The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

The Politics of Health Care Reform Vote

Posted by Alan on August 30, 2007

Pretend for a moment you’re a Democratic legislator. Your party controls your chamber. You sit on committees that both interest you and benefit your district. You even have a nice office and, while you could always use more, you have sufficient staff to get your work done.

As a conscientious representative you want to address the needs and concerns of your district. You’ve received lots of letters from the district concerning problems with the state’s health care system. You’ve met with constituents unable to get coverage or about to lose it. You’ve also read the polls. Clearly, something must be done to fix what you perceive to be California’s broken health care system. 

You’ve been focused on other important issues, but clearly health care reform is a high priority for the Legislative Leadership and the Governor. You know Assembly Speaker Fabian Nunez and Senate President Pro Temp Don Perata combined their separate bills into a single package, Assembly Bill 8. And you’ve heard a lot of opinions about it from your district and interest groups.

You know the bill has been heard by various committees, but you’re not sure if they impacted the content of the legislation or not. Most of the talk you hear about the bill has focused on politics (will the Governor sign it?), not on the substantive policy behind its provisions.

Based on what you’ve been hearing of late, AB 8 may be seriously flawed. The individual health insurance reforms sound like those in New Jersey, where premiums are on average 350 percent more than they are in Califronia. Empowering a state agency to raise payroll taxes (oops, let’s call them fees) on every business in the state without any considering the impact on job creation, overall state revenues and business growth strikes you as bordering on fiscal irresponsibility. You’ve heard been getting a drumbeat of messages from health insurance agents in your district concerning these problems and more. Yes, they have a vested interest in the current system, but they have their own reform package for achieving universal coverage. And they do know how the real world works.

You know Speaker Nunez and Senator Perata have been in heavy negotiations on health care reform.  The Governor has vowed to veto any bill which doesn’t spread the cost of the plan beyond employers and which fails to cover all Californians (which means he’ll veto AB 8). Yet you know the Governor’s own plan, because it includes taxes on doctors, hospitals and others, requires a tw0-thirds vote. After the state budget debacle you’re not convinced two-thirds of either house would vote on whether to continue putting Mother’s Day on the calendar.

The negotiations must be getting intense, because your Majority Leader is on the phone. Speaker Nunez and Senator Perata are bringing AB 8 to a vote. And they’re putting Governor Schwarzenegger’s proposal into a bill so it can be voted on, too. The Majority Leader wants to know how you intend to vote. What’s your answer?

On the one hand, you’re pretty sure Assembly Bill 8 is greatly flawed with numerous and dangerous unintended consequences. As Senator Perata himself said recently, “When we try to do things fast around here, we usually make mistakes that we regret.” This seems like one of those times. The goal should be to get health care reform right. If it takes a few more months, so be it. You were sent here to do what’s right, not what’s expedient.

On the other hand, the Leadership has made it clear it wants a “yes” vote. It will demonstrate the Democratic’s commitment to  addressing the state’s seroius problems (and perhaps leave behind the memory of the budget fiasco). If it turns out AB 8 is flawed, follow-up legislation can be introduced or the regulators can fix it. And a yes vote is good politics. Certainly a lot of your constituents — and contributors are clamoring for reform.  You want a successful carreer in Sacramento. This is one of those times when the Leadership will be tracking who is with them and who isn’t.

What’s your answer? Vote for a flawed law or score political points at the risk of enacting damaging legislation?

But wait, is that really the choice? Is there a way to get the political benefit of a yes vote, but do the right thing and delay enactment of a bad bill? Well, the Governor has vowed to veto AB 8 as written. And the Republicans are unlikely to give the Administration’s proposal enough support to reach the two-thirds majority. Does this mean you can vote for the bill knowing it won’t become law?

So, pretend for a moment you’re a Democratic legislator. What’s your answer?


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