Aides say governor may ask employers to shoulder worker coverage, but is seeking other ideas.

The Sacramento Bee (California)

As Gov. Arnold Schwarzenegger‘s team of health care consultants prepares a plan for overhauling California’s $200 billion health care industry, administration officials say the governor is willing to consider all solutions — including those that may be unpopular with the governor’s allies in the business community.

Though employer groups vociferously oppose requiring businesses to cover their workers, the governor’s staff says that could be a part of his proposal.

“Everything is on the table,” Schwarzenegger’s communications director, Adam Mendelsohn, said last week.

Schwarzenegger actively worked in 2004 to repeal Senate Bill 2, a state law requiring big employers to provide coverage.

But his opposition was based on how that law was written, administration officials now say. In recent days, they have been careful to clarify that the governor is not absolutely opposed to employer mandates.

Kim Belshe, Schwarzenegger’s secretary for health and human services, said at a press briefing last week that the governor was likely to embrace an approach that requires all sectors to shoulder some of the costs of covering the more than 6 million Californians who are uninsured.

The governor is “open to the principle of shared responsibility, and that involves government, that involves individuals, that involves employers, that involves health plans and providers,” Belshe said during a press briefing.

Business groups say they remain firmly opposed to a requirement on employers.

“We’re opposed to employer mandates,” California Chamber of Commerce President Allan Zaremberg said. “It’s part of our principles.”

The discussions are happening as Schwarzenegger’s team of health care consultants has held hundreds of meetings with groups representing insurers, hospitals, doctors, consumers and others.

Participants in those meetings say the governor’s advisers have solicited recommendations but revealed little about the proposals Schwarzenegger intends to unveil in his State of the State speech in January.

Aside from a single-payer system that would dramatically reduce the role of the private sector in the health care industry, the administration has not ruled out anything.

The idea of requiring employers to provide coverage is just one of the controversies.

Consumer advocates just as adamantly object to the idea of requiring individuals to buy health insurance, just as motorists must have auto insurance.

“The problem is there are no checks on the profits or the huge overhead of the insurance companies who would be guaranteed a new consumer base under this plan,” said Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights.

The scope of the governor’s plan will depend largely on how much new money will be pumped into the system. The estimated cost of covering the state’s uninsured residents is about $12 billion annually.

Taxes are probably off the table, given the governor’s consistent opposition to tax increases. But it is unclear whether enough money could be cobbled together from other sources to make a difference.

Belshe recently told the Los Angeles Times that the state could redirect some of the billions of dollars in Medi-Cal spending that now go toward counties and hospitals that treat the uninsured.

But Assemblyman Hector De La Torre, D-South Gate, said doing so would decimate emergency rooms around the state and endanger everyone.

“If you did something like that, you would devastate the safety net,” De La Torre said. “That’s just robbing Peter to pay Paul.”

De La Torre, a veteran of various health committees in the Legislature, plans to introduce legislation that will include an employer mandate and cover more than the 1 million residents that SB 2 would have, had it not been repealed.

“We know we can get our bills out of here,” De La Torre said, referring to the Democrats’ control of the Legislature. “I don’t know (the Republican governor) can say the same thing.”

Assembly Speaker Fabian Nunez said Democrats in the Assembly will meet in mid-January to develop a “unified proposal that we’re going to roll out sometime in February.”

Nunez said he supports the concept of shared responsibility.

“The employer should be required to pay a percentage of the cost of the premium,” Nunez said. “And for the people who are employed, if their employer is going to pay for a portion of it, then they’ve got to pay the other portion.”

Even before the governor presents his plan, consumer advocates are preparing for the worst.

Anthony Wright, executive director of Health Access, described his meetings with the governor’s consultants as being “like high school dating,” in part because the expressions of interest are entirely one-sided. The administration officials, he said, have been soliciting ideas but are not sharing their own views on the best approach.

Part of the reason for the lack of clarity may be that there are competing viewpoints within the administration.

The governor is getting advice from aides like Belshe, who ran the state health department under Republican Gov. Pete Wilson, and from Daniel Zingale, who ran the Department of Managed Health Care under Democrat Gov. Gray Davis.

But in the end, it will depend on Schwarzenegger. In recent days, he surprised his staff by saying publicly that he wanted a plan that would cover “half” of the uninsured.

A week later, he told Tim Russert on NBC’s “Meet the Press” that he wanted all uninsured Californians to have coverage.

Some of the governor’s staff members have begun to downplay expectations. After Schwarzenegger’s “Meet the Press” appearance, Mendelsohn was quick to say that universal health care is a “goal” that can be reached over time, not a pledge.

Dustin Corcoran, vice president for government relations of the California Medical Association, which represents doctors, said the governor “has certainly raised the bar very, very high.”

“He’s standing at the base of a big Austrian Alp right now, looking up at it,” Corcoran said. “It’ll be interesting to see if he can climb it.”
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The Bee’s Aurelio Rojas can be reached at (916) 326-5545 or [email protected]. Kevin Yamamura of The Bee Capitol Bureau contributed to this report.