The politics of the health care vote

The Assembly’s partisan passage of a health care plan has been described in historic terms.

But things are not necessarily what they seem.

In reality, with all of the bill’s financing and, indeed, the bill’s very implementation, contingent upon passage of an initiative in November, the real-world impact of this week’s vote is minimal. In fact, the passage of the bill may have as much to do with term limits as it does with health care.

The vote — with every Republican in opposition — simply had the force of a parliamentary white paper, a nonbinding reflection of where Assembly Democrats and the Republican governor are on health care reform.

The Assembly’s move prompted many, most notably Senate leader Don Perata, to ask, “What’s the rush?” The speaker’s office claims there is a set of fast-approaching deadlines, and that quick passage is necessary to get the health care financing initiative on the November ballot. The speaker’s term limits initiative is on the February ballot.

In order to get the health care financing on the November ballot, an initiative would need a title and summary from the attorney general’s office by Feb. 14. In order to get the measure on the ballot, proponents would need to gather 1.2 million signatures, to be submitted to county election offices no later than April 21.

It is that tight window that is motivating the speaker, says spokesman Steve Maviglio.

“Every day, thousands of more Californians lose their health care coverage. The longer we wait, the worse the problem gets,” Maviglio said.

But in the meta-language of California politics, the vote was a loud affirmation of just who’s in charge of the Assembly, and hinted strongly to others that the governor and the speaker may forge a political alliance that could lead to the continuation of Núñez’s speakership for six more years. It also is a sign of the tensions between Núñez and his Senate counterpart, and the coming weeks promise to be used in part to pressure the Senate to act quickly.

The speaker was able to coax his caucus to vote for a bill that few of them had read. And though the state’s largest labor organization had expressed reservations about the bill, urging Núñez and caucus members to delay the vote, there was not a single dissenting Democratic vote Monday.

Núñez’s show of strength comes less than a week after he made an animated speech to his caucus, pushing for health care reform, urging more money for the Yes on 93 Committee, and insisting to his caucus that no matter what happens in February, he intends to be speaker well into 2008.

But there is another theory: That the timing of the health care plan’s passage was meant to increase momentum for Proposition 93, the initiative on the February ballot that would allow Núñez and Perata to remain in power.

Skeptics of that theory note that the bill’s chief obstacle is now Perata — one of the people who stands to gain the most by Proposition 93’s passage. If a quick health care deal is really the ticket to Proposition 93’s passage, why then is Perata slowing down the Núñez health care juggernaut?

The Núñez bill is scheduled for its first Senate hearing in a Jan. 16 meeting of the Senate Health Committee.

But there is evidence for those who want to make the health care–term limits connection. Some of the health care proposal’s strongest supporters, namely the Service Employees International Union and the American Federation of State, County and Municipal Employees, are also among the top donors to Proposition 93, a point not lost on No on 93 spokesman Kevin Spillane.

“Obviously, huge sums of money have been pouring in from these unions in recent days,” he says. “The link seems pretty clear. It’s basically pay-for-play politics with proposition 93. Health care legislation has become a fund-raising vehicle for Fabian Núñez to cling to power.”

SEIU unions have contributed $1.1 million to the Yes on 93 effort. AFSCME unions have given another $610,000. (Not all donors to Proposition 93 are supporters of the speaker. The chief opponent of the health care pan, Blue Cross, has given the Yes on 93 campaign $50,000.)

Any policy linkage between the two has been denied not only by Núñez’s office, but also by the Schwarzenegger administration.
“They’re two separate issues,” says Schwarzenegger spokesman Aaron McLear. “He hasn’t taken a position on Proposition 93, and his position has nothing to do with health care.”

McLear noted the governor has said that he would not support a change in term limits without a change in the way the state draws legislative districts. But it was still unclear what the governor’s ultimate stand on Prop. 93 would be.

What is clear is there is plenty for the service unions and county employees to like in Núñez’s proposal. In amendments introduced just hours before the vote, home care workers, many of whom are represented by SEIU, would receive more state money for health care coverage. The bill sets out an additional 50 cents per hour from the state to help pay for health coverage for home care workers.

“We represent low-wage workers. We have an interest in doing something for them,” said SEIU spokeswoman Jeanine Meyer Rodriguez. “This provision is consistent with the larger goals of the bill — to provide health care coverage to people who don’t have it.”

Rodriguez also said there was no link between her union’s support for health care and Proposition 93.

“Health care is complex enough. There are enough issues here to work through. Whatever speculation people want to make, they can make. We’ve demonstrated we’re focused on getting health care right.”

There is also something for county workers in the bill. In the amendments adopted Monday, there is a new provision for a $25 million “Workforce Development Program Fund” to be “used exclusively for retraining county hospital and clinic systems’ health care workers.”

Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights called the $25 million “slush-fund money to do the work the union should be doing themselves.”

Flanagan said these amendments were “stuck in at the last moment and hidden in the fine print of the bill.”

And the new state coverage for low-income adults drives people to public hospitals — hospitals that have union representation. Section 72 of the new bill states, “each enrollee shall be assigned a medical home at a public provider affiliated with a public hospital or at a community clinic. … All covered services shall be provided by designated public hospitals, their affiliated public providers, and community clinics, except with respect to those medically necessary services that are not available or accessible through these providers.”