Skelton: Health overhaul passed without debate?
Things don’t always go as hoped. A prime example is the Democrats’ push for single-payer health care legislation in California.
A good-government hope was that this effort would result in a thoughtful, substantive legislative debate worthy of the monumental issue of universal health care.
That hope was dashed Thursday in a legislative fiscal committee, which failed to carry out what should be its primary duty: to dig into the innards of a spending bill and examine whether it makes financial sense.
The contentious bill, AB 1400, sailed through the Assembly Appropriations Committee on a party-line 11-3 vote without any discussion at all. Shameful.
This measure, after all, would completely change health care coverage for Californians. Insurance companies would be shoved aside. People would be switched from their current coverage — whether private, federal Medicare or Medi-Cal for the poor — to a new state-run plan called CalCare.
The purpose is to cover everyone and reduce health care costs by eliminating private insurance overhead and profit — and negotiating lower provider fees and drug prices. There’d be no premiums, copays or deductibles. And many services would be added, including dental, vision, hearing and long-term care for Medicare beneficiaries.
But it would require by far the largest state tax increase in history, estimated at $163 billion. The state would also have to find an additional few hundred billion dollars. No one knows how much. Washington would need to be persuaded to turn over to Sacramento all the federal Medicare and Medicaid (Medi-Cal) money now spent in California.
How about: Is this state government remotely capable of pulling off such an ambitious endeavor? Is it fiscally attainable and sustainable?
The 16-member Appropriations Committee asked nothing.
But that’s not primarily the fault of the members, the new chairman — Assemblyman Chris Holden, D-Pasadena — or the bill’s author, Assemblyman Ash Kalra, D-San Jose. Blame long-established legislative procedure.
The California Legislature was organized many years ago to operate as a mass-production bill factory. Term-limited legislators want a long list of enacted bills — no matter how trivial — to display on their résumés when they run for another office. And they don't have the luxury to spend years getting the legislation right.
Moreover, they’ve imposed inane deadlines on themselves.
AB 1400 has a Jan. 31 deadline for Assembly passage to the Senate. Lots of bills face that deadline. Which is silly because the contents of a bill that misses the deadline can later be inserted into a measure already in the Senate. It’s a tawdry process called “gut and amend.”
The single-payer bill — called that because only one entity, state government, would pay providers for health care — did have a respectable hearing on Jan. 11 in the Assembly Health Committee. Democrats there moved the bill to the Appropriations Committee, some of them unenthusiastically.
There should have been several in-depth hearings in the Health Committee. But that’s not the way the Legislature operates. Except with the state budget, which gets dissected for months.
The Appropriations Committee, up against the deadline, acted on roughly 100 bills last week in less than three hours. Around half were approved and half rejected. Members were not polled on each measure. Roll calls were substituted. It was robotic.
The bills’ fates already had been decided in private by the committee chairman, his top staff and the legislative leadership, mainly Assembly Speaker Anthony Rendon, D-Lakewood. That’s the way it works with appropriations committees. They can be a fast track or a roadblock for legislation, depending on the house leadership’s political whims.
Why would anyone want to be a member?
A committee seat attracts campaign contributions because the occupant does, theoretically, pass judgment on major bills that matter to special interests. It's also a place where an Assembly member can show loyalty to the speaker. And members have a leg up on winning passage of their own spending bills.
But close-up scrutiny of proposed laws — or what passes for it — occurs mainly in “policy” committees, such as health.
“If the Appropriations Committee isn’t going to review the fiscal matters of a bill, what is the purpose of this committee?” asks Republican Assemblyman Vince Fong of Bakersfield, a committee member.
“How can a fiscal committee of the Legislature allow a bill to get out of its committee with no funding mechanism?”
Particularly a bill that a committee staff analysis estimated could cost between $314 billion and $391 billion annually if it were in effect now. The analysis also cited a study showing that $222 billion in employer and household health care spending would need to be replaced.
To put those numbers in perspective, Gov. Gavin Newsom’s proposed budget for the next fiscal year totals $286 billion. He’s neutral on the single-payer legislation.
The tax increase measure, Assembly Constitutional Amendment 11 by Kalra, probably won’t even be in play this election year. The tax hike would ultimately have to be approved by voters. The Appropriations Committee amended AB 1400 to emphasize that it can’t take effect without a funding mechanism.
The funding that’s proposed would radically change how health care is paid for. Now, most people covered by a plan pay the same premium for the same service. Under ACA 11, the more money you made, the higher your health care taxes.
“Those with lower incomes would pay nothing or next to nothing,” Kalra says. “Health care would be much more affordable than now. It would be a more comprehensive and moral system.”
But for everybody?
There’s lots of confusion.
“I expect a very intense debate on the Assembly floor,” Fong says.
That’s also what committees are for — or should be.
George Skelton is a columnist for the Los Angeles Times.
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