Health care and the six-state split

A plan crafted by Silicon Valley venture capitalist Tim Draper to carve California into six states would do a lot more than change the lines on a map.

It would have a profound effect on California’s health care system, which is now in a dramatic transition because of the Affordable Care Act.

“We have choice in food, in clothing, in houses, in apps, in news. But if we live in California, we have one choice in government.”

“We want a smaller state that is more responsive to the people in it. It is trying to govern a state that is ungovernable,” Janet Chandler, who favors creating a new state of Jefferson from territory in from far noerthern California.

If Draper’s “Six Californias” initiative, aimed at the 2016 ballot, ultimately is approved, California’s current social services will only exist if each of the new states individually decide to keep them. One of those affected services would be health care.

Programs like Medi-Cal, the multibillion-dollar program that serves about a fifth of California’s population, receives half of its funding from the state and half from the federal government. It would have to renegotiate with the federal and new state governments to receive funding. This would delay people getting healthcare, says Doug Kim of the California Primary Care Association, which represents about 600 not-for-profit community clinics across California.

Medi-Cal — the government health care program for the poor, the elderly and the disabled — served at least seven million people last year and may serve 10 million before long – an expansion that could cause still more delays.

“When it comes to health care, time is an issue,” Kim said.

Draper’s initiative, which could qualify for the November 2016 ballot as early as this month,  would split California into six states: The state of “Jefferson” out of the northern-most 14 counties; “North California” by combining Sacramento, Napa and surrounding counties;  “Silicon Valley” out of San Francisco down to Monterey County; “Central California” from the San Joaquin Valley; “West California from Santa Barbara to Los Angeles counties; and “South California” from Orange, San Bernardino, Riverside, San Diego and Imperial counties.

“Covered California, the state’s online marketplace portal for health insurance created under the federal Affordable Care Act, would no longer have jurisdiction and would not have a place to operate.”

County registrars and the secretary of state are in the midst of validating the initiative’s more than 1.1 million signatures. The validation process begins with counties selecting signatures at random and testing if they are valid. Based on that sampling, the counties then project how many valid signatures have been collected.

If time is an issue in potential health care changes, it’s also an issue for Draper: The clock is ticking.

As of Aug. 28, Draper’s proposal, a constitutional amendment, had some 404,585 valid signatures, according to the secretary of state’s office, or about half of the 807,615 signatures it needs to qualify for the ballot.  The random sampling deadline is Sept. 12.

To Draper, who is confident he can make deadlines, says dividing the state makes sense.

“Choice is good. More choices (are) better,” Draper told Capitol Weekly in earlier interview. “We have choice in food, in clothing, in houses, in apps, in news. But if we live in California, we have one choice in government. That choice is to be a part of the worst run state in the union.”

“The idea has been in the making for decades,” he added. “I worked with (former GOP state Senator) Becky Morgan when she was looking into breaking the state into three. And as you know I have worked hard to allow choice in education in California. There is nothing new here.”

Meanwhile, supporters of the Jefferson Declaration Committee are petitioning the California Legislature to separate from California in order to create the state of Jefferson.

“Every new state will start with a clean slate. Each state will be able to decide what laws and tax structures best suit the needs of its community,” says his campaign web site.

But starting with a clean slate means each state has to decide what services it is going to offer.

And while any discussion of the impact of the six-state split is speculative, some effects appear likely.

For starters, each individual state would have to renegotiate complex agreements with the federal government to get funding for an array of health care-related services. Insurance companies, hospitals and clinics would have to be relicensed within each new state.

Covered California, the state’s online marketplace portal for health insurance created under the federal Affordable Care Act, would no longer have jurisdiction and would not have a place to operate, Kim said.

The new states would not even be required to have something like Covered California, which is currently viewed as a model for the country.

States like Jefferson and Central Valley would be poorer than the other states and may not have the resources to fund social or other programs, many of which require matching funds, including Medi-Cal. The Central Valley, for example, might not have the tax base to support publically-funded social services.

A number of other health care-related organizations contacted by Capitol Weekly said they have not yet analyzed the impact of the six-state split.

Meanwhile, even though the fate of Draper’s initiative remains uncertain, supporters from California’s northern counties, the Jefferson Declaration Committee, are petitioning the California Legislature to separate from California in order to create the state of Jefferson.

On Aug. 28, Jefferson supporters chanting “The time has come for 51!” – a reference to the 51^st state — came to the Capitol steps to file a declaration passed by the Siskiyou County board of supervisors stating that rural counties are not being adequately represented in the Legislature and thus wish to separate from California.

Some say Draper’s proposal is illegal because it uses the initiative process, not the legislative process as outlined in the U.S. constitution.

Their goal is receive a favorable majority vote in the Assembly and the Senate, then move onto Congress for the required Congressional approval.

“We’re here to give representation for each and every county in Jefferson,” Jefferson declaration advocate Mark Baird said to the crowd of green shirts marked with Jefferson’s gold seal, which depicts two Xs that signify “double crossed by Sacramento.”

If the Legislature rejects their petition to separate, Baird contends they could sue on the basis of lack of representation. That would entail overturning a 1964 Supreme Court ruling that required state legislatures to base their districts’ representation on population, rather. Because of this, urban areas like San Francisco and Los Angeles obtained more representatives in both houses.

As for Draper’s approach to splitting the state, Chandler is uncertain if everyone wants to split from California.

But if other parts of California want to separate, Chandler said, “I would support anybody’s efforts to separate and form a government that represents them.”

Draper’s proposal is illegal, Shasta County Declaration committee member Kayla Brown said, as it uses the initiative process, not the legislative process as outlined in the U.S. constitution.

Draper supports the State of Jefferson movement not through money, but when Draper heard they would be coming to the capitol, he sent some emails to people, Baird said.

“I think his [Draper’s] heart is in the right place,” he said. But if he knew then what he knows now, Baird thinks he would have written it differently.

Certainly others have done it differently.

“ “Splitting California isn’t new by any means. There’ve been something like 220 attempts to divide California, starting before it was even a state,” said Stan Statham, a former northern California Assemblyman who carried legislation in the 1990s to split California first in half and, later, into thirds.

“The reason is simple, California’s too big,” he earlier told Capitol Weekly. “It’s like Gov. (Jerry) Brown’s slogan back when he was first governor in the 1970s: ‘Small is beautiful.’ Besides being beautiful, small is also easier to manage.”
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Ed’s Note: Dorothy Mills-Gregg is a Capitol Weekly intern from Sacramento State University.