Health Care Updates: AB 8 to Pass, But What Will Final Compromise Look Like?

by Robert in Monterey [courtesy of Calitics - Front Page]

Over the last few days there has been significant legislative movement on AB 8, the N??ez/Perata health care reform bill. Anthony Wright of Health Access California describes some of the crucial amendments that passed on Friday, amendments which Randy Bayne notes garnered the Cal Labor Fed's support of AB 8 as the bill now includes some cost containment protections (though not as much as hoped, since caps on hospital billing weren't included).

AB 8 seems set for legislative passage, but after that an Arnold veto is expected, writes Bayne. So what next for health care? As the legislature and the governor plan a special session, the details of any final compromise will be absolutely important - and will determine whether the bill will actually be useful, or will be a cure worse than the disease. More...
In today's Sac Bee, Daniel  Weintraub suggests that a health care deal "is coming into focus" and describes the details:

The agreement would likely come in two pieces -- legislation that lawmakers would approve this week or soon after in a special session, and a separate measure that would appear on the November 2008 general election ballot to finance the plan.

The legislation would outline a program requiring nearly everyone in California to buy insurance, with subsidies for people making less than four times the federal poverty rate, or about $80,000 a year for a family of four. Insurers would have to cover everyone who applied, regardless of pre-existing conditions, and could not charge customers more because they had been sick in the past.

The subsidies, along with an expansion of free care for the poorest of the poor, would be financed by a new payroll tax, an increase in the sales tax, a special fee on hospitals and an infusion of federal money. [A tax that would have to be put to voters - Robert]

It's not clear where Weintraub is getting this from - but it is a major cause for concern, because such a compromise includes the thoroughly odious individual mandate. The centerpiece of Mitt Romney's reform, individual mandates have proved a disaster in Massachusetts, with sky-high premiums and insufficient guarantees of care. Even if subsidies materialize - and as the current plan depends on federal funding of programs like S-CHIP for this that is being opposed by the Bush Administration, it seems those subsidies are far from certain - it will not be enough to prevent the premium costs from ruining many who are underemployed, work part-time, or face other sources of financial stress.

An individual mandate is poison, and must NOT be a part of any final health care plan. All it would accomplish is a massive transfer of wealth from struggling individuals and households to insurers, who would still be able to deny care, slash benefits, and raise premiums. At worst it would be junk insurance that folks would be forced to buy.

I have expressed my skepticism of AB 8 in the past. I think it suffers from a common misconception in America, that the problem is a lack of health insurance, when in fact insurance is by no means a guarantee that people will receive the care they need, or that they will get that care at an affordable price. As it stands now, AB 8 does appear to be a worthwhile plan. Even though the California Nurses Association is right that it won't do much to solve the core problems, and that we should be trying to get rid of the health insurers, AB 8 seems like it would be able to extend to more Californians some kind of coverage with sufficient, though incomplete, cost containment provisions. As a stopgap until we get single-payer, AB 8 may work, although I am also skeptical about whether it's worth a ballot fight - those resources should be reserved for a single-payer ballot effort.

That conditional support of AB 8 would vanish entirely if an individual mandate were to be included as part of a final compromise. And as that idea keeps getting floated, it becomes all the more important that we let our Democratic legislators know that an individual mandate is completely unacceptable.

As someone who is currently uninsured, I would be willing to fight against an individual mandate plan, and would certainly vote against a ballot measure to fund a plan that included an individual mandate. Californians want health care reform - but that doesn't mean any reform is good reform.