Health care reform is on the political center stage in Sacramento this week as the State legislature reconvenes after its summer recess. Our elected representatives now have until Sept. 14 to decide whether any healthcare reform will be enacted at all this year. But if healthcare policy and politics aren’t difficult enough to understand and work though, the dialogue was made more difficult against the backdrop of the stalemate in adopting the state budget and prison reform requirements. Now that the 51-day budget impasse has ended as Republicans in the state Senate extracted enough concessions from the Governor and Democratic lawmakers to allow the $145 billion spending plan to pass, we will see if there is a political will to truly reform healthcare.

Many health care groups in San Diego interested in reform have been engaged in a sincere dialogue since January to reach agreement on principles to evaluate proposals to reform healthcare statewide. In general, these groups would support such reform proposals if:

  • Basic health care coverage to all California residents without regard to ability to pay or medical condition is provided;
  • Equitable sharing of financial responsibility for those who are unable to pay the cost of basic health care (sharing among employers, individuals, government, health plans and providers);
  • Incentives for prevention, healthy life-styles and personal responsibility for health are provided;
  • Reform results in more market-driven cost and quality in the health care industry and easy access to the information that will be required to achieve it;
  • Reform minimizes the shifting of cost from the uninsured and under funded to the insured;
  • Unfunded government regulatory mandates are addressed; and,
  • The issue of equity in government reimbursement (to cover the cost of the service) is addressed.

Assembly Bill 8 (Nunez, D-Los Angeles) appears to be the front-running vehicle for health coverage and reform legislation.

This legislation is a “play-or-pay” plan with employers contributing at least 7.5 percent of payroll for health care benefits. The governor’s “play-or-pay” proposal includes an individual mandate, 4 percent tax on hospitals, 2 percent tax on physicians, Medi-Cal payment increases and coverage for the uninsured.

Philosophic and practical concerns by various groups make several of the governor’s proposal problematic. AB 8 does not pass the test of principles described above.

For reform to work, we all have to play a part. Employers need to ensure that their workers can access healthcare coverage at a price that makes it realistic, including a subsidy that helps the low-wage employers who can’t take the financial hit on their businesses, and would eliminate jobs instead. No one wants this outcome. As an individual, you need to help your own cause by supporting requirements that workers take advantage of coverage provided by your employer, or an alternative provided by a purchasing pool. Again, lower-wage workers need to have a subsidy of some kind to help pay for coverage.

What do you think? What challenges do you face as a healthcare consumer? Let’s start the dialogue today and see how far we can get on voiceofsandiego.org in 24 hours.

— STEVEN ESCOBOZA

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