Just weeks ago, Governor Arnold Schwarzenegger set Sacramento atwitter when he told a Los Angeles audience that one of his major goals would be to expand health insurance coverage.
“”We feel we shouldn’t have 6 million people uninsured,”” Schwarzenegger said. “”We maybe cannot solve the whole problem, but we definitely can cut it in half and do something that really is impressive, and show the rest of the nation that it can be done.””
Then, during a Nov. 27 interview on NBC’s “”Meet the Press,”” the governor went a step further, telling host Tim Russert that in addition to reforming the prison system and pushing forward a redistricting plan, he wanted to ensure coverage for all of the state’s 6.7 million uninsured citizens. The plan would also encourage a healthier lifestyle as well as take advantage of technological advances to streamline medical services.
The sentiment is a good one: An ounce of prevention – particularly in health care – is easily worth a pound of cure. According to the Agency for Healthcare Research and Quality, a federal agency that gathers data on the health care system, five of the top 10 reasons for hospitalization are related to cardiovascular disease – which is in many cases preventable. Preventive medicine and early detection of health problems drastically reduce both the cost of treatment and the likelihood that medical complications will arise. And the Centers for Disease Control and Prevention estimate that physical inactivity and obesity cost California over $7 billion in medical costs, either directly or indirectly.
Schwarzenegger’s plan has the potential to save the state billions of dollars in the long term – and probably thousands of lives – if it can be implemented. But the devil is in the details, and so far Schwarzenegger has only outlined how the plan won’t be paid for, reiterating his seemingly eternal pledge not to raise taxes.
“”The governor believes very strongly that a solution of this magnitude is going to require shared responsibility among employers, individuals, insurers, doctors, hospitals and the state,”” Schwarzenegger’s chief spokesman Adam Mendelsohn told the San Jose Mercury News.
What that means in practical terms is anyone’s guess.
The governor may turn to a system similar to the one hammered out by Massachusetts Gov. Mitt Romney – a Republican who also must contend with a Democratic legislature in a typically left-of-center state – that requires all residents to obtain health insurance by next July. The law would apply only if the state determines that affordable insurance is available for each citizen, and the poor and small businesses will receive subsidies to help cover the costs of insurance. Businesses that don’t provide coverage for their employees will be assessed a fee.
But many financial analysts have suggested that such a program would be prohibitively expensive in California, arguing that the Golden State has a larger population of uninsured, poor citizens and illegal immigrants, and a smaller proportion of companies that already offer insurance. According to the California Health Foundation, this kind of system could cost the state an additional $9.4 billion per year. (The state has already spent more than $10 billion this year supporting the uninsured and underinsured, according to Kimberly Belshe, Schwarzenegger’s secretary of health and human services.)
Last year, a coalition of business interests – with Schwarzenegger’s blessing – successfully repealed a 2003 law hastily passed by the Democratic assembly just before former Gov. Gray Davis’ recall. Many complained that the law, which required certain firms to provide insurance for their employees, didn’t go far enough, covering only 1 million uninsured Californians. Companies, in turn, lamented that the bill was expensive enough to drive them out of business. Further, the bill was silent on the self-employed and firms with fewer than 50 employees.
If a plan covering all the uninsured never gets off the ground, Schwarzenegger has indicated he may instead try to guarantee insurance coverage for California’s children. Covering the state’s nearly 10 million kids would be expensive in itself – an estimated $500 million to cover just over 760,000 uninsured children.
But in 2005, Schwarzenegger vetoed a similar plan, ironically, because the bill contained no funding mechanism.
With the state facing a budget shortfall of over $5 billion, coming up with a workable plan that satisfies lawmakers, businesses and the public while leaving the state’s coffers intact would be no small feat.
Concluding his interview with Russert, Schwarzenegger refused to support a specific presidential candidate, saying that he would wait until their positions were fully supported.
“”I think that all of our candidates that are out there are talking about [these issues],”” the governor said. “”But I will see as time goes on when they really zero in on those subjects.””
For Schwarzenegger and his as-yet nebulous health insurance plan, we’ll do the same.
