THE TREATMENT MAY 5, 2009
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Blog
and is a regular contributor to the Treatment.
During the fifth and last of the White House Regional Forums on Health Reform, held in Los Angeles several weeks ago, domestic policy advisor Melody Barnes didn't provide much detail about the substance of health reform. But she did provide a timeline. She indicated that in order to meet Obama's goal of passing comprehensive health reform this year, legislation would need to be ready within 100 days. This ambitious timetable is what struck me and many other audience members, judging from my conversations afterwards. Sitting next to Barnes at the forum was California Governor Arnold Schwarzenegger, whose recent attempt at health reform provides a reminder for why Obama and Congress need to be mindful of the clock. Lots has been written about the stalling of the Governor's health reform in California last year. But, at the end of the day, the simplest analysis is that he ran out of time. The recent deal on reconciliation suggests that some are learning lessons from California both about clock management and the parameters of negotiating across party lines. Schwarzenegger unveiled his health reform in January 2007. The Democratic majorities in the legislature already put forward similar versions of health reform, as well. But the Republican Governor also wanted votes from legislators of his own party, both for political and procedural purposes, since California is one of only three states that require budgets and taxes to be passed with a 2/3 supermajority. (If it sounds tougher than getting 60 votes in the U.S. Senate, it is.) But all through the spring and summer of 2007, the Governor waited for Republican legislators to engage--even though many made clear that they could not support many of the essential components of his proposal: new regulations on insurers, a minimum standard for employer contributions to worker benefits, public program expansions, and anything that looked like a new tax. (As one Republican staffer told me early in the year, “we can’t cross the first bridge.” So when Republican Senators argue against the public health insurance option, the relevant question is whether they are on board with everything else.) It wasn't until the very end of our legislative session in September when the Governor decided to move forward without Republican legislative leadership. He called the Legislature into special session to pass a framework for health reform by majority vote--thus only requiring Democrats--with the intent to go to the ballot for the financing components. Only in October--after the normal legislative session had ended—did the Governor actually release his preferred legislative language. That left precious little time to negotiate the many tough details, before a reform package passed the Assembly on a party line vote in mid-December. To qualify for the November 2010 ballot, the ballot measure on financing was filed--and thus unamendable--before the California Senate could even consider the proposal in January 2008. The failure of reform in California has been attributed to the state's economic and budget crises that started to loom, or the powerful interests in opposition. Even with all that, many think a deal in the Senate was possible if there was time to make more changes. We ran out of time. Federal reformers don't have the unforgiving deadlines of qualifying a ballot initiative, but other factors--including the politics around the 2010 elections--loom. Governor Schwarzenegger let the Republican legislators run out the clock on health reform. We shouldn't let that happen to federal reform, whether we are looking at President Obama's next 100 days, or the October 15th date for reconciliation.