Schwarzenegger and health care: far less than meets the eye

Along with education, health care ranks as the top concern of California
voters. Many are paying more out-of-pocket costs for their care. Many fear
losing coverage, as they see the unraveling of the health care system we all
rely on. Employers continue to scale back their benefits, and budget cuts at
the state and federal level have threatened public programs and providers.
Over six million Californians don’t have any coverage, and as a result live
sicker, die younger, and are one emergency from financial ruin.

You wouldn’t know there was a health care crisis, listening to any of the
governor Arnold Schwarzenegger’s State of the State addresses. Given the
scope of the problem and the interest of voters, it’s a startling omission.
He is the most prominent (if not the only) politician in the nation without
a health care reform plan.

In his speech this year, the only action he proposed in health care this
year was to write a letter to Congress, on the specific subject of allowing
the re-importation of medicines from Canada, where drugs are significantly
cheaper. But even on the specific issue of prescription drugs, the governor
did not propose any state action, neither to allow the state of facilitate
re-importation (an approach he vetoed for two years), or to allow the state
to negotiate with drug companies on behalf of millions of uninsured and
underinsured Californians (an approach he opposed in Proposition 79 last

The day before the State of the State, the governor announced the plan to
enroll more children in Medi-Cal and Healthy Families. But there was less
than meets the eye: The governor’s budget proposal did not expand
eligibility to a single California child. The proposal did not even fully
restore the outreach and enrollment efforts that had existed prior to the
budget crisis.

In addition to the school- and community-based outreach efforts that went
unfunded, the best way to insure unenrolled children is as part of a
comprehensive effort to cover *all* children, as the experience in counties
like Santa Clara show. In fact, the governor vetoed a bill to cover all
children last year. In his re-election year, the governor has yet to propose
any way to meet the goal he set during his recall campaign, to “insure all

The lack of leadership is surprising, given what is going on in other
states. Last month, Illinois’ governor signed a universal children’s
coverage measure. Last week, the Maryland legislature passed a requirement
on very large employers, including and especially Wal-Mart, to provide
health coverage to their workers. Maine is beginning to implement Dirigo
Health, a major coverage expansion plan. Massachusetts will likely pass a
major health bill this year, or if not, face at least one ballot measure.

The debate over health care reform is brewing in many states, and California
is no exception. Just two years ago, the legislature passed an expansion of
employer-based coverage. Opposed by Schwarzenegger at the height of his
popularity, the law was defeated by the slimmest of margins, garnering 49.2
percent of the vote, suggesting that voters are ready to support health
reform. San Francisco supervisors are expected to vote in the next month on
a local employer-based coverage expansion. The children’s coverage proposal
is still active in the legislature, and may be on the ballot in November as
well. A full-fledged universal coverage bill, the California Health
Insurance Reliability Act, passed the Senate last year and is pending the
Assembly. These are all positive steps that deserve support, to cover more
Californians, so they don’t deal with the health and financial consequences
of being uninsured.

Unfortunately, the governor has not been part of this debate. When he wasn’t
pushing for more power to make budget cuts, his major effort on health care
coverage has been to say “no,” vetoing bills and opposing ballot measures.

By doing so, he’s created an opportunity for his political opponents this
fall to run on health care issues, and win. Even before the special
election, the voters parted ways with the governor’s ballot recommendations
to support health issues like children’s hospitals and mental health.

But this governor has shown his ability to change. His budget proposal met
the “first, do no harm” test on health programs. He took an important step
in the past week to extend emergency coverage to those seniors facing the
federal government’s Medicare drug debacle. Perhaps the new year can provide
new hope for health reform

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