As a campaign issue, healthcare is comatose

Republican Gov. Arnold Schwarzenegger promises comprehensive healthcare reforms but says he’s saving the details for after the election.

His challenger, state Treasurer Phil Angelides, is proposing to expand coverage of children and require large companies to pay for workers’ insurance, but his ideas, mostly Democratic standbys, aren’t getting much attention.

Healthcare would seem to be a big issue in California, where more than 6 million residents are uninsured, urban emergency rooms teeter on the brink of closure and rising costs are pinching the state budget as well as taxpayers.

It is not, however, much of an issue in the gubernatorial campaign.

One reason is voters themselves, said Mark Baldassare, survey director of the nonpartisan Public Policy Institute of California. In a recent poll, just 4% of those likely to cast ballots ranked healthcare as their No. 1 concern in the governor’s race.

Most voters have insurance and are “generally satisfied with the kind of healthcare coverage that they’re getting personally,� Baldassare said.

Schwarzenegger, with a wide lead in the polls, has not seen the need to wrestle with the complexities of the issue, or its many controversies, on the campaign trail.

His political record on the matter is spotty and at times uneven.

In his 2003 campaign, Schwarzenegger promised to “make sure that every child in California is insured.�

In 2004, Schwarzenegger opposed Proposition 72, which would have required medium-sized and large businesses to buy health insurance for their employees. That measure, attacked by a well-funded ad campaign by the California Chamber of Commerce and other businesses, failed by a slim margin at the polls.

In 2005, supporting it in concept but calling it too costly, he vetoed a Democratic proposal to extend coverage to 800,000 uninsured children. The bill would have allowed those who earn up to nearly $60,000 for a family of four, triple the federal poverty line, to enroll in the state Healthy Families program. (The current threshold is 250% of the federal level.)

This year, he vetoed a bill by state Sen. Sheila Kuehl (D-Santa Monica) that would have created one public insurer to cover all Californians. (Angelides took no position).

Critics say the governor’s opposition to Democratic proposals and his failure to offer solutions of his own do not bode well for a second term.

“He’s a total failure on trying to provide any kind of healthcare reform,� said Deborah Burger, president of the California Nurses Assn. “Voters will not have a clear understanding of what they’re getting when they vote for him, as far as healthcare reform.�

But on Friday, in a Fox News interview, the governor said: “We are going to go and do everything that we can to reform healthcare, to provide healthcare for everyone in California.�

Schwarzenegger has made some strides in healthcare, some observers say.

In August, he supported legislation allowing the state to fine hospitals for lapses that cause serious injury or death. His budget this year included about $250 million to prepare for such disasters as a pandemic flu or bioterrorist events. And he reached a deal with Democrats to lower drug prices for more than 5 million Californians and acceded to their demands to allow sanctions against noncompliant drug companies.

“The governor believes that the biggest problem facing Californians is affordability and the rising costs of healthcare,� said Adam Mendelsohn, a Schwarzenegger spokesman. “He wants to make healthcare a centerpiece of the next term.�

Some experts said that makes sense.

“What we’ve seen in the last three years is, initially, an approach from the governor to sort of take small bites at different parts of the healthcare problem,� said Peter Lee, chief executive of the Pacific Business Group on Health. “It’s really been recently that we’ve seen the governor embrace the need to try to tackle head-on the full range of cost, quality and access problems in healthcare.�

Schwarzenegger has tapped healthcare policy experts to help draft a reform plan, with the idea of laying out the particulars next year in his State of the State address. Their members include Herb Schultz, a former aide to Democratic Gov. Gray Davis, who helped write the bill that became Proposition 72, and John Ramey, who worked with the California Chamber of Commerce to help defeat the measure.

In a San Diego Union-Tribune Op-Ed piece in September, Schwarzenegger wrote that he favors an approach that “provides affordable medical treatment to people when they are ill,� “strives to make sure people don’t get sick in the first place,� “supports cost containment,� “promotes personal responsibility and builds on existing private and public systems� and “recognizes the shared responsibility of individuals, employers and government.�

“Those are the kind of statements that suggest a broad direction but avoid a specificity that doesn’t really let us know where he’s going to go if he’s reelected,� said E. Richard Brown, director of the UCLA Center for Health Policy Research.

One thing that Schwarzenegger has made clear -- his opposition to new taxes -- would limit the scope of any proposed reform, said Jack Lewin, the outgoing chief executive California Medical Assn.

“We don’t believe you can get 7 million insured here without any additional resources,� Lewin said.

Angelides’ platform is largely based on Democratic proposals that have been defeated at the polls or vetoed by Schwarzenegger.

For one, he favors expansion of the Healthy Families program, which mostly serves children of the working poor. As he sees it, the move could be covered in part by a tax on the wealthiest Californians or by proceeds from Proposition 86, a $2.60 tax increase on a pack of cigarettes, if it passes on election day.

Angelides also calls for a plan similar to the proposal in the failed Proposition 72. But he would require only the largest companies -- those with 200 or more employees -- to pay for their workers’ health insurance. Such a plan would benefit 600,000 uninsured Californians, said Chris Woods, Angelides’ policy director.

Angelides would prohibit HMOs from spending more than 10% of the fees they receive from premiums on profits or overhead. HMOs can currently spend up to 15% of those fees on overhead, Woods said.

Some experts cautioned that Angelides’ plans fall short of achieving near-universal coverage and some elements would probably run into the same powerful opponents in Sacramento, including the California Chamber of Commerce, that helped defeat Proposition 72 and other proposals.

“It’s tougher than ever to get those remaining industries that don’t provide coverage to pick up employer coverage in a big way,� Lewin said.

Mandating that employers cover insurance without broader reform worries small businesses, said Scott Hauge, president of Small Business California.

“I do think small businesses are willing to step to the table and pay something,� Hauge said. But “we’re scared to death about double-digit increases in healthcare� and “we don’t see a lot of effort in trying to lower costs.�

Focusing on employers with more than 200 workers also doesn’t target the vast majority of the working uninsured, who labor in organizations with fewer than 50 employees, said C. Duane Dauner, president of the California Hospital Assn.

“Do we believe that there are effective ways of a more comprehensive approach?� Dauner asked. “The answer is yes.�

Still, his campaign officials say Angelides, who supports the goal of universal coverage, offers more of a solution than Schwarzenegger has.

“Schwarzenegger hasn’t done anything to expand healthcare. Angelides -- it’s a central part of his platform,� said Woods, Angelides’ policy director.

In fact, neither candidate has articulated precisely how he would achieve the broader reforms that each says he favors.

“And with 6 1/2 million uninsured,� Brown said, “we have a long way to go.�

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