The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Key to California Health Care Reform: Personal Ambition?

Posted by Alan on December 9, 2007


The stars for comprehensive health care reform in California any time soon are falling out of alignment. The constituencies of the major players, Governor Arnold Schwarzenegger, Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata are locking the principals into positions with little room for give. The looming $10 billion state budget deficit makes creating a $14 billion health care program look like lunacy. Time is growing short to qualify the funding initiative necessary to finance reforms. And the differences between the parties are very real, fairly complicated, and challenging to bridge.

Capitol Weekly’s Anthony York, however, describes one driver which might pull things together: the political ambition of Speaker Nunez. Writing in the Los Angeles Times, Mr. York emphasizes the importance of voters passing Proposition 93 on the February 2008 ballot to the Speaker’s career. Proposition 93 changes California’s term limits law. Currently, legislators may serve six years in the Assembly and eight in the Senate. Proposition 93 reduces the total tenure permitted from 14 years to 12 years, but allows the entire time to be spent in one house. If it were to pass, instead of being termed out next year, Speaker Nunez would be able to remain Speaker Nunez for another six years.

Passage of Proposition 93, however, looks as likely as, well, passage of comprehensive health care reform in California any time soon. It’s hovering a little shy of a majority in current polls. And although there’s a significant number of undecideds, historically they tend to break more towards the “No” side of any initiative. Then there’s Insurance Commission Steve Poizner’s commitment to spend “whatever it takes” to defeat the ballot measure — he’s already contributed $1.5 million to the “No” campaign. And recently the prison guard unions, upset over the failure of the legislature to raise their member’s pay, have committed to the “No” campaign.

What could save the measure? The support of Governor Schwarzenegger. And it’s not beyond the realm of possibility Governor Schwarzenegger would come on board. As Mr. York points out, however, the price is health care reform. According to Mr. York, the Governor “has consistently used Nunez’s desire to change the term limits law as leverage in his negotiations with the speaker about healthcare reform ….” He cites Speaker Nunez’s move to support a mandate for all Californians to have health insurance coverage, albeit with an “affordability exemption,” as proof of the effectiveness of this lever.

Put bluntly, what Mr. York is suggesting is that Governor Schwarzenegger would trade his support for the term limits to induce Speaker Nunez to adopt the Governor’s health care reform package. However, there’s a couple of serious problems with this. First, Governor Schwarzenegger’s support may not be enough to salvage Proposition 93. As the San Jose Mercury News reported earlier this month, only nine initiatives have passed in the last 15 years when more than $1 million has been spent to defeat them. And those that did pass tended to be simple and straightforward. Term limits, is neither, instead representing the ultimate in insider-politics. Would the Governor risk political capital to push for passage of a measure which may be doomed beyond saving? He might, but with initiatives of his own to worry about in 2008, he will need to get a lot to make the risk worthwhile.

Which underscores the second reason a Proposition 93/health care reform trade seems unlikely. The compromises the Governor would seek to extract could undermine support for the health care reform package among the Speaker’s allies, most notably, the unions. Mr. York acknowledges this at the end of his article, but, in my mind, it belongs front and center. Labor’s calculation is simple: is keeping Fabian Nunez as Speaker worth caving in on important health care reform provisions? The answer depends in large part on who the next Speaker would likely be. Mr. York identified eight potential successors to Speaker Nunez in a Capital Weekly post last month. Virtually all would be acceptable to the unions. What all this means is that the while Labor wants to support the career of Speaker Nunez, it may not be willing to pay Governor Schwarzenegger’s price.

In an ideal world, the specific provisions of health care reform would be decided on their merits. The benefits to any individual’s political career should be of minor concern. That’s not how things work, however. If the political ambitions of a current legislative leader results in responsible, meaningful reform, that’s terrific. If, however, that ambition  results in reforms that do more harm than good, no one’s political career will benefit — nor should it.

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