This story just broke. About 45 minutes ago, the California Senate Health Committee voted 10-1 not to move the bill out of committee, rendering it dead.
http://www.bizjournals.com/...
There are a lot of lessons from California's long, painful year at trying to get universal coverage. I will name just a few:
- Developing a health care reform proposal using 4-5 staff in the Governor's Office, without the involvement of major stakeholders or the Legislature is a loosing strategy. Hillary Clinton learned the hard lesson of developing a plan behind closed doors in 1993 and the mistake of not developing the plan with the input of the Congress. An inside access only model to policy development in the Executive Branch is a nonstarter.
- If you are Republican Governor, you need to work with the Republicans in your legislature if you want their support. Failure to consult with the members of his own party in the process of drafting his proposal meant that not a single legislator was willing to carry the Governor's bill.
- Drafting a proposal that competes with the plans proposed by the President Pro Tempore of the Senate and the Speaker of the Assembly and then vetoing their bill when it come to you for signature is probably not a good way to build support with the legislators who do want health care reform.
- As the IOM has concluded, states cannot achieve universal coverage on their own. Massachusetts, Vermont and Maine are all struggling. California's projected $14 billion budget shortfall didn't help either. And then there is the economy and the sub-prime crisis that are pushing health care off the top of the agenda.
Governor Schwarzenneger deserves our thanks for trying to make good on his pledge of universal coverage this year. But his plan had something for everyone to hate and the process dragged on so much longer than anyone anticipated, that the policy window slammed shut and the budget deficit reared its ugly head before it could be done. And lots of powerful interests were lined up against it: the doctors, nurses, businesses, unions, tobacco industry, insurers, public hospitals, etc.
And even if the legislature had approved the bill, the financing was going to have to be put to the voters in November as a ballot initiative. The last 5 times there has been a ballot initiative on health care on the CA ballot it has been soundly defeated.
The main sticking points were over the following issues;
An individual mandate
A tobacco tax
Covering undocumented workers
The amount available for subsidies
The plan to lease the state lottery for revenue
Universal coverage
It will be imperative for the next President to take on this issue early in his/her presidency. The President and Congress must be willing to work together to act quickly and interest groups must at least be heard. And an effort will need to be made to find common ground with Republicans who are social moderates.
Everyone had hoped California would be the next state to enact truly universal coverage.
We will have to wait another day.