Comparing Health Reform in California and Massachusetts

by awright [courtesy of Calitics - Front Page]

A new comparative analysis shows that the pending California Health Security and Cost Reduction Act, AB x1 1, takes major steps in health reform far beyond the much-discussed Massachusetts reform of 2006. A full copy of the 8-page analysis is available HERE at the Health Access website.

The analysis, entitled "Health Reform in California and Massachusetts: Different from Start to Finish," concludes that AB x1 1 would provide a broader benefit to California consumers than what was passed in Massachusetts. The report lists "top ten" major differences between the California 's AB x1 1, and the health reform law, Chapter 58, passed in 2006. In contrast with Massachusetts, the California proposal includes:

1) New, Broader Financing, including a Tobacco Tax

2) A More Meaningful Employer Contribution

3) General Fund Protection

4) Significant Cost Containment

5) Subsidies up to and above 400% of the federal poverty level

6) Key Differences in the Individual Mandate, Affordability and Enforcement

7) A Transition to Guaranteed Issue

8) Medical Loss Ratios and Increased Insurer Oversight

9) Not Just a Connector, but a Negotiator

10) New and Improved Public Health Care Options

WHERE ADVOCATES STARTED IN MA: Probably most interesting to the progressive readers of Calitics is the comparison of AB x1 1, not with what passed in Massachusetts, but with advocates first proposed. Many consumer and community groups (www.massact.org) originally proposed a 5-page ballot measure as leverage to force health reform, and to influence its content. They collected all the signatures needed, but they ultimately decided not to file, given the deal passed in the legislature.

Their ballot measure included subsidies for not just low-income but middle-income families up to 400% FPL, financed by minimum contributions for large employers of 5-7% of payroll, and a 60-cent tobacco tax--none of which made it in the final Massachusetts package, but is included (if not more robustly) in the pending California plan.

More...

WHERE CA IS NOW: California advocates ended up where Massachusetts advocates started--although now we have to wage the ballot campaign those in Massachusetts didn't. At the same time, if the effort succeeds, then California will have a reform that goes further and is much better financed and stable over the long term.

The conclusion of the report is that Massachusetts and California start from different places, and the plans are different enough, that they will end up having different results. Critiques of the Massachusetts plan simply do not apply to California's effort.

But it's notable that the California conversation has been largely been about doing more than MA, rather than doing less. That's positive momentum for the national reform effort.