Health Care Reform Discussed at Town Hall Meeting

With over six million Californians lacking health care coverage, competing proposals for health care reform are being discussed and promoted in the state legislature. Bills by State Assembly Speaker Fabian Núñez, State Senate President pro tem Don Perata, and Gov. Schwarzenegger take some steps toward universal coverage, while State Senator Sheila Kuehl’s bill promises universal coverage through a government administered single-payer system.

The California Labor Federation has also been working to craft proposals for health care reform that help working families. (Check www.calaborfed.org/ or the Feb. issue of Labor for details.)

Fabian Núñez discussed his health care legislation at a Town Hall meeting at UCSF Children’s Hospital Feb. 3.

The event featured a panel discussion and question and answer session with audience members. Many union members attended, including teachers affiliated with the United Educators of San Francisco, members of United Healthcare Workers-West (SEIU), and the California Nurses Association. Health care is a priority for the labor movement this year, with the issue a major sticking point in contract negotiations as health care costs continue to rise.

San Francisco Assemblymember Mark Leno said that the state was in a crisis mode and needed to deal with health care as a top priority. Leno said that nationally12 percent of health care costs are spent on Type 2 diabetes—a preventable disease—and that the percentage could be as much as 33 percent in 20 years. Leno also pointed out that individuals who are uninsured use emergency rooms for primary care, at a cost to taxpayers: “This is not a viable way of doing business,” Leno said.

Leno said that Speaker Núñez had taken the lead on big issues like the global warming legislation (which Gov. Schwarzenegger took credit for) and was now taking the lead on health care. “We believe as Democrats in the Assembly that access to health care is not a privilege but a right for every Californian in a modern society,” Leno said. “That’s the framework for our bill.

Assemblymember and Budget Committee Chair John Laird of Santa Cruz pointed out that 800,000 children in the state are uninsured and that, “Access is a cornerstone of the Speaker’s bill. It puts kids first.” Also speaking were SF Assemblymember Fiona Ma and Jim Beall of San Jose. Beall said that Democrats wanted to change the current system with its complicated bureaucracy to a more simplified one that would cover everyone and contain costs. East Bay Assemblymember Mary Hiyashi pointed out that expanding health insurance to cover all children would be a benefit to the state. “Children miss school due to health problems that are preventable, like dental problems,” she said. “If they are insured and stay healthy, they can remain in school and that means more money for schools,” (funded based on average daily attendance).

After introducing panelists representing health care, small business, children’s advocacy and uninsured workers, Núñez told the audience, “It is fitting that we are doing this in San Francisco, where a new plan will cover 82,000 uninsured residents.” Núñez said that the political will existed to pass some form of health care legislation this year. He said that the governor’s plan “has some good elements in it, as does the Perata plan.”

Núñez’s “Fair Share Health Care” bill prioritizes insuring all the state’s children in households with incomes up to 300 percent of the federal poverty level ($60,000 for a family of four). Unlike Schwarzenegger’s proposal, it doesn’t force individuals to purchase health insurance. It establishes an employer mandate for a pay or play model for health care expansion.

The Núñez bill creates a state purchasing pool, expands public programs, and provides cost containment, in part by emphasizing prevention and health management. It would cover all children regardless of immigration status. “The only document I’m concerned about is a clean bill of health for all Californians,” Núñez said, to applause from the audience. He also said that insurers would be told to cover everyone regardless of pre-existing conditions. He said that because his plan would simplify benefit choices, employers would have an easier time navigating the system.

Núñez acknowledged that his proposal may not satisfy those who want a truly universal system. “There are some in my caucus who would prefer a single-payer plan,” he said, with the union members and many others in attendance applauding. “But we have a long way to go to get to single payer.” Shiela Kuehl’s single payer bill passed the legislature last year but was vetoed by Schwarzenegger.

A panel discussion followed the Assembly Speaker’s comments. Kelly Clemens, an uninsured worker, described her situation as a companion caregiver, unable to afford health insurance with other expenses like a student loan. Small business owner Gwen Kaplan said her company offers insurance to its 20 employees because “we want to keep our employees, and we don’t want people to miss work because they’re sick.”

Dr. Andrew Bindman of SF General Hospital called the current system, “A travesty,” and said that demand on the health care system was undermining quality care. He echoed Leno’s comments that prevention is key. “We have an opportunity to reduce the high end costs like providing dialysis,” Bindman said. “More people are getting dialysis now as a result of diabetes being untreated. I see patients who wait too long to get treated whose condition could have been prevented with early detection.” This is especially true for the uninsured who can’t afford a doctor visit and wait until their condition becomes an emergency to get treatment. Not only was this not cost effective for treating people, but Bindman pointed out that, “The efficiency of the ER to put people back together is compromised and can’t work best for all of us if it has to provide basic services for the uninsured.”

Dena Lahn of the Children’s Defense Fund said that the high cost of administration was a huge drain on the health care system. Her organization worked to push for universal coverage for all children. She pointed out that one of the high administration costs is checking the documentation of citizenship for children of immigrant workers. She said some families would not seek health care out of fear of having their undocumented status lead to deportation. Without treatment, many kids still go to school sick and, “Unhealthy children have an adverse impact on schooling,” Lahn said.

During the Q&A that followed, specifics of the Núñez bill were discussed and questions were asked about mental health coverage, prescription drug costs, coverage for the unemployed, and the health impacts of air pollution. Supporters of single-payer pressed the Speaker on backing the Kuehl bill. One comment was that single payer would be good for the economy and save money for the state.

Fiona Ma said she was a strong supporter of Sheila Kuehl’s bill and as a member of the Assembly Health Committee would work to move it through the committee. Mark Leno said he looked at the Kuehl bill as “the tortoise in the race” which would eventually win, and that, “when business realizes that single payer will save costs, then we’ll get there.”
Núñez said he was committed to move the Kuehl bill through the Assembly and put it back on the governor’s desk, “but knowing he’ll veto it, we need to do something for the six million uninsured now.” He added that there isn’t yet the broad public support for single-payer and that many people have a visceral reaction to government-run health care. “Public opinion needs to be changed and we do have to keep pushing for it and talking about it,” Núñez said.

While Núñez’s bill would cover only the employed, he said he wanted to expand coverage to include low-income, unemployed, and childless adults within five years. The Schwarzenegger, Perata, and Núñez proposals contain a mix of employer and employee funding, various approaches to contain costs, and differing caps on insurance company profits and employer costs.

- Paul Burton