One of the enduring takeaways of the Schwarzenegger era is just how much latitude he is given on the national level as some kind of transformative post-partisan leader, when those same reporters know that California is crumbling into dust under, and in many cases because of, his leadership.  We witnessed this again today as national media types heaped praise on the Governor issuing a letter about the Obama health care reform plan:

“As Governor, I have made significant efforts to advance health reform in California. As the Obama Administration was launching the current debate on health care reform, I hosted a bipartisan forum in our state because I believe in the vital importance of this issue, and that it should be addressed through bipartisan cooperation.

“Our principal goals, slowing the growth in costs, enhancing the quality of care delivered, improving the lives of individuals, and helping to ensure a strong economic recovery, are the same goals that the president is trying to achieve. I appreciate his partnership with the states and encourage our colleagues on both sides of the political aisle at the national level to move forward and accomplish these vital goals for the American people.”

I love the phrase “significant efforts,” by the way.  Others might call them “failed efforts,” but YMMV.

But this “praise” for health care reform is just a piece of paper.  One would think that the national media would seek to know the actions of the Governor on health care – one would be wrong, but one would still think that.  And it would take about 10 seconds of Googling to figure out that the Governor has vetoed key elements of the legislation working through Congress.  Last year he vetoed AB1945, which would have banned rescission, the insurance industry practice of dumping sick customers for technical violations on their applications like typos the moment that they try to use their policies for treatment.  He vetoed SB840, the universal health care bill, on multiple occasions in the past.  He vetoed SB1440, which would have mandated that insurance companies spend 85% of premiums on medical care.  He vetoed SB973, which would have created a public insurance option by linking local and regional measures.  He vetoed AB2, expanding the state’s high-risk pool for people with pre-existing conditions.

He basically has vetoed many of the same provisions to be found in the current health care bill.  And he is threatening to veto every bill on his desk this year, including another bill to ban rescissions so that customers who have paid insurance premiums for years aren’t left to die when they want to use their policies.  Anthony Wright notes some of the other bills:

* AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender.

* AB 2 (De La Torre): INDEPENDENT REVIEW, to create an independent review process when an insurer wishes to rescind a consumer’s health policy, create new standards and requirements for medical underwriting, and requires state review before plan approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.

* AB 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services.

* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses.

Dan Walters calls these bills “nothing of cosmic importance”.  Well sure, he’s not going to have a kid, and women are charged more than men by insurance companies anyway!  To an entitled white man with a good-paying job, he doesn’t have to worry about losing his policy or not getting comprehensive medical coverage.  But to a woman who can’t afford to lose her job to have a baby, or someone with a mental health problem who can’t get relief for his suffering, or someone with an individual policy living constantly in fear that his or her insurance will get revoked precisely when they need it, these are issues of “cosmic importance.”  Anyone saying otherwise is ignorant.

And yet the Governor will have no problem holding these bills, and these people, hostage.  His buddies at the Chamber of Commerce probably don’t want him to sign them at all.  So he writes a pretty letter supporting health care reform, while denying the very same measures to his own constituents.  And national media types call him a “bold leader.”

I mentioned this yesterday, but California lawmakers gave final approval to a bill that would ban the practice of rescission, where insurance companies drop coverage for policyholders after they try to use it based on alleged technical inaccuracies in their application form.  Here’s what AB2 would do:

AB 2 would require:

• Individual health care service plans to be subject to an independent external review before denying or rescinding coverage.

• The state to establish standard information and health-history questions to be used on policy applications.

• That intentional misrepresentation be shown before an individual health care service plan can be rescinded.

This language basically complies with what would appear in federal legislation before Congress banning rescission.

Now Arnold Schwarzenegger has a choice to make.  Does he side with people who are denied coverage after paying premiums for years?  Or does he side with his usual pals in the Chamber of Commerce who will push for anything, no matter how immoral, to maximize profits?

Everyone should know that Schwarzenegger vetoed a similar bill to this last year.  He’s always been a Chamber of Commerce sock-puppet and I don’t expect him to change now.  However, Schwarzenegger has been an alleged proponent of health care reform at the national level, and in a recent letter endorsed the concept of guaranteed issue of insurance, which obviously conflicts with allowing insurers to rescind policies.  He also supports continued state regulation of the insurance industry.

Well, here’s his chance.  The Legislature has acted to ban what I call insurer-assisted suicide, and Arnold can make his decision by either signing the bill or vetoing it.

There’s lots of significant news in the Legislature’s last week regarding various bills, and it’s extremely difficult to keep up with it all, probably by design.  I should point out that, while the legislative calendar has an end date, there’s no actual reason for some of the forced bottlenecks that result in hundreds of bills being passed at the last minute.  It creates a shroud of secrecy in which special interests rule, and saps the public trust.  A Democratic leadership actually interested in positioning government as somewhat decent would remove these forced bottlenecks from the internal legislative rules and allow bills to be approved on a rolling basis.  That said, this is the system we have now, and here’s a bunch of news about various bills:

• A new bill would exempt non-General Fund workers from furloughs.  This would reverse one of the dumbest provisions in the budget bill, the practice of forcing furloughs on workers not paid by state government, saving almost no money and depriving people of needed services.  Of course, the Governor will probably veto this one, because he hates admitting how wrong he is.

• Democrats on that vaunted water committee have decided against floating a bond to pay for any restoration or overhaul of the Delta.  This means Republicans won’t vote for it, and very little will come of this very important committee thrown together at the last minute.  Some conference committee reports are here, but a deal looks remote, as it would need votes from some of the empty chairs in the Yacht Party.

• One bill that has cleared both chambers would set up “Education Finance Districts”, “in which three or more contiguous school districts can band together to try to increase local taxes.”  This is a small step to make it easier for districts to pass parcel taxes to fund schools, but at this point every little bit helps.  The 2/3 rule for approving such taxes would remain.

• With all the talk of health care reform, it’s notable that an anti-rescission bill has once again passed the legislature.  The bill would also simplify insurance forms.  Last session, Arnold Schwarzenegger vetoed it.  There’s something you don’t hear much about from the Democratic leadership – Arnold Schwarzenegger vetoed a bill that would have banned insurance companies from dropping patients after they get sick.  He sided with the forces of insurer-assisted suicide.  This is your modern Yacht Party on this issue:

“Any of those who have read the various exposés in the Los Angeles Times and others . . . is aware that health insurers have admitted and acknowledged they engaged in a form of post-claims underwriting,” said Sen. Mark Wyland (R-Escondido). “It is unethical and, considering what some of these people have endured, it really borders on the immoral.”

However, Wyland said he would not vote for the bill because the Department of Insurance has proposed new rules to solve the problem, and he wants to see how they work.

Hey, give ’em a chance to see if the immorality stops!  If not, we can think it over.

• The Legislature may extend a homebuyer’s tax credit passed in a previous budget agreement that was nothing but a bailout for developers.  It only credited new construction, and was structured only to benefit high-income households who could afford new construction.  By the way, sales of new units have fell since this was enacted, so it’s not even meeting its intended purpose.  But it’s a giveaway to a special interest, so off the money may go, even though we cannot afford it at this time.

• A bill to ban bisphenol A (BPA) from children’s products was delayed after the Assembly couldn’t muster 41 votes.  The debate in the Assembly last night was pretty fierce.

• Cities and counties reacted angrily to a proposed bill to slow local government bankruptcies until vetted by the California Debt and Investment Advisory Commission.  On the merits this looks to be a bill that would install more control on locals from Sacramento, although there are arguments on both sides.  But mainly it’s about the fate of union contracts in local bankruptcies, I don’t think either side would deny that.

• A roundup of other bills passed yesterday can be found here.

The Senate Health Committee held its first hearing on SB810 (Leno), the single-payer health bill.  While I’ve made my belief in the inevitable problems of states trying to fund health care when they cannot deficit spend well-known, if I was on that committee I’d go ahead and vote for it.  But I recognize the need to strengthen the broken health care system on all fronts, given the political realities that the Governor has vetoed single-payer multiple times in the past, and that the Republicans will never sign off on the funding, and so even if by some miracle the Governor put pen to paper we would have to wait until 2010 for full passage, and another year for implementation.  In the interim, a number of very interesting health care reforms have cleared the Assembly Health Committee already, and progressives should take notice of them.  Anthony Wright has some of the details.

The Assembly Health Committee on Tuesday approved a number of key health consumer protections. The measures would expand guarantees of coverage to Californians who are underinsured, uninsured or, in some cases, just plain inadequately served by their health care providers.

One of the bills would sharply increase civil fines in response to the insurer practice of retroactively canceling policies after patients become sick and need expensive treatments. Another would address a vast, and quickly expanding, demographic of the uninsured–young adults transitioning between school and careers that offer financial stability and benefits.

Yet another would require insurance brokers and employees to reveal their financial interests-such as paid commissions – in selling certain health care policies. One measure would require private providers to cover more of the costs of doctor-ordered medical equipment, something Medicaid and MediCal already do.

See the post for the full details on AB1521 (insurers revealing their commissions), AB730 (big fines for rescissions), AB29 (raising the age limit for dependent coverage from 19 to 26) and AB214 (requiring health plans to cover durable medical equipment).  All 4 would have an immediate and tangible benefit for Californians, and all are common-sense reforms.  Fining rescissions would attack the inequities in the system and prevent fraud, as would the agent commission rule.  Raising the age limit would provide stability for those young people transitioning from college to starting a career, and adding protections for what is insured also adds stability (the fact that people can be made to pay for their own wheelchair is kind of nuts).  None of these deal with the long-term cost drivers that bust state and federal budgets, and none deal comprehensively with the crisis of the uninsured.  But all of them help, and we need to press forward on all fronts right now.

One of the worst elements of the current budget crisis is that it crowds out all of the other urgent problems facing the state.  Nowhere is this more true than in health care.  When the Nunez/Schwarzenegger overhaul failed last year, the problem never went away.  And there are a host of other issues with health care delivery that linger.  Fortunately, we’re seeing a little progress and a few good ideas that can set a course for the future.

First, the state reached an agreement with Blue Cross to reinstate 678 patients who were wrongly removed from their insurance plan in a practice known as “rescission”.  Basically, the insurer waits until a patient files a claim and then invents a reason to cancel their policy.

The insurer has agreed to reimburse the subscribers for any out-of-pocket medical expenses and create a third-party process to review policy cancellations.

Blue Shield faces up to a $5 million fine if it does not take corrective action, said Darrel Ng, insurance department spokesman.

Between Jan. 1, 2004, and May 31, 2008, Blue Shield improperly dropped 678 subscribers, the agency said.

Obviously, the state meeting its responsibilities to protect California consumers is helpful, but it doesn’t solve the big problems of health care delivery.  One of the most pressing concerns how to get quality care out to rural areas, where there is a dearth of doctors and facilities.  Fortunately, John Garamendi has a plan to recruit new doctors to rural health centers.

State Lt. Governor John Garamendi is proposing an ambitious fast-track medical school at University of California-Merced in an effort to create more doctors for the San Joaquin Valley, one of the most physician-poor regions in the state […]

Entering freshmen – recruited from San Joaquin Valley high schools, with family ties to the region – would study at UC-Merced and local community colleges, then train in existing medical centers and clinics, instead of at a pricey research-oriented hospital.

They would be encouraged to train as primary care physicians and learn the challenges of practicing medicine in this vast region, where 130 languages are spoken and many residents suffer from chronic ailments such as diabetes, heart disease and respiratory ailments from dust, diesel-burning farm equipment and wood-burning stoves.

And then there are the macro issues with rising costs and the uninsured in general.  Recognizing the dire needs in this area, foundations and nonprofits are stepping up in this area with advocacy that will hopefully bring more attention to the issue.

Overall, while the budget is obviously the pressing concern, we cannot overlook these burgeoning crises throughout California public policy.  There is sadly no magic fix for them, even if a budget is someday signed.

Hector De La Torre’s bill, AB 1945, which would have forced health plans to seek approval from a third party before rescinding health insurance – a VERY common practice, unfortunately – was vetoed by Arnold today. Interestingly, Arnold was for it before he was against it as De La Torre noted:

Having the governor not engage in any discussions or negotiations for months, and then just veto the bill is astonishing,” he said. “The issue was good enough to use as an applause line in his State of the State Address in January, but not to sign a good piece of legislation that would protect insured people in the individual market.

It’s another sop to the HMOs, whose business model relies on preventing people from getting the health care they need. This is especially true on the individual health insurance market (the one John McCain wants you to rely on) – if you get sick, the insurance company is going to comb over your application, your policy, and your life with a fine toothed comb to find a reason to cut you off and watch you suffer.

Arnold has vetoed a lot of bills this session, but few vetoes will hurt more Californians than this one.  

Technically, the session is over in Sacramento, but of course, with no budget, the work will go on.  More on that in a moment, but let’s take a look at the bills that have passed thus far.

Hundreds of bills passed through their respective houses and made their way to the Governor’s desk.  Among those passing:

• AB 1945, which cracks down on insurance company rescission policies

• SB 1301, the California DREAM Act, allowing children of illegal immigrants to access financial aid for college

• SB 375, a major land use bill that would improve transportation planning and reduce urban sprawl (this is a real coup)

• AB 583, the Clean Money pilot project bill that would make the 2014 Secretary of State election a Clean Money race.

UPDATE: More bill passage from the indispensable Frank Russo:

• AB 1830 (Lieu): This is the good version of the subprime mortgage bill that passed in a weaker state earlier this year.

• AB 180 (Bass): Another mortgage bill that seeks to go after predatory lenders and “foreclosure consultants.”

• SB 1440 (Kuehl): This is a big one.  It sets a minimum requirement that insurers spend at least 85% of their premiums on health care.

• SB 840 (Kuehl): The single-payer bill, which will be promptly vetoed by the Governor, sadly.

• A couple toxic chemicals bills: AB 1879 and SB 509.

• AB 2939 (Hancock): Allowing cities and counties to implement stricter green building guidelines than state law, which are already tightening through SB 375.

Among the bills that failed:

• SB 1522, a health care reform bill which would have standardized the individual health care market and made it easier to comparison shop, as well as set a floor for basic minimum care.  That those who most strongly pushed for comprehensive health reform would fail to pass this common-sense fix makes no sense to me.

• SB 110, which would have created an independent sentencing commission to review and revised sentencing guidelines and parole standards.  Another failure of leadership in our prison crisis, as lawmakers refuse to loosen their grip on the rules which they’ve abused and led to this disaster.

As for the budget, now the legislature, out of session by constitutional mandate, must work on nothing else.  Sen. Perata has called the bluff on the Republicans, asking them to formally submit their unspeakably cruel budget plan so that the whole state can see their priorities for what they are.

There was a strange colloquy near the end of yesterday’s Senate session (Republican Senator Jim Battin is pictured at right), where the Republicans were clearly caught flatfooted, flustered in their responses like school kids admonished for not doing their homework, and having a hard time coming to grips with what Perata told them. This is a reprise of what Perata did last year when Senate Republicans held the budget up and when he asked them to come up with their own proposal.

Perata: Right now, the bill that I brought up yesterday is kind of an orphan. You have your opportunity to present a bill that you outlined today in your press conference. I appreciate the fact that there is a substantial amount of work to be done on that bill. We know, because we started ours 8 months ago. So you’ve got a lot of work to do. But we’re very confident you can do it. Every day we will be here to see how we’re doing […]

Republican Senator Jim Battin: I just want to make sure I understand what your expectations are. So what you want from our caucus is a full budget document, is that correct?

Perata: Yeah. A budget.

Battin: And every day we are preparing that, you want to meet.

Perata: Yeah. You know what I don’t’ want to do is to be caught in that position where people are getting confused whey we don’t have a budget. Now every day we meet, we can say, “you’re working on it.”

Battin: And you also want to have the trailer bills as well?

Perata: Yeah. A budget.

Battin: You would actually allow us to bring it up for a vote on the floor?

Perata: You betcha.

Battin: So my expectation is that it will fail…And then what?

Perata: Let’s not prejudge. You may come up with a piece of work that will knock our socks off. So let’s see what you will do.

It’s a neat trick, and good for political purposes.  I don’t know how it gets us closer to a budget.  Schwarzenegger still wants the sales tax hike, Yacht Party Republicans are still dead-set against it, and Democrats are trying to compromise and on the edge of cracking.  But they seem to believe, this time around, that the budget can be blamed on Republicans in November and there’s a benefit in campaigning on the issue (I think that’s why Perata wants a real plan).

So nobody knows how this ends.  And the victims are the public employees, the long-term care workers, the schools, the health clinics, the everyday Californians that did nothing wrong and don’t deserve this anxiety.  

With this epic FAIL maneuver on the budget, Arnold Schwarzenegger signaling here that his little state employee wage cut gambit didn’t work.  It didn’t produce the kind of compromise he wanted and it sent him tumbling in the polls as he attempted to cynically hold innocent bystanders hostage in an unrelated fight.  So he had to cut off all bills instead.  Maybe now, he thinks, the legislators will take notice.

But let’s understand what he’s doing here.  Yesterday, as a culmination of four years of work, Alan Lowenthal’s bill to clean up the ports of Oakland, LA and Long Beach passed the State Senate.  Eliminating the toxic pollution at the ports would save 3,700 lives annually according to the California Air Resources Board.  The bill would enact a $30 container fee on every import, using that money ($300 million annually) for investment in reducing pollution and improving freight rail.  It’s a milestone bill that is sorely needed to improve the air quality of these communities.

It’s not an exaggeration to say that Arnold’s latest stunt will actually kill thousands of people from reversible diseases.

There’s a bill pending in the Senate Appropriations Committee authored by Fiona Ma (AB 2716) which would deliver guaranteed paid sick days to all California workers.  This bill has the support of 73% of the public and would make the state the first in the nation to provide this to their residents.  Arnold would rather stamp his feet and issue ultimatums than improve the lives of Californians and do the bidding of the overwhelming majority of the public.

On health care, while we cannot expect a comprehensive plan to come out of this legislative session, there is a deal coming together that would improve health care for those who have insurance by mandating some strict rules for the industry:

In the final weeks of the legislative session, they are negotiating measures that would limit insurer profits on individual plans, require plans to provide a minimum set of benefits and restrict insurers’ ability to cancel policies retroactively […]

Three million Californians buy health insurance on their own rather than through employers. Insurers keep premiums low — and profits high, their critics say — on some individual policies by limiting the services they cover. Such plans may exclude prescription drugs and maternity services, for example; others may cover only hospital visits.

Many of the policies have big deductibles and require patients to pay large portions of their expenses, costing them much more than coverage obtained at workplaces.

The game-playing by Arnold on the budget means that, in all likelihood, these rules will not go into effect, and individual consumers of health insurance (like me) will remain incredibly vulnerable to the vicissitudes of the insurance industry, which has shown already a penchant to deny coverage and jack up premiums.  That too will put the lives of Californians at risk.

There’s a human cost to the bullshit that Terminator Boy isn’t accounting for.  His head is in the clouds, and he thinks he can bully the legislature liked he bullied people in scripted movies for decades.  But the recklessness will cost money, pain, suffering, and even lives.