A few weeks ago, I left a post about an employer based state health insurance reform plan being pushed by Illinois Gov. Rod Blagojevich. In that posting I had included a snippet about California’s efforts for health care reform and made mention of the fact that the California Nurses Association helped pass a single payer bill in the California legislature last year only to have it vetoed by The Arnold. The override failed by a lack of four votes in the Senate and six to eight votes in the Assembly. The Arnold, of course, submitted a compromise bill putting insurance back into the picture. The bill is labeled AB1.
According to Dr. Don McCanne of the Physicians for a National Health Program writing in “The Quote of the Day” column:
ABx1 1 is an employer pay or play, combined with an individual mandate. It calls for five tiers of insurance coverage, allowing the wealthy to have the best, and, well, you know (and we thought that two tiers were inhumane). Much of the 210 pages of the bill is dedicated to tortuous, complex administrative machinations designed to keep the private insurers in play, at a cost in greatly diminished health care justice, compared to what we could have had.
McCanne continues:
California currently has 6.6 million uninsured residents; 5.1 million are considered “permanently uninsured.” If this proposal works as designed (a highly unlikely scenario), it would bring medical coverage to about 3.6 million Californians.
And who are these millions of people who would be exempt from having coverage? “12739.501. (a) A person or family who has an income at or below 250 percent of the federal poverty level shall be exempt from the requirements established in Section 8899.50 of the Government Code if the person’s or family’s share of the premium for 8899.50 minimum creditable coverage exceeds 5 percent of his or her family’s income.”
Of all of the policy tradeoffs to achieve compromise, this is the sickest. The millions who do not qualify for the medical welfare programs, and don’t have enough income to pay the premium for the “minimum creditable coverage” are excused from being included in our universal health care program.
What’s that? Excused from the Universal Care Health Program? What is it about the word “universal” that they do not understand?
California Senator Shelia Kuehl introduced the Single Payer bill, SB 840 which was vetoed by The Arnold.. This is what Senator Kuehl has to say about this compromise bill currently marching through the State Houses in California.
The press characterizes the bill as “providing” or “extending” coverage to all but a few Californians.
This is a mischaracterization, nothing is “provided”. Instead, all Californians would be required to buy insurance with no caps on premiums, no regulation of the cost of insurance or medical expense, no maximum deductibles, and no floor on how little coverage you can buy and satisfy the legal requirement. If you do not buy insurance within 62 days after the requirement kicks in, the Franchise Tax Board is authorized to collect premiums determined by the Managed Risk Medical Insurance Board by garnishment of wages or mortgage liens.
With respect to employer based health care coverage, Sen. Kuehl has this to say:
Your employer would be required to spend from 1% to 6.5% of payroll (depending on the size of the payroll) to buy insurance policies for employees. Employees would be required to take the insurance and to pay whatever supplemental premiums, co-pays and out of pocket costs are not paid by the employer. There are no caps on what the employee would pay, only for the employer. There is a vague term about “hardship” letting people out of the mandate, but no definition is offered and, as in Massachusetts, if you are excused from the mandatory purchase of insurance, you simply have no insurance!
Feeling a little anxious? Well read on.
Other troubling provisions include no minimum coverage provision, no choice of physicians or hospitals, and more unsupervised health care workers. There is presently no funding in the bill, only the promise of an initiative and the hope that the Feds will provide more money for children’s insurance (and we already know about that). The 85% rule that requires insurance companies to spend that much on “care” is already currently on the books and insurance flagrantly includes marketing, IT and some admin overhead as care. The bill allows this to continue. More ominously, the bill does not clarify that in the case of failure of the initiative, whether or not Californians are individually mandated to purchase insurance.
Regarding the Unions, Senator Kuehl has this to say as to whether they like the bill:
Well, some of them (do). SEIU, who has organized and hopes to organize healthcare workers is positively salivating over the bill, to the extent that their national leader, Andy Stern, is engineering moving out the current state leader, who has questioned the bill, in favor of a new leader who will go along with it. AFSCME has also come on board with the bill, thinking that public employees will benefit. (However, with all the hits the bill brings on the state budget, this may be short sighted). About half of the unions in the California Labor Federation are with it, and half are against it but not taking a firm position. The California Nurses, the California School Employees and the Teamsters, among others, are strongly in opposition.
So, sports fans, it sounds like a brave new world is coming with health care reform. I am not too happy about being in the bleachers on this go-round. I see a fair number of arguments that the Democratic candidates proposals differ only marginally, and in my opinion, that is true. But stop for a moment and take a cold hard look at the rest of the game plan. With respect to California, The Arnold is a Republican, albeit a somewhat moderate one, and his plan will definitely lean to insurance. With respect to the candidate’s proposals, I choose to look beyond the proposals and to the candidates themselves for a further viewpoint. I worry that Hillary is a “big team player” and that Barak is too negotiation oriented. Edwards seems to be a little different. Below that sunny exterior lives a disciplined contender who is well able to fight the good fight and win. The word on the street is that during his days as a trial lawyer, when insurance found out that he was the guy on the case, they had a tendency to settle much more quickly. Combine that with his populist rhetoric and his refusal of corporate money and he looks even better. Maybe best of all is the MSM studious snubbing of his campaign. In my book that speaks volumes. Since polls show that Edwards is the most likely candidate to beat any of the Republican candidates, it is no wonder they want to bury him. The choice is yours, but this here single payer fan is gettin’ on the Edwards train..
Thanks Toni for a great analysis of this CA healthcare disastrous AB1 bill. I hope everyone notices that it protects private health insurance firms with little or no new obligations to actually provide coverage to sick people. Instead it sets up employer pay & play and individual mandates with FIVE tiers of coverage levels and more tax subsidies. Yet it still excludes low income & very sick people & allows expenditures on insurance administrative & marketing overhead to be considered funds spent on “healthcare”. This is great for insurance companies but a stab in the back for anyone paying health premiums. It seems worse than Rommney’s MA mandatory insurance plan, which is already an economic mess in that state.
This CA legislation just again shows that we can either pay for further control by private insurance and dump more money at them or we can pay for expanded patient healthcare coverage. But we can do both since insurance must restrict coverage to to only the more healthy & younger and deny care to the sick to maintain their high profits. Only non-profit singlepayer system puts patients and patient care first because it eliminates the greedy private interests. Gov. Arnold S. has made CA stumble backward, I hope Sen. Kuehl has more success in the next legislative session with real singlepayer reform legislation.