If you're going to follow what appears to be the single biggest issue in California politics this year, then you're going to need to learn a few key terms, starting with...
"Pay or play"... "Mr. MIBB"... "ERISA"... and, today's most important concept, "mandates." Yes, we're talking about health care reform.
This morning,
Senate President Pro Tem Don Perata (D-Oakland) threw his hat into the ring with a proposal he admits is a work in progress. By this time next month, you're likely to see several more plans floated in Sacramento, all aimed at shrinking the number of uninsured Californians.
In fact, several legislators introduced their own proposals last week. But today's announcement symbolizes the opening bid from at least one half of the Democratic leadership. And any plan from the Pro Tem will likely carry a lot of weight in negotiations with
Governor Schwarzenegger in the new year.
What follows is by no means a full explanation of the Perata Plan, but it should give you the general gist of what he's pitching.
The Senate leader says he's aiming to provide health insurance for all citizens who have a job and their families. That, he says, would cut the number of insured Californians by some two thirds... but would still leave more than 2 million without coverage.
(By the way, the group to be covered does not appear to include illegal immigrants, either adults or children.)
It might help to think of his proposal as a modified form of 2003's
Senate Bill 2, later overturned by voters in a referendum known as
Proposition 72. The Pro Tem's suggestion is to return to the notion (contained in SB 2) of mandates on employers.
Employers would have to either offer health insurance, or pay money into a state system that then attempts to buy affordable coverage for millions of currently uninsured workers. [Hint: this is the often referred concept of "pay or play."]
But Perata also includes mandates on employees. Workers would have to
prove they have health insurance, or else forfeit some existing state tax credits they currently receive.
Perata's aides say the plan would cost between $5 billion and $7 billion. To help defray the cost, it would attempt to collect additional federal dollars by making more of the working poor eligible for Medi-Cal coverage (that expansion would theoretically trigger a new federal subsidy, thus some extra cash to make this all work). But none of the costs, says Perata, would come out of the state's already-strapped General Fund.
So, how much of the costs would an employer pay, and how much would an employee pay?
SB 2 pegged it at 80/20 (employer/employee). The governor has said that's why he campaigned to overturn the law; in an interview this past June, he suggested something like "50/50" might be more reasonable. Consumer advocates, however, say that would be too much out of a worker's pocket.
And if that isn't enough, legislative Republicans are already saying they are against
any mandate on employers to pay for employee health care coverage. Period.
Still, the debate is only beginning. And all sides said today they appreciate the Senate leader putting some ideas on the table, ideas he admitted are likely to get tweaked. "Everybody has to be engaged," Perata told reporters.
Some audio clips of Senator Perata from this morning are below:
* On the reaction to his proposal, and how he hopes the debate will play out.
* On why he's not pushing a proposal for universal health care coverage.
* How the issue, and the various legislative proposals, will be handled.