Update: AB 8 Passed the Senate and the Assembly

(Note: I work for the It’s Our Healthcare Coalition which includes member organizations in support of both SB 840 and AB 8).

This morning, Assembly Speaker Fabian Nunez and Senate Pro Tem Don Perata held a press conference about AB 8. 

They were joined by supporters of AB 8 such as Count Dracula, the CEOs of all of the major health insurance companies in California, the honorary co-chair of the Schwarzenegger for Senate 2010 committee, and a bunch of people who like to drown kittens. Oh wait, that’s not what happened at all. 

Yet that’s what you might have expected given the rhetoric coming from some quarters. The rhetoric has gotten well beyond ridiculous, and it’s time to stop engaging in bizarre fantasies and the shrill invective and start talking seriously about the healthcare reform debate in California. 

When it comes to debating the merits of AB 8 and SB 840, it’s easy to bash insurance companies and  it’s easy to believe that politicos are about to sell us out on something so vitally important.  But none of that deals with the fact that large elements of the progressive movement are supportive of AB 8 for very legitimate reasons. 

Reasonable people can disagree.  Nobody is compelled to support AB 8.  But to ignore these stakeholder groups and their legitimate interests in seeing healthcare reform this year (much less to demonize them as some have done) is not only bad politics, it’s wrong.

[More on the jump]

First, let’s look at some of the groups who have come out in support of AB 8:

• The California Labor Federation
• SEIU
• AFSCME
• the Unitarian Universalist Legislative Ministry of California
• AARP-California
• California ACORN
• the Latino Coalition for a Healthy California
• Congress of California of Seniors
• AFTRA
• Health Access California

They’re not exactly the Legion of Doom. 

Were AB 8 to pass, it would represent the single largest expansion in health coverage in decades.  It would extend coverage to literally millions of Californians. AB 8 would cover approximately 70% of the uninsured, a tremendous increase over SB 2 (passed in 2003), which would have covered approximately 20% of the uninsured had it not been repealed via referendum (Prop 72) in 2004. 

There is no denying that AB 8 is not universal healthcare.  But there is nobody who is seriously arguing that true universal healthcare, much less single-payer healthcare, will be signed into law in California this legislative session. 

And so those who argue that we ought to withhold support for AB 8 in favor of waiting for something better (e.g. SB 840) are actually saying that it is better to continue to allow people to suffer now and take the risk that nothing substantial will happen for years instead of helping those we can in the interim.

For the 4.9 more than three million Californians who would get coverage under AB 8, the issues are real and urgent, and asking them to wait even another year is asking them to endure the risk of incalculable harm: bankruptcy, preventable sickness and death, harm to themselves and their loved ones.  It is fine to argue that AB 8 does not represent a complete solution to the healthcare problems we face, and I would agree with that.  But absent a strong argument (one that shoulders the burden of proof) it’s simply callous to ask that others be martyred and denied protection based on some abstract political calculation. 

And make no mistake about it, a political calculation is what undergirds all of the arguments against AB 8 from those who will not tolerate anything less than a jump from the status quo to a single-payer system in one fell swoop. 

There is no reason that I have seen offered by supporters of SB 840 to oppose AB 8 in its current form except that a) AB 8 putatively helps the insurance companies by expanding health insurance coverage to more people and b) passage of something now might stymie a change to a universal or a single-payer system. 

THE MOMENTUM ARGUMENT

First, let’s deal with the issue of momentum.  Opponents of AB 8 like the California Nurse’s Association have (amazingly) pointed to the enactment of Medicare as an example of gradualism gone awry, thereby killing momentum for fundamental reform.  RoseAnn DeMaro, the Executive Director of the California Nurses Association, in an article with the inflammatory title of Whose
Life Doesn’t Count? writes:

With public frustration over the collapse of our healthcare system mounting, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, also provides one of the best arguments against incremental steps. When Medicare was enacted 40 years ago many contended that the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

You follow that logic?  Medicare is “our most successful national health program,” which demonstrates that we ought not to take incremental steps like…the enactment of Medicare.

We know we can help millions of people now. We don’t know whether it is even possible, much less likely, that we will be able to enact more meaningful reform in the next couple of years.  I don’t think that this means we pack up and settle for something short of a solution.  But taking one affirmative step towards a solution does not mean that you can’t take another step later on.  Does anyone really think that enacting Medicare seriously made us worse off? Would any progressive, if they could go back in time, argue against its enactment because of our current situation? Bueller? Bueller? 

THE ROLE OF INSURANCE COMPANIES ARGUMENT

Anyone who’s concerned about the role of insurance companies in our healthcare system would be perverse to oppose AB 8. Here’s why: AB 8 substantially reforms the role of insurers in our healthcare. It sets a floor for the percentage of premium dollars that must be spent on healthcare (85%). It creates a public insurer to change the playing field and guarantee that there’s real competition with low overhead and driving the market in the right direction. Finally, it bans denial of insurance for pre-existing conditions and actually requires health insurance plans to help fund a real, adequately-funded, high-risk pool.

Many of the things we hate about insurance companies are now completely and utterly legal.  It boggles my mind that anyone who supports single-payer healthcare wouldn’t, while we still have the current system, want insurance companies to be better regulated.

(full disclosure, CTA has hired me to work on blog outreach about NCLB)

The main flaws of NCLB have been known for years.

1. The program is woefully underfunded to the tune of a whopping $56 billion
2. It relies too heavily on one measurement of student achievement,: standardized testing.

Luckily this bill comes up for re-authorization this year and we have a great chance to get it right.  Unfortunately, the current NCLB bill from Miller and Pelosi is more like something we would expect from the Bush Dogs.  It fails to fix the above, and in some respects goes backwards.  The California Teachers Association (CTA) is urging people contact their Members of Congress and ask them to Vote NO on NCLB, saying this proposal “does nothing to improve the law”.  A series of blog ads are now up (Calitics ad is coming) on a whole host of Californian and national blogs, calling out Pelosi and Miller on their insistence on punishing teachers and students.

Urban education expert and author Jonathan Kozol has been fasting for 67 days as a “personal act of protest at the vicious damage being done to inner-city children” by NCLB.  Kozol has a powerful piece up today on HuffPo:

The poisonous essence of this law lies in the mania of obsessive testing it has forced upon our nation’s schools and, in the case of underfunded, overcrowded inner-city schools, the miserable drill-and-kill curriculum of robotic “teaching to the test” it has imposed on teachers, the best of whom are fleeing from these schools because they know that this debased curriculum would never have been tolerated in the good suburban schools that they, themselves, attended.

The current proposal still relies on just test scores, instead of multiple measures of student and school success like attendance/graduation rates, a rigorous curriculum and the number of students taking honors and AP classes.  It adds a merit pay program (a truly bad idea, more on that later this week), creates four new levels of sanctions on schools and does not guarantee that there will be funding.  more on the flip…

Here is NEA on the current proposal:

We are also concerned that this Title imposes many additional mandates and requirements on schools and states (such as the longitudinal data system and student mobility audit) without any guarantee that additional funding will be provided to meet both new mandates and help states and schools overcome the cumulative $56 billion shortfall that occurred since 2002 between the NCLB authorized and actual funding levels.

More restrictions and no guarantee of funding.  Great….

Kozol again:

The justification for this law was the presumptuous and ignorant determination by the White House that our urban schools are, for the most part, staffed by mediocre drones who will suddenly become terrific teachers if we place a sword of terror just above their heads and threaten them with penalties if they do not pump their students’ scores by using proto-military methods of instruction — scripted texts and hand-held timers — that will rescue them from doing any thinking of their own. There are some mediocre teachers in our schools (there are mediocre lawyers, mediocre senators, and mediocre presidents as well), but hopelessly dull and unimaginative teachers do not suddenly turn into classroom wizards under a regimen that transforms their classrooms into test-prep factories.

The real effect of No Child Left Behind is to drive away the tens of thousands of exciting and high-spirited, superbly educated teachers whom our urban districts struggle to attract into these schools. There are more remarkable young teachers like this coming into inner-city education than at any time I’ve seen in more than 40 years. The challenge isn’t to recruit them; it’s to keep them. But 50 percent of the glowing young idealists I have been recruiting from the nation’s most respected colleges and universities are throwing up their hands and giving up their jobs within three years.

When I ask them why they’ve grown demoralized, they routinely tell me it’s the feeling of continual anxiety, the sense of being in a kind of “state of siege,” as well as the pressure to conform to teaching methods that drain every bit of joy out of the hours that their children spend with them in school.

My sister is getting close to getting her teaching credential.  How are we going to keep people like herself in the profession, when we are going backwards with this law?  California needs to hire 100,000 teachers in the next ten years.  The law would make it more difficult to hire and retain the teachers we need to improve California’s schools.

The Democrats were elected to Congress with a mandate for change.  NCLB was on their lists of things to fix.  Why do we have a Bush Dog bill instead of a real bill?  Are we saving gunpowder on this issue too?

We can’t let the past repeat itself. This law is too important for the future of our public schools.  Find out more on the NCLB page.  And take action.

(AB 8 is on the floor of the Assembly right now. – promoted by Brian Leubitz)

There are other things going on besides the Petraeus/Crocker testimony today, though I’m not covering much of it.  But this is kind of important for the future of our nation on its most valued domestic policy.  Over the past few days in California rumblings of a health care deal was moving into focus.  Dan Weintraub that this would result in a deal between the Governor and the Legislature on a workable reform featuring shared responsibility from hospitals, individuals, employers and doctors, with the funding for said deal to be delivered in a ballot measure later on.  Here’s the way it would go:

The legislation would outline a program requiring nearly everyone in California to buy insurance, with subsidies for people making less than four times the federal poverty rate, or about $80,000 a year for a family of four. Insurers would have to cover everyone who applied, regardless of pre-existing conditions, and could not charge customers more because they had been sick in the past.

The subsidies, along with an expansion of free care for the poorest of the poor, would be financed by a new payroll tax, an increase in the sales tax, a special fee on hospitals and an infusion of federal money. The new state charges would be put before the voters because they would require a two-thirds vote for approval in the Legislature, where Republicans have vowed en masse to oppose any increase in taxes or fees.

But before such a deal can be reached, Democrats might send Schwarzenegger legislation that would place the entire burden for expanding access to insurance on employers — an approach the governor has already said he would reject. Labor union supporters of the Democrats may want to force Schwarzenegger’s hand on that issue before any discussions about a compromise can occur.

Once Schwarzenegger vetoes that bill, if it comes to him, he would call the Legislature back into a special session to focus on health care and a handful of other issues. If that happens, the governor’s aides believe they could reach agreement with lawmakers relatively quickly.

If so, such a deal would set the stage for a ballot measure campaign in 2008 that would promise Californians two things: an expansion of health insurance to millions of people who lack coverage today and protections against losing coverage for people who already have it.

Well, let’s take a look at what happened today.  An amended AB8, with positive movement on affordability and cost containment, received the support of health care experts and top labor groups.  The Senate and Assembly schedules a vote for today which has only an employer-based pay mechanism.  And the governor pledged to both veto it and call a special session.

Gov. Arnold Schwarzenegger said today he will call a special session of the state Legislature to deal with health care, as lawmakers prepared to debate a Democratic plan he has pledged to veto […]

“What everyone wants, and what we all want, is access to health care so it is affordable and so that everyone can have health care, and no one ever has to worry about it again, that they maybe have to file for personal bankruptcy because they have to stay in a hospital for a few days,” Schwarzenegger said at the University of California, Los Angeles. “So we are working on this right now. We’re going to have an extended session, a special session that we are calling today.”

Schwarzenegger says the Democrats’ bill asks too much of employers, while they reject his demand that health insurance be mandatory.

Sounds like Weintraub got some good information.  The question is whether the resolution will wind up as Weintraub suggests it.  If so, this entire move by the Democratic leadership and their allies in labor has been an enormous kabuki dance.  They get a chance to say they tried it their way but they just had to compromise with the governor, when it seems this may have been part of the deal all along.

Maybe we’ll get meaningful health care reform out of a special session.  But I’m not terribly optimistic.

UPDATE: In addition, it’s not clear to me that having 50 separate health care deals in 50 states is a desirable outcome.