Governor's health plan faces tough judge today

By Clea Benson
Sacramento Bee
Thursday, February 15, 2007
A state Senate panel is expected today to begin the first formal scrutiny of Gov. Arnold Schwarzenegger's sweeping proposal for overhauling health care in California.

Wielding the gavel at the Health Committee hearing will be a member of the Legislature who believes many of the governor's ideas won't work.

State Sen. Sheila Kuehl isn't rushing to judgment. For the past four years, the Santa Monica Democrat has studied health care while pushing California to abolish private insurance and replace it with universal coverage administered by the state. Schwarzenegger last year vetoed Senate Bill 840, Kuehl's bill establishing such a single-payer system.

Schwarzenegger criticized Kuehl's solution as "government-run health care." Now, it's Kuehl's turn to examine the Republican governor's plan, a very different approach that would actually increase the number of insurance customers by the millions.

"My role on these proposals is to to say, 'These are the facts,' " Kuehl said Wednesday. "So far, I think the emperor has some clothes, but not a full wardrobe."

Schwarzenegger has proposed covering the estimated 6.5 million uninsured in California by requiring individuals to buy coverage, employers to help pay for it, and insurers to sell it to anyone who wants it. Doctors and hospitals would also be asked to chip in to help fund the estimated $12 billion expansion of the health care system.

Kuehl, a critic of the profits made by the insurance industry, says she's most concerned about an element of the governor's proposal that she feels has received little attention so far: the requirement that state residents must buy insurance. The poorest would be eligible for fully or partially subsidized coverage, but Kuehl believes purchasing mandatory insurance could be onerous for some working families.

"The only attention paid to the cost of the premium is for relatively poor people, so if you are earning (more than that), there is no limit on what the premiums could be," she said.

Still, Kuehl likes some elements of the governor's plan, such as his proposals to require insurers to sell coverage to everyone and to increase the rates paid to doctors who take Medi-Cal patients.

Though they don't see eye to eye, the administration appreciates Kuehl's contributions to the discussion, said California Secretary of Health and Human Services Kim Belshé, who is expected to testify at today's proceedings.

"We share the same goal, but we have differences of opinion on how to get there," Belshé said.

Kuehl will reintroduce Senate Bill 840, which will be part of the debate this spring. So will health care overhaul bills written by Senate President Pro Tem Don Perata of Oakland and Assembly Speaker Fabian Núñez of Los Angeles, both Democrats. Senate Republicans are also pushing a smaller plan that would rely largely on shifting tax dollars around to cover more people.

Though their bills more closely mirror the governor's approach of covering more people within the current insurer-based system, both Núñez and Perata have also signed on as co-authors of Kuehl's bill. Perata is "encouraging all proposals to be a part of the discussion," explained his spokeswoman, Alicia Trost.

Kuehl says she, too, wants to make sure that all ideas are carefully considered.

"My role as author of SB 840 is clear and different from my role as chair of the Health Committee," she said. "As chair of the committee, my job is to take all of these other proposals and vet them and work day and night to see what collective solution can be achieved."

Whether that solution can happen this year, as the governor would like, remains to be seen. For one thing, as Kuehl points out, no one has introduced any bills on the governor's behalf. For that reason, she's calling today's proceedings a briefing, not a hearing.

Also, Republican lawmakers have indicated they are unlikely to sign onto expansions of health care that would include undocumented immigrants or shift costs to some businesses, both elements of the governor's plan.

"The governor has indicated he wants a reform that is bipartisan," Kuehl said. "If by that he means there must be Republican votes, I think we achieve very, very little this year."

No matter what happens this year to reshape the insurance system, Kuehl says, a single-payer system could still be enacted eventually.

A single-payer system, she said, "is the appropriate end point of health insurance reform in California. But I don't want to force people who are currently in the system who are suffering or lacking in insurance to wait until we have the perfect solution. So we will continue to work out single payer to prepare for the day when we have the right governor or the right initiative atmosphere."

Today's hearing is scheduled for 10 a.m. in the state Capitol.

The Assembly Health Committee will hold an overview hearing on the health care proposals from the governor, Perata and Núñez on Tuesday.

The Assembly will hold a separate hearing on single-payer health care on Feb. 27. Kuehl is expected to testify.

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