Budget a Bad Omen for Insuring the Uninsured

As lawmakers prepare for a special session on health care reform and the Governor touts a broad coalition backing universal coverage, the recently enacted budget should serve as a reality check.

Governor Arnold Schwarzenegger and his staff has made clear that any reform package emerging from the special session needs to include an “enforceable” requirement for every Californian to obtain health care coverage. This makes sense. Requiring carriers to issue coverage to all applicants without a corresponding mandate to buy is a formula for disaster. People are logical. If it makes economic sense to simply wait until medical services is needed before buying coverage that’s what they’ll do. Of course, when healthier individuals exit an insurance pool, overall claims increase which leads to higher prices for those remaining. This drives more low cost individuals from the pool and premiums move even higher. Eventually you wind up with New Jersey where the average premium for individual health insurance is 350 percent higher than in California.

So the state’s promise of passing an enforceable mandate to buy coverage along with a mandate for carriers to sell that coverage is critical to the overall health care reform package.

One of the tenants of the California of Health Underwriters’ Healthy Solutions health care reform plan is that the state should demonstrate it can meet its current obligations before making new promises. Unfortunately, to date, the state has failed in this regard. As the Healthy Solutions document notes, as many as a million Californians are eligible for state-run health care programs, yet fail to enroll. According to the California Health Interview Survey, 447,000 children are eligible for, but not enrolled in, state health programs. Healthy Solutions calls on the state to first enroll this group before creating new programs.

It seemed the state was going to do just that. Earlier this year the Governor held a press conference at the Northeast Valley Health Corp clinic in the San Fernando Valley promising additional state funds to support enhanced outreach.  According to the Los Angeles Daily News, the commitment was so firm nonprofit health clinics and local government agencies had already increased staff to bring many of those 447,000 into the state’s Healthy Families and MediCal programs. Yet, as part of the deal to pass a budget, an estimated $66 million was cut, resources which health advocacy groups told the Daily News would have enrolled about 100,000 children during the current fiscal year. The Northeast Valley Health Corp had hired nine people in April for this effort. At least half will now be let go and the others reassigned.

So, here’s what we’re about to witness: Legislative Leaders and the Governor will announce plans to expand eligibility for Healthy Families and MediCal. They’ll promise to enforce a requirement for all Californians to obtain health care coverage and offer premium subsidies to those in households with less than 400 percent of the Federal Poverty Level. At roughly the same time, the Northeast Valley Health Corp will be laying off roughly half of the nine people it hired in April to expand outreach to children and reassigning the rest.

This strikes me as a credibility problem of near Lyndon Johnson-like proportions. As CAHU suggests, the state needs to keep its current promises before making new ones. Yet the budget fiasco of 2007 demonstrates this may be beyond its ability.

At the very least all of this should (but won’t) give advocates of single-payer programs pause. After all, it’s a pretty bad omen when a liberal Legislature and a moderate Governor fail to reach out to 100,000 kids. Imagine what might happen when the pendulum swings to a conservative state government. And the pendulum always swings.

The Great Health Care Reform Coalition of 2007 — Maybe

Governor Arnold Schwarzenegger and Speaker Fabien Nunez held a press conference on Friday (September 14th) in support of comprehensive health care reform (a video of the complete press conference can be viewed at the Governor’s web site). They were joined by a diverse group of stakeholders, something the Governor gladly pointed out. “When we started down this road last December, everyone said health care was too complicated to fix. They said we could never unite all the interests groups with a stake in the issue. but look who is standing with us today — groups that were against us and against each other when I stood here last December are now standing together for reform.”

It was an impressively broad and substantial group of leaders:
• Lloyd Dean, president and CEO, Catholic Healthcare West
• Annelle Grajeda, president, SEIU Local 721
• Renee Fraser, past president, National Association of Women Business Owners – Los Angeles
• Dr. Richard Frankenstein, president elect, California Medical Association
• Mario Molina, CEO, Molina Health Care
• Robert Warnagieris, Ed.D., executive council member, AARP
• Barry Arbuckle, chair-elect, California Hospital Association
• Diana Dooley, CEO, Children’s Hospital Association
• Richard Cordova, president and CEO, Children’s Hospital Los Angeles
• Don Crane, CEO, California Association of Physician Groups
• Theresa Brown, president, California Association for Nurse Practitioners
• Dr. David Feinberg, physician
• Liz Helms, founder, Chronic Care Coalition
• Debra Cherry, executive vice president, Alzheimer’s Association California Southland Chapter
• Erin Pak, CEO & executive director, Korean Health Education Information and Research
• Lupe Alonzo-Diaz, executive director, Latino Coalition for a Healthier CA
• Rose Yu, Allergy and Asthma Foundation of Southern CA
• Bill Dombrowski, CEO, CA Retailers Association
• Laura Yamanaka, President, National Association of Women Business Owners – Los Angeles
• Blair C. Salisbury, California Restaurant Association Board Member and President CEO, El Cholo / Barn Burner BBQ / Dona Rosa
• Tyrone Freeman, president, United Long Term Care Workers Union
• Ben Chu, CEO, Kaiser Southern California
• Howard Kahn, CEO, L.A. Care Health Plan
• Karen Vigil, senior vice president and CEO, Blue Shield of California, Individual, Small Group and Government Business Unit
• Jay Gellert, National CEO, Health Net
• Dave Anderson, CEO, United Health Care, Southern California

The Governor described the group as “big supporters of our health care reform — of our proposals.” There are two interesting aspects to all this. First, as was acknowledged by Speaker Nunez, the group was supporting the effort for comprehensive health care reform without knowing what the final package looked like. This can be dangerous for both lawmakers and the endorsers. It also means the stakeholders standing behind the Governor were there primarily to show a shared commitment to passing meaningful health care reform during the upcoming special session.

Second, the gathering demonstrates the broad support available to the initiative likely to be required to fund whatever legislation comes out of the special session. And an initiative will be required. There is virtually no chance of getting the two-thirds vote of the Legislature required to pass new taxes and fees. So the only path available to the Governor, Speaker Nunez and Senate President Pro Tem Don Perata is to seek approval of the funding from the people.

Yet it’s always tough to get new taxes and fees passed. Especially substantial taxes and fees like those required to fund health care reform. Substantial taxes means substantial opposition. It will take a coalition like those at the press conference to overcome this opposition.

So the question is, how real is the coalition? Can it survive the reality of health care reform legislation? If it requires an individual mandate will the unions at the press conference still back it? If it requires a fee on doctors, will the California Medical Association stay onboard? If the legislation assures a death spiral in the individual marketplace, will the health plans in attendance still support the package?

There’s no way to know now, but time will tell. For the present, the participants at the press conference is a testament to the political strength of the Governor and the strong momentum behind comprehensive health care reform. That’s all, but as the special session draws nearer, it’s a good start.

A Health Care Reform Initiative May Be Unprecedented, But Its A Sound Idea

I have a great deal of respect and admiration for George Skelton, the veteran Los Angeles Times journalist. Yet I have to take issue with his September 13th column in which he takes Governor Arnold Schwarzenegger and the Democratic Legislative Leadership to task for contemplating an initiative to fund the health care reforms expected to come out of the upcoming legislative special session.

Mr. Skelton claims the initiative would “confirm many people’s view that the Legislature is indecisive and irrelevant.” He also warns that by backing an initiative, Governor Schwarzenegger “would further alienate Republican legislators. He would be shunting them aside again, signaling that they’re not needed.” He goes on to question the timing of an initiative. It would likely be on the November 2008 ballot — more than a year after the special session adjourns and shortly after a bruising budget battle which is likely to be worse than what we endured this year.

Much of what Mr. Skelton says is true. People do hold the Legislature in low regard. Republican lawmakers are increasingly marginalized (and will likely continue to be until the way we draw legislative districts in the state is changed so as to make more of them competitive). The timing of the initiative is unfortunate.

Yet, it also is the right thing to do. What makes the initiative route worth traveling is that it holds out the promise of making comprehensive health care reform a reality. The Legislature is impotent any time a two-thirds majority vote is required. The Governor, Speaker Fabian Nunez and Senate President Pro Tem Don Perata could ram there heads against that wall, lose and slink away. Instead, they’re taking the only path the current political reality in California leaves them.

Is the need for an initiative an example of a healthy state government? No, in fact it’s evidence of just how dysfunctional state government has become. Will it bring the state meaningful health care reform? It certainly holds out that promise. The key, of course, is whether the framework of reform, including the elements that don’t require passage by a two-thirds vote, will actually make California’s health care system better. Based on the version of Assembly Bill 8 passed by the Legislature, the answer is no. Hopefully the special session will produce more responsible legislation, something worthy of being financed by the very necessary initiative.

Unintended Consequences and Guarantee Issue

I’ve written a lot in this blog about unintended consequences. Like the law of gravity it is ever present, impacting everything. Simply put the law of unintended consequences is that whatever the intent of any given piece of legislation, among its impact will be things unhoped for. No matter how well intelligent and savvy the authors, no matter what intended consequences result, any piece of legislation will have unanticipated, unwanted and unwelcome results.

Proof that the unintended consequences is a strong force can be found in a report conducted by Milliman, Inc., a respected independent actuarial firm on behalf of America’s Health Insurance Plans, an industry trade group. Putlished in July, the report takes on special significance in light of the health care reform initiatives put forward by Governor Arnold Schwarzenegger, Speaker Fabian Nunez and Senate President Pro Temp Don Perata. (The Impact of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets).

The study demonstrates that while the goals of reforms which established guarantee issue and community rating were laudable, “they frequently had unintended consequences that disrubted the individual marketplace,” according to Leigh Wachenheim. a Principal and Consulting Actuary at Milliman.

This result shouldn’t surprise anyone. These reforms bring into the insurance system individuals with higher costs than those previously in the pool. This is what is these laws intend to do and, personally, I believe it is a good thing. However, where there’s no offsetting incentive or requirement for lower risk individuals to buy insurance, the result is higher claims than previously experienced. This means rates go up for everyone. This in turn drives some low risk consumers out of the insurance market. Which means further increases are required for what is now an even higher cost pool. This antiselection process leads to substantially higher premiums as only high risk individuals remain in the pool. There’s nothing sinister about this. It’s the way every medical coverage pool works whether it’s for-profit or non-profit, government-run or private.

And it’s what happened in the eight states studied by Milliman. In two of the states, New Hampshire and Kentucky, the results were so negative and severe the guaranteed issue and community rating laws were repealed. A similar dynamic occurred in Washington leading to a significant weakening of its guarantee issue provisions. In other states, carriers fled the individual market where they can and the cost of coverage has skyrocketed. Another impact the study identifies is that the reforms do not appear to be effective in increasing the number insureds in these states.

This report should be required reading for every legislator and the governor, too. Hopefully they will come to the logical conclusion: guarantee issue can have a very positive impact on the market, but only if it is done correctly. This means linking guarantee issue not on the promise of an effective mandate to purchase coverage, but on a mandate to purchase coverage proven to be effective.

That’s why the California Association of Health Underwriters, in its Healthy Solutions health care reform plan, recommends triggering guarantee issue only after 90 percent of California’s population has medical coverage. Until then, CAHU recommends expanding the current state pool for high risk individuals so it can serve as an effective  insurer of last resort. Even after the 90 percent threshhold is met, carriers should be permitted to raise the rates and exclude from coverage pre-existing conditions of the 10 percent who fail to abide by the law. (The length of time these penalties could be applied would be commensurate with the length of time the individual remained outside the insurance system).  

Without an effective mandate to purchase coverage, the guarantee issue provisions being pushed by the Legislative Leadership and the Governor will do more harm than good.  Premiums will increase, carriers will leave the market, and the number of uninsured Californians will remain untouched.  This obvioulsy is not their intent, but it would be the likely result. Afterall, just because consequences aren’t intended, doesn’t mean they’re not foreseeable.

The Curtain Goes Down on Act I. Now Comes Act II.

As predicted, the Legislature passed Assembly Bill 8 (Nunez). The Senate vote was 22-to-17 vote and in the Assembly it moved forward on a 45-31 vote. (Significantly, there will apparently be no vote this year on Senate Bill 840 (Keuhl), the single payer proposal). Governor Arnold Schwarzenegger immediately announced he would veto the bill and pledged to call a special session to iron out an acceptable health care reform package (his full statement is below).

None of this is surprising. Nor should it be taken as a failure of the Administration or Legislative Leaders — although that’s how many reporters will no doubt describe it. Lawmakers and their staffs worked hard to reach a compromise before the regular legislative session adjourns this week, but time, the complexity of the issue, and the press of other issues made that impossible. What’s impressive is how close they came. Which sets the stage for a productive special session.

Not that anyone’s asked but my wish list for the special session:

• Detailed language on what each side (the Governor and the Legislative Leaders) are proposing.
• Time for interested parties to digest this information
• Meaningful public dialogue on the proposals with all parties keeping an open mind on how to achiee their common goals.

In short, while some backroom negotiating is inevitable, there’s been too much of it concerning AB 8. It’s time for the process to open up. What the Governor and the Legislative Leadership need to do is be very clear on their health care reform goals while not getting too locked into how those aims are achieved (the Governor makes a good start in this direction in his statement). By sincerely listening to alternative approaches, it may be possible to reach a workable and meaningful compromise. It’s happened before. Let’s hope it can happen again.

Here’s the Governor’s statement on health care reform in full:

Gov. Schwarzenegger Issues Statement Regarding Health Care Legislation

Gov. Arnold Schwarzenegger today issued the following statement regarding Assembly Bill 8, by Assembly Speaker Fabian Núñez and Senate President Pro Tem Don Perata:

“I applaud all the hard work that has gone into efforts to reform California’s health care system, but I cannot sign AB 8 because it would only put more pressure on an already broken health care system.

“First and foremost, AB 8 does not cover everyone. Any reform that leaves millions without health insurance and fails to address our dangerously overcrowded emergency rooms simply maintains a broken system. I have said from the beginning of this debate that coverage for all Californians is critical to reducing health care costs for everyone.

“AB 8 does not protect consumers because insurers would still be allowed to deny coverage, leaving Californians vulnerable to loss or denial of coverage when they need it most.

“I also believe that AB 8 is financially unsustainable. I have always said that I would not sign a health care bill that puts the vast majority of the financial burden for reform on any one segment of our economy. AB 8 unfortunately does that by requiring businesses to pay at least 7.5 percent of their payroll into a state fund or on health care services for employees.

“I believe we can find agreement on a financially sustainable reform plan that shares responsibility, covers all Californians and keeps our emergency rooms open and operating. The historic agreement reached this past week on the use of hospital contributions for coverage demonstrates that a more balanced approach is achievable.

“We have made tremendous progress on this issue during the past session and have found considerable common ground.

“That is why I intend to call a special session of the Legislature so that we can finish the job of truly reforming our health care system. I know that legislative leaders are willing to get the job done.

“We must keep working until we achieve the kind of historic solution that all of us and the people of California want.”

More on the Likely Special Session/Initiative

It all does seem to be coming together. Not having seen the details of the deal, it’s tough to know how much is good and how much isn’t, but a deal seems to be coming.

Daniel Weintraub of the Sacramento Bee has a great summary of what’s shaping up. It describes a deal pretty much along the lines of what I wrote about yesterday. The Democrats pass bills. The Governor vetos them. In a special session they produce compromise legislation which is contingent on an initiative passing in 2008 to fund the reforms. (The initiative is important for two reasons: it sidesteps the need for a two-thirds majority in the legislature and it allows the Governor to declare it is a post-partisan compromise because ordinary Republicans — not necessarily elected ones — will vote for it).

What we’ll be looking for this week is the details. Will it still empower the Managed Risk Medical Insurance Board to impose a health care fee on all businesses in the state without legislative oversight? Will the requirement for all individuals to buy coverage really be enforceable? Will it segregate individuals receiving premium subsidies into a state-run pool or will it allow them the same freedom of choice that their non-subsidized neighbors will enjoy?

Ideally, a draft of compromise legislative language will circulate this week while the vote/veto dance waltzes on. Since I’m on a role, prediction wise, I’m guessing the special session would be scheduled to start on September 24th. This has two benefits: staff will have more time to flesh out and fine-tune the detailed language of the compromise and its after Yom Kippur.  As an added bonus it will hopefully give the public some time to digest the compromise and offer ways to improve it. Whether lawmakers will be open to suggestions on how to improve their compromise remains to be seen. Being a glass-half-full kind of guy, I’m hopeful.

A Special Session AND An Initiative. Oh Joy!

I’ve been predicting that Governor Arnold Schwarzenegger would call a special session to push through a health care reform package for quite some time now. As the Legislature faces adjournment in less than a week, it looks like it’s now become all but a certainty. But it seems the special session is only a prelude. According to an article by Mike Zapler in the San Jose Mercury, the Governor will use the a special session to pass a framework for reform, but make much of it contingent on funding to be enacted by an initiative.  The Mercury reports an aide to the Governor predicting that “Schwarzenegger would assemble the ’strongest, most robust health care coalition ever put together’ to push for the initiative.”

The aide is probably right. The Governor will be able to muster support among hospitals, insurers, consumer groups, and unions to create a unique and potent coalition. There’d still be opposition, including from some from hospitals, insurers, consumer groups and unions. But the mere fact that these stakeholders would be split on the issue is a huge win for the Governor.

How the split within these interest groups works itself out will depend in large part on how well the framework is designed and what funding mechanisms are included in the initiative. For example, the Democratic majority’s legislation, Assembly Bill 8 (Nunez) gives unprecedented power to the Managed Risk Medical Insurance Board to raise fees on every business in California without considering the impact of the fees on the state’s resources or economy.  If the Governor endorses this approach the framwork will be perceived as hopelessly flawed by a substantial portion of the business community which would otherwise have supported the Governor’s ballot measure.

The nature of the taxes and fees the Governor proposes will also impact the outcome. Broader taxes will be required to raise the billions of dollars required to achieve anything close to universal coverage. Some in the business community support a one-percent increase in the sales tax to raise the necessary funding. Others will argue this is a particularly regressive form of taxation which punishes low income families — albeit this population will no doubt benefit the most from the overall package.

In looking for more narrowly-targeted  taxes, the Adminstration may want to look at the list of potential financing mechanisms proposed by the California Association of Health Underwriters in its Healthy Solutions health care reform plan. CAHU recommends taxing activity which directly impacts health care costs. This includes common targets like smoking and alchohol, but CAHU goes further. It recommends imposing fees on handguns and ammuniation and on unhealthy foods. These would no doubt be controversial, but there’s no denying they target significant drivers of increasing medical expenses. (Full disclosure: I helped draft Healthy Solutions and pushed to have these targeted taxes included).

 What all this means is, the coming week will be devoted mostly to political theater. Act One will be symbolic passage of Democratic reform proposals followed quickly by vetos. Act Two will be the special session. If robust public debate flourishes at this point the result could be a framework for reform which is reasonable and effective. Act Three would be the funding initiative, most likely to be part of the November 2008 ballot.  What’s interesting is, while the script is finally becoming clear, no one is really certain yet if the play is a comedy or a tragedy.

Recent Amendments to AB 8

Assembly 8 (Nunez) is being amended to reflect the state of current negotiations continue between the Governor’s and Legislative Leadership’s staffs. The California Progress Report has an excellent summary of the bill written by Health Access Executive Director Anthony Wright.

Two of the most signficant changes to note concern affordability of coverage and expansion of small group health insurance reforms. Previously AB 8 required all employees of companies choosing to participate in the state-run California Cooperative Health Insurance Purchasing Program (Cal-CHIPP) to purchase coverage through the pool unless they were insured under another plan. The recent changes now enable an employee to decline coverage if the worker’s share of the premium would exceeded five percent of the worker’s income. This change was high on the agenda of unions and some consumer groups. AB 8 also provides that employees insured in the state pool who earn less than 300% of the Federal Poverty Level (appromiately $60,000 for a family of four) could not be required to pay more than five percent of their income in premiums.

The other signficant change expands the current small group health insurance rules to employers with 100 full-time employees, down from 250 employees in earlier drafts of AB 8.  This addresses the fear of some that, by heavily regulating groups of greater than 100 employees it would encourage those with lower-claims to self-insure. (Self-insurance becomes more viable with the size of a business and is more appealing to companies with low claim rates).  This in turn would leave higher-cost groups in the insured pool, driving up premiums. The changes to AB 8 should reduce this concern, although not entirely eliminate it.

Does any of this matter? With just a few days left for a vote on AB 8 it is growing increasingly unlikely that a compromise will be reached in time. In fact, there is a rumor circulating in Sacramento that Democrats will bring AB 8 (and perhaps Senate Bill SB 840 (Keuhl), the single-payer bill, to a vote knowing the Governor will veto it — regardless of how close negotiators are to a deal. Since neither bill is likely to receive a Republican vote this would allow Democrats to strengthen their claim to be the champions of health care reform as an election year approaches.

I’m of the belief that the Governor would use his veto message as an opportunity to call a special session focused on health care reform. This would be done either in coordination with the Leadership (to put pressure on recalcitrant Republican Legislators) or to maintain his dominant position in the process. For a clue to his motivation, keep an eye on whether the Leadership amends AB 8 again before the symbolic vote. If there are significant changes, it’s a sign the Governor is on board with the dance. If they vote on the bill as is, it’s more likely the parties are seeking a negotiating advantage at the other’s expense. The result, of course, is the same. The good news, however, is that a special session would give those excluded from the current closed-door negotiations a chance to thoroughly review, and hopefully amend, AB 8.

Politics is Fun, But It’s Policy That Matters

I’ve written more than a few posts about the politics behind California’s health care reform debate (like the one earlier today). One reason is to provide some insight on why things may be unfolding the way they are. Another reason is because its fun and sometimes interesting.

But at the end of the day, it’s the substance of legislation that matters. Especially when it comes to health care reform. After all, health care represents about 15 percent of the state’s economy. In dealing with this issue, lawmakers will impact job creation, business growth, government resources and, most importantly, the pocketbook of every California family.

The desire of Governor Arnold Schwarzenegger, Assembly Speaker Fabian Nunez, and Senate President Pro Tem Don Perata to pass something quickly is understandable. There’s a lot of strong political reasons for each to reach a deal before the Legislature’s scheduled adjournment on September 14th. However, because it is understandable doesn’t make it sound. The artificial deadline results in a focus on the wrong question. Instead of asking “what package can be signed?” the meed is to ask “what legislation should be signed?”.

So long as the final version of the bill is being written behind closed doors (or in the Governor’s famous smoking tent) the focus will remain on the wrong question. It’s not that the Governor’s and Legislative Leadership’s staffs aren’t well intentioned, smart and hard working. They are all three. It’s just that good public policy is achieved through vigorous public debate. The final package needs a thorough airing it can’t get in the insular world of a few rooms in downtown Sacramento. 

Getting health care reform right is more important than passing a bill quickly. If that means calling a special session of the Legislature to allow time for robust public input, then so be it. A special session presents challenges of its own, but the result will be far more substantive than what’s likely to emerge before September 14th.

Governor’s New Health Care Reform Ally

Governor Arnold Schwarzenegger won new support for his health care reform plan today, again demonstrating that it is dangerous to underestimate his political savvy.  According to the Sacramento Bee, the California Hospital Association came out in support of Governor Schwarzenegger’s health care plan, including its fee of four percent on gross hospital revenue (Hospitals back Governor’s plan).

Yes, there are some critical caveats to the deal. For instance, the fee on private hospitals’ revenue would be permanently capped at four percent. The fee itself would be contingent on passage of an initiative, which, according to the Bee is currently planned for the November 2008 ballot. That initiative would assure the fees raised from hospitals would be put in a trust along with federal matching funds. The trust would be kept separate from the general fund. First dibs on the trust money would be to raise Medi-Cal fees paid to hospitals.  The initiative would also have to provide for mandatory cost-of-living increases on hospital Medi-Cal reimbursements.  Any money left would be required to be spent on reducing the number of uninsured in the state. Added 9/7/07: At the same time, the CHA Board voted to put a stop to charging pateients for the disputed difference between their hospital bill and their health plans’ coverage, a practice known as “balance billing.”

This is a great deal for the hospitals. By getting their state Medi-Cal fees increased, the amount the hospitals receive from the federal government increases. This mitigates some of the financial impact of the fee. Locking in the fee at four percent helps insulate them from future political decisions. And the fewer uninsured, the less uncompensated care they need to provide. So while there’s some pain in the deal for the hospitals, there’s a lot of gain, too.

For the Governor, the deal is a major political boost. Hospitals are very critical centers of influence in their communities. Which is one reason the Governor has reportedly been personally on the phone calling hospital heads across the state — especially in the districts of Republican lawmakers. Additionally, having an interest group subject to one of the Governor’s taxes endorse the plan is a major coup. Expect to hear it mentioned every time doctor and business groups complain about the fee the Governor would impose on them. Added 9/7/07: Finally, the elimination of balance billing is a very pro-consumer victory for the Governor.

The Governor’s and Legislative Leadership’s staffs continue to try to hammer out a compromise on health care reform which could be voted on before the September 14th scheduled adjournment. The support of the hospital association will strengthen the Governor’s hand in those discussions. First, he now has another ally who can put significant pressure on lawmakers where it counts — in their districts. Second, it builds momentum towards the Governor’s viewpoint. And third, it again demonstrates his strong political skills, reminding Speaker Fabian Nunez and Senate President Pro Temp Don Perata that while Governor Schwarzenegger is still relatively new to the game, he’s very good at it.