AB 1x1

Today the Senate Health Committee voted 7-1 not to advance AB 1x1 the massive health care reform bill championed by Speaker Fabian Nunez and Governor Arnold Schwarzenegger. That means health care reform legislation is killed for the year given the timing to make it on the ballot. Chron:

Shortly before the committee hearing, Senate President Don Perata, D-Oakland, said in a letter to Gov. Arnold Schwarzenegger that he does not support the measure because it lacks adequate funding and could worsen the state's budget problems.

The measure, which passed the state Assembly last month, needs the backing of a majority of legislators in each house before it can be sent to the governor, who supports it.

Schwarzenegger, speaking to the editorial board of the Chronicle, said he will do everything he can to keep the measure alive.

"I'm not taking 'no' for an answer," he said. "We've come a long way to get as far as we have ... this is the last mile."

The $14 billion plan was the product of more than a year of negotiations between the Republican governor and leaders of the Legislature's Democratic majority. The proposal had the backing of a diverse group of corporate, labor and consumer groups but failed to attract the necessary six votes from the 11-member health committee largely because of concerns over the long-term costs of the plan.

The amount of resources mobilized for this fight was enormous. Many groups and organizations poured many man hours and dollars into advancing this cause and then this specific piece of legislation. It is a bitter end to a noble goal: reforming our health care system. Our health care system is a disaster, yet fear of the unknown determined the outcome. We could not ensure that the expenses would not out strip revenues a crucial calculation given our state's current precarious fiscal state. It was not clear how much this bill would impact working middle class Californians. The plan was attacked from the right and the left.

The good thing is that this is not the mid-nighties all over again. When the budget situation improves we will again have a shot at reforming the system. This loss does not mean we have to wait a decade before working hard to enact sweeping change.

This is a victory for the status quo today, but we have a chance in the not too distant future to enact the reforms legislators dared against all odds to advance this past year. There were many more reasons for this to fail than to pass. That will not change the next time we take a shot at it. Hopefully we will learn some lessons from this fight and have a better chance the next time. They sure did a lot better than we did nationally in the mid-90s.

Today was the day the AB 1x1 was to be brought up in the Senate Health Committee. It didn't. Senator Don Perata asked to delay the vote until Monday since there were not enough votes to pass the bill. To complicate matters the Legislative Analyst came out with her report that had enough consternation about cost containment for the state that it made Senators nervous about moving forward. AP:

Given the Democrats' resistance, it seemed unlikely Perata could obtain the votes without changing the composition of the 11-member panel, although he has said he does not plan to do so. The committee's four Republican members have been opposed to the bill as an expensive and unnecessary expansion of government into the private health care system.

Democrats also sounded queasy about the potential expense, and they sought assurances that the state would not be saddled with new costs.

"It just seems to me that we go into it with a little more certainty of what the price might be," said Sen. Darrell Steinberg, D-Sacramento. "Otherwise we don't go forward."

There are many more reasons for legislators to say no to major health care reform than to say yes. That does not mean that the bill shouldn't pass or that it is impossible to pass reform, but rather that this was always an uphill battle. The state of the economy and the budget made the odds even worse. It is providing an easy out for Democratic legislators who might otherwise be supportive.

Legislative Analyst Elizabeth Hill fed their fears with a report that undermined the administration's insistence that California can extend medical coverage to millions of uninsured people without having to spend additional state money.

More likely, she said, the new health care program would become a drain on the state budget. Hill said she estimated conservatively that within five years, the program would cost the state between $300 million and $1.5 billion a year.

"What you have in front of you is by no means the worst-case analysis," Hill said.

There is no way to guarantee that the cost of insurance will not rise at a higher rate than they anticipated. There are outs for the state. It's not as if it would be on the hock for the plan no matter what. Safety measures were built in. Howevier, if the legislators feel like it is more likely than not that we will encounter a situation where the costs exceed the revenue in the near future then it is not worth it for them to support a plan that they believe is headed for failure.

There are hard choices ahead for Senator Perata. Does he want to pull Yee or Kuehl off of the committee, or let this die a quiet death?

The status quo of our health care system is unacceptable, but that does not automatically translate into passage of this plan, no matter how well constructed.

Things are not looking very good for the prospect of health care reform in California at the moment. The bill AB 1x1 is going to come up in the health care committee tomorrow. Sen. Kuehl, the chair of the committee already indicated she would not support it. That meant if only one other Democratic Senator on the committee pulled their support the bill would not be able to advance on a straight vote. CapAlert has the goods.

On the eve of a hearing for landmark health legislation, a spokesman for Sen. Leland Yee said the San Francisco Democrat will oppose the health care measure. The move throws into limbo whether the legislation has the necessary votes to move forward.

“The costs are a big concern for him,” said Adam Keigwin, a spokesman for Yee, regarding the $14 billion health care price tag that coincides with a projected $14.5 billion budget hole.

We have not yet see the report from the Legislative Analyst that Perata requested. This seems to be an early indication that the report was not particularly favorable.

Meanwhile the It's Our Health Care coalition just sent out an email encouraging their members to contact their Senators.

If the Senate doesn't pass AB x1 1 this week -- first out of the Health Committee tomorrow, then, if it passes there, on the Senate floor shortly afterwards, health care reform in California will be dead for the year.

A golden opportunity will be wasted. Health care reform here in California and at the national level will be dealt a body blow. And millions of Californians who could have been helped will be left to suffer the consequences of a deteriorating and dysfunctional health care status quo.

If you want to change the status quo and support reform this year, call your Senator now!

Click here to look up your Senator's phone number and call them today!

Senate process allows for Perata to request that Kuehl pass the bill on without voting. However, it is unclear if he is interested in having her do that. Perata does also have the power to pull Lee from the committee and replace him with someone who will vote for the bill. However, Perata has been throwing considerable cold water on the whole thing and it does not seem like he is inclined to force the issue.

It is a real shame to see so much time and effort come down to this. California had a real shot at passing significant, historic health care reform. The odds have always been stacked against it, just like they are right now. Ever the eternal optimist, I still believe they could get this thing done. It is really up to Perata.

It has come down to this: will any Democratic Senator on the health care committee vote against the proposal besides Sen. Shelia Kuehl? The Capitol Weekly has all of the wonky details:

The Senate Health Committee is chaired by Sen. Sheila Kuehl, D-Santa Monica, who is openly opposing the bill. Kuehl’s opposition gives the bill’s supporters a single-vote margin on the 11-member health committee.

That means that any Democrat on the committee could single-handedly sink the proposal. And not all of the committee members are sure they’re going to vote for the bill. Kuehl, who has promised an exhaustive examination of the proposal, delayed the first hearing by a week.

“The issue I have is that we have a $14 billion shortfall,” said Sen. Leland Yee, D-San Francisco. “We are cutting services like you cannot believe. So how can we pay for a new health care plan?”

The Senate, in particular this committee is moving slowly on this proposal to examine all of the details. This will not be a repeat of the rapid fire passage of the energy deal during the Enron crisis. AB 1x1 is a major piece of legislation that should impact just about every single Californian. I for one am glad that it is being gone over with a fine tooth comb.