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Let’s Avoid Serious Mistakes in the Next California Healthcare Reform Bill
By Rose Ann DeMoro
Executive Director
California Nurses Association
With its vote today, the Senate Health Committee deserves the thanks for all Californians for its thorough, deliberative process and for taking a principled courageous stand despite the enormous pressure brought to bear by those who were pushing for hurried passage for a badly flawed healthcare bill
Following this vote, the nurses of California offer our pledge to work with legislators, community groups, and labor for genuine healthcare reform that avoids the serious shortcomings of AB x 1.
AB x 1 was rejected not because Californians and the legislature like the status quo or do not yearn for fixing our broken healthcare system. The bill collapsed because it was fundamentally flawed on its merits on access, quality, and cost.
Among our key concerns were the mandate forcing individuals to purchase insurance with no controls on costs or a minimum standard for benefits or quality, the failure to provide meaningful protection to families facing a huge spike in out-of-pocket costs, and the danger that the low employer mandate would encourage employers to drop current coverage.
We also pay note to the serious underfunding of the proposal, represented by a tobacco tax and the absurd premise of basing a health bill on essentially encouraging individuals to smoke.
Many the remarks by committee members during discussion on the bill bear particular note, including committee chair Sen. Sheila Kuehl’s comment that not voting for this bill “does not mean we prefer the status quo, any more than Gov. Schwarzenegger was saying he preferred the status quo when he vetoed SB 840,” a single-payer, Medicare-for-all style bill.
We concur with Sen. Leland Yee who noted, “the only way we can get true health care reform is with a single-payer process” that “is fair and makes sure everyone is covered.”
We look forward to working with Sen. Kuehl, Sen. Yee, and everyone who is dedicated, along with us, to a genuine, comprehensive reform, such as Sen. Kuehl’s SB 840.
In the interim, there is a short term alternative. Adopt AB x 1’s fee on hospitals reimbursed through higher Medi-Cal payments to hospitals proposed in the bill, and use the resulting federal money to expand coverage for children.
Here are ten reasons why we opposed the bill, and problems that should be avoided in future legislation:
1. Forcing individuals to buy insurance policies without knowing the cost or what coverage they will receive.
2. No meaningful cost controls on rising premiums, co-pays, or deductibles.
3. Failure to identify minimum coverage, likely to be cheap HMO plans without dental, vision, mental health, long term care and other essentials which will cost extra.
4. Gaping holes in supposed affordability protections. No cap on premiums or out-of-pocket costs for middle-income families. Low-income employees were ineligible for public subsidies if they opt out of employer coverage offer which could be a gym club membership or health savings account.
5. Harsh penalties for individuals who fail to buy insurance, including garnishing wages or mortgage liens, but no penalties for employers who don’t comply.
6. Incentives for employers who now provide benefits to cancel coverage to pay cheaper fee or shift more costs to workers. The bill encouraged large employers like Wal-Mart to dump lowest wage employees into the public pool.
7. Sunset of hospital fees and tax credits and a two-thirds vote for increasing employer mandate. No similar protections were available for individuals who would bear the burden of future increases in costs.
8. Linking funding to a tobacco tax, so anti-smoking programs would continually undermine the plan’s funding base.
9. Jeopardizing public safety net hospitals. The bill gave higher reimbursements to private hospitals while shifting $1 billion from counties to pay for the plan.
10. Systemic underfunding. The Legislative Analyst Office projected likely shortfall of $3.9 billion. Figure far greater if the costs of state-subsidized premiums are higher, the number of uninsured matches federal numbers not the proponents’ estimates, and if the impending recession pushes more Californians into the pool.
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