Tricky diagnosis for health plan

A peculiar but seasonal image might help toward understanding the convoluted status of the California health coverage expansion bill that passed the Assembly on a strict party-line 45-31 vote Monday. Think of health reform as a beautifully wrapped Christmas gift atop a dubiously shaky Rube Goldberg cash-dispensing machine and surrounded by an ominous gang of Grinches who want to take away the gift because it violates their particular agendas.

First thegood news, if the numbers to pay for it actually added up — especially as the state now faces record-breaking deficits — the bill negotiated by Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Núñez might eliminate health care vulnerabilities for millions of now-uninsured Californians, even those with pre-existing health conditions.

In its present state, the plan essentially reflects Schwarzenegger’s goal of “spreading responsibility” among the newly insured, employers, insurers and treatment providers. Changes from the Democratic lawmakers primarily concentrated on shifting more of the financial burden away from the working poor and lower-middle class.

But as always, the catch is how to pay for it. Health coverage expansion is billed as an annual $14 billion program — of which nearly $5 billion is to come from federal funding sources that could end at any time. Another $1.6 billion would be from a hefty new $1.50 tax on every pack of cigarettes. Yet fewer and fewer Californians smoke each year, a trend that would presumably be accelerated by raising cigarette prices to about $5.50 per pack.

So for starters, close to half of the $14 billion funding is already on relatively shaky ground. And fierce enemies of every other element in the funding package lie in wait; ready to spend millions on negative TV advertising to protect their bottom line. Health reform becomes especially vulnerable because it was structured as a hybrid of legislation and upcoming voter initiative, since the foregone conclusion was that legislative Republicans would block any spending on the bill from winning the required two-thirds approval.

Not only that, each principle of managing the health coverage money would also magnetize determined opposition. Fiscal conservatives decry the spending and warn of higher premiums plus small-business shutdowns. The left wants something closer to a government-operated single-payer system.

Strangely, right now the biggest roadblock to passage is state Senate President Pro Tem Don Perata, a Democrat who has not previously been known as a spending watchdog. Perata asked the state’s bipartisan legislative analyst to examine the long-term effects of the bill on the state’s general finances, and says he won’t bring the bill to the Senate floor until he gets the answers.

This comes across as a welcome example of common sense. However, it is widely speculated among Sacramento political insiders that Perata is actually making a power-play to gain advantage over his rivals and give him a trump card for some future deal.

The bottom line is that with all the battering faced by this potentially beneficial bill, it will require something of a miracle cure to take health reform off life-support.

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