“Ninety Years of Health Insurance Reform Efforts in California” from the California Research Bureau is our site of the day

The California State Library has issued a fascinating 65 page report that recites the history in California dating back to 1918 and Governor Hiram Johnson to expand health care benefits in the state as well as Federal efforts in this vein. My thanks to Anthony Wright of Health Access California who spotted this report and listed it on their blog.

“Ninety Years of Health Insurance Reform Efforts in California” was written by Michael Dimmitt, Ph.D of the California Research Bureau, which is housed in the California State Library.

In reading through what is said about the 44 ”significant” legislative measures to reduce the number of medically uninsured people in California and the 4 ballot propositions during these 90 years, you will see that there is not much really new under the sun. There are single payer plans--mandates on employers, employees, or both—requirements on insurance companies—and a variety of ways that health care is proposed to be paid for. All sorts of taxes and shared costs, and varieties of limits on rates, deductibles, and shared costs.

You’ll also learn about how taking care of the medical needs of indigents has been a county responsibility, which lead to the building of county hospitals and at various times has shifted to the state itself, and how the back and forth on this is related to various fiscal crises in the state.

The report also briefly discusses requirements of the Federal Employee Retirement Income Security Act of 1974 (ERISA) and how the preemption in this statute has hamstrung California and other states in taking action.

Here are a few of the morsels in this report, many of them footnoted:

• Between 1961 and 2002, health care costs increased almost without interruption. No effort to contain them has proven successful over the long term. Cost pressures include increasing demand, extensive deployment of new technologies, increases in the prevalence of chronic disease, and fee-for service delivery systems.

• Federal programs provide health care coverage to over 7.4 million Californians. If the programs were not in place, the number of uninsured in the state would double.

• Gilmer and Kronick report that increases in the cost of health care from 1979 through 2002, are the primary reason for the decline in health insurance coverage during that time.

• They project that the number of uninsured, non-elderly Americans will grow from 45 million in 2003 to 56 million by 2013.

• More than 20 percent of Californians, 6.6 million people, currently lack health care coverage over the course of the year according to research conducted for the California Healthcare Foundation.

• The number of Californians without any insurance at any point in a year has been estimated to be 4.9 million.

• As a consequence of the growth in premiums, the number of people covered by health insurance in California decreased from 64.6 percent to 54.7 percent between 1987 and 2005.

• Of those without health insurance, as estimated 75 percent are working people and their families.

• During his three-term tenure as Governor, Earl Warren submitted at least four health care reform proposals to the legislature, but none were adopted. His first proposal would have established a universal health care system in California. The Governor’s subsequent proposals were not as sweeping in scope.

• Between 1950 and 2007, 38 health care reform proposals were introduced in the legislature. Very few were signed into law.

This report is primarily a history but does have some analysis. Though it does go through 2007, it stops with AB 8 of the regular session which was vetoed by Governor Schwarzenegger.

It’s conclusion:

“Expansion of health care insurance coverage in California has been an unmet challenge for the last 88 years. Whatever reforms the governor and the legislature pursue, balancing powerful competing economic issues is a demanding and difficult process. The conundrums of ERISA, employer mandates, financing and health care cost containment may prove to be intractable. However, at no other point in the history of the health care coverage debate has the governor and legislative leadership individually concluded health care coverage needs to be reformed. The action is historic and the time for reform in California may be at hand.”

Read it through and draw your own conclusions.