Postmortem analysis of health care bill

Who killed health care and why?

That was the question circulating around the Capitol this week in the wake of the Senate Health Committee’s vote killing the compromise bill brokered by Speaker Fabian Núñez and Gov. Arnold Schwarzenegger.

Most senators cited fiscal concerns in their decision not to support the bill. But it was clear Tuesday that neither the speaker nor the governor truly believed that the fiscal analysis was the true reason health care failed in the Senate.

In fact, both Núñez and Schwarzenegger seemed to indicate that the LAO report was being used as political cover for senators who voted against the bill.

“We have to find out what is the reason and why it did not pass,” Schwarzenegger said. “Not what has been given to the public, but what is the real reason … In acting, we call it the sub-layers, the different colors underneath.”

“I can tell you as a Democrat, I’ve looked at LAO reports,” said Núñez. “What we like to do is we pick the stuff we like, that’s advantageous to us, and the things that are not, we sort of ignore and brush aside.”

A spokeswoman for Senate leader Don Perata reiterated that the health care bill died under the weight of the state’s fiscal problems. “Our sole motivation is the governor’s budget and our deficit,” said Perata spokeswoman Alicia Trost. “Everything we care about as Democrats and human beings is at risk. Our first priority is figuring out how to not lay off hundreds of teachers and not kick 165,000 kids off of Medi-Cal, and then we can talk about doing other things.”

Núñez said he did not want to “point fingers at any one person” over his bill’s demise. But there was plenty of blame in the subtext. He took issue with Perata’s analysis that the health care bill was not truly bipartisan, and he took some shots at the way Sheila Kuehl, the chairwoman of the committee that killed the bill, conducted her committee hearing.

“I don’t know that (the bill) was given the type of balance and objectivity that I would have given it in a hearing. There’s clearly now a different vetting that we’re going to have to go through.”

“If you’re going to have disagreements, they ought to be over the facts,” said Núñez. “We did not have a hearing, not for one minute, on the facts of this bill. That debate was not about the facts.”

So, who do the speaker and governor think did kill health care? The list of potential culprits range from the California Nurses Association on the left to Blue Cross and tobacco companies, who were trying to protect their economic interests.

And while nobody cited concerns for the insurance industry or tobacco companies in their vote Monday, one of Schwarzenegger’s health care experts, Daniel Zingale, indicated those powerful interests were largely responsible for the bill’s demise. “There’s nothing new about a panel of legislators voting down health care reform under intense lobbying from special interests — tobacco, Blue Cross, whoever else was active over there,” Zingale said. “That’s familiar.”

 “The coalition against this bill was clear across the political spectrum,” said Mark Ridley-Thomas, the lone senator to vote for the bill in the Health Committee on Monday.

Schwarzenegger led a formal wake for his health care proposal at a Capitol news conference this week. But as stakeholders and interest groups lick their wounds after the Senate defeat, many are already trying to figure out what’s next.

Schwarzenegger lamented the failure of Perata to seize “this golden opportunity” to put a health care proposal before voters in November. Health care reform has a poor track record with California voters. But backers of the bill were optimistic that a contested presidential election with a motivated Democratic Party base provided a once-in-a-generation opportunity to get a health care deal approved by voters.

“It’s pretty obvious why we all felt November was so important,” said Zingale.

Schwarzenegger said he had not had time to sit down with Núñez and other health care leaders to discuss a strategy. And, he noted, Perata “has not even called me” to discuss how to proceed from here.

One possibility may be to extend health insurance coverage to California’s 760,000 uninsured children. Groups like the California Endowment and Children Now have been focused on securing health coverage for children, regardless of what happened to the comprehensive health care proposal.

AB1 by Assemblyman John Laird, D-Santa Cruz, would set the framework for extending children’s health coverage. It would expand the state’s Healthy Families program to cover all children at or below three times the federal poverty level. And it would offer a way for families above that income threshold to buy in to the program.

Sen. Darrell Steinberg, D-Sacramento, has introduced a bill identical to Laird’s AB1 in the Senate. Steinberg, who abstained on AB1X1, said the defeat of the bill puts pressure on the Senate to take some action on health care this year.

“I think it is very important that the Senate articulate alternatives,” said Steinberg. “The lead alternatives are children’s health care, transparency, and beginning to phase in coverage for uninsured adults.”

AB1 has passed both the Senate and Assembly and is currently being held at the Assembly desk.

Like the speaker’s health care plan, Laird’s AB1 does not have a funding source. And a spokesman for Núñez said that if the Senate balked at the cost of the speaker’s health care proposal in these lean budget times, there was no reason to believe the Senate would be any more forthcoming in its support of Laird’s measure, or one like it.

“It’s still a problem of money,” said Núñez spokesman Steve Maviglio. “The Senate made it clear. They said we have to take care of our existing budget problem first.”

“If you are able to keep intact the hospital fee tax and a tobacco tax, we not only could cover 800,000  children, but we could begin making progress on the issue of uninsured adults,” Steinberg said.

Trost said that after the budget mess is ironed out, the Senate “would be happy to look at all kinds of things.”