Speaker of the Assembly Fabian Nunez On the Assembly Passed Health Care Reform Bill

• We require every California resident to have and maintain health care coverage and we provide a combination of public program expansions, subsidies, tax credits and other tax breaks to make the coverage affordable.

I want to take a minute to emphasize affordability protections because I know those are of particular concern. The Act’s affordability protections include:

• Expansions of eligibility for public coverage so the lowest income Californians will have coverage with little or no cost sharing.

• Moderate income families without employer sponsored coverage will have access to refundable tax credits.

• We state legislative intent to authorize tax credits for early retirees between the ages of 50 and 64 and budget an extra $50M to pay for it.

• Employers will be required to establish Section 125 tax-free accounts so that employees can pay for health benefits on a pretax basis.

• We exempt low income people from the individual mandate entirely if they can’t get into subsidized coverage.

• Anyone, regardless of income, can seek a temporary or permanent exemption from the individual mandate based on hardship and affordability through the MRMIB.

Contrary to claims from organizations with their own agendas, AB 1x does make serious changes in the way insurance companies do business.

• We require every health plan and insurer in the state to accept anyone subject to the individual regardless of their health status or claims history.

• Carriers will be obligated to spend at least 85 cents of every premium dollar collected on health care and health benefits.

• Regulators will establish five coverage choice categories for all individual market products and carriers will have to offer benefits in each category.

• There will be one standardized HMO and one standardized PPO product in each coverage choice category so consumers can make "apples to apples" comparisons.

Other cost containment elements include programs to improve the prevention and management of high cost and chronic diseases, expanded use of electronic records and methods to reduce paperwork, limit medical errors and improve the quality of health care delivery, and comprehensive, system-wide accountability and transparent public reporting of costs and quality for all elements of the health care system, including hospitals, physicians, health professionals and health plans.

One of my top concerns during negotiations was to ensure the stability and viability of California's safety net. In fact, we enhance it. Safety net protections include:

• A Medi-Cal rate increase to public, private and district hospitals of over $2.3 billion which will continue to grow over time.

• Counties with public hospitals will be able to keep a stable population bu developing a local coverage option for newly covered low income adults providing their health care through county and community clinic delivery systems.

• At full implementation, community clinics will receive an additional $140 million to support clinic visits for any remaining uninsured persons.

There have been on these pages charges that the financing for the plan is murky or hidden. Untrue, and somewhat frustrating when it comes from supporters of SB 840, which has no financing plan at all.

AB 1x1 has a specific financing proposal accompanying the bill. Through a companion ballot initiative anticipated for November 2008, this reform package ensures that adequate financing is in place before the reforms take effect in 2010 and that the entire package will be self-sustaining through dedicated revenues. The total financing package includes: employer and employee contributions, an across the board fee on hospital services, increased tobacco taxes, additional federal funds, and revenues returned to the state by counties for those low-income persons newly enrolled in coverage and no longer in need of county funded health care services.

It’s ironic that no move toward universal health care will ever win universal support. But this bill deserves the widest possible support. This is a far reaching bill that not even progressive Democratic governors are advancing in their states.

Of course health care is not our only challenge. It is also imperative to address the state's budget imbalance. But the way AB 1x is funded we can tackle health care without limiting our ability to address the budget imbalance. Letting health care get worse does nothing to make the budget better.

I hope this summary is helpful in outlining the nature of our bill. Of course, the full story is available in the bill and analysis on the Assembly website. I do understand that no answer or fact will satisfy some who are willing to go through any number of intellectual contortions to suggest that the language doesn’t say what the language does. To them I can only say it would be a shame if disappointment over the chances of single payer (and I’m a supporter of single payer) detracted from the opportunity we have to do a strong measure of good for the millions of Californians who don’t have, or are having trouble affording, health care. A plan for San Francisco is one thing. A plan for Santa Monica is one thing. A plan able to get signed into law and get voter support for its funding is quite another. And that’s the remarkable success we’ve been able to achieve after a long and serious year of effort.