MANDATE?
Opposition to individual mandate in Governor’s plan a sticking point
Mandates and regulations will begin to reform individual insurance market away from risk selection in direction of competition on value
Guaranteed issue by insurers relies on mandates
Leaving out mandate compromises universality
Affordable benefit package must be available before individual mandate is enforced
Sensible and feasible outreach strategies and auto-enrollment will make enforcement, penalties rare
HOW THINGS STAND NOW
Special legislative session on health and
water policy convened mid-September;
Governor’s proposal put in legislative
language early October: too little, too late?
California Labor Federation (state AFL-CIO)
opposing Governor’s plan outright; Democrats
and labor lukewarm at best
Assembly hearing scheduled 10/31/07
WHERE DOES CALIFORNIA GO FROM HERE?
One ballot initiative, none, or several?
Financing: lottery, sales tax, property
tax reform, cost containment, or what?
Subsidies and the employer payroll
tax: Splitting the difference?
“Nixon to China”? A deal can be cut:
will leaders compromise and risk
antagonizing their bases?