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Legislators in Sacramento are in for a dose of tough medicine Monday when they resume negotiations on California’s $145-billion, woefully overdue budget. If they don’t resolve their differences quickly, Gov. Arnold Schwarzenegger’s healthcare reform package could flatline, along with the state’s hopes for much-needed improvements in medical coverage.

More than 6.5 million people in California lack health insurance. Others struggle with rising premiums, shrinking coverage and poor medical care. The governor’s plan, which would cost about $12 billion, would require everyone to purchase insurance (an intriguing idea) and would make employers responsible for coverage or for contributions to a state insurance pool (which, although costs should be shared, is more problematic). Democrats in the Senate and the Assembly are pushing a plan that forgoes the individual requirement and calls for larger contributions from business.

Agreeing on the details won’t be easy. Complicating matters, the Legislature must act by Sept. 14 if it wants to reform healthcare in 2007 (or, as the governor has called it, “the year of healthcare”). Sacramento has put together big deals in shorter amounts of time -- witness last year’s consensus on greenhouse gas reduction -- but every day it wastes bickering over politics leaves 24 fewer hours to come up with a reasonable compromise.

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The budget woes provide a convenient excuse for legislators on both sides of the aisle to avoid this painstaking work. Fortunately, Californians aren’t letting them off the hook. Last Saturday, 3,500 people in eight cities took part in California- Speaks, a statewide healthcare policy workshop. The vast majority -- 82% -- said they believed that the state’s healthcare system needed “major change.” The AARP is promoting a healthcare rally Wednesday at the Capitol and is among many organizations pouring millions of dollars into ad campaigns calling for action.

Schwarzenegger, Senate President Pro Tem Don Perata (D-Oakland), Assembly Speaker Fabian Nuñez (D-Los Angeles) and Assembly Republican leader Michael Villines of Clovis were all on hand at CaliforniaSpeaks meetings, and all promised to act.

“In the absence of real action on the part of the federal government and Congress,” Nuñez said, “we in California are going to deliver.”

States play an important role as laboratories for national healthcare reform. California should maintain its place in the vanguard. Starting next week, it must get serious about insuring its citizens.

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