Closing the Coverage Gap

The Legislature will begin work Tuesday on the urgent task of expanding health insurance at a time when millions of Californians are without any protection. It is one of the most promising but also one of the most challenging issues before this year’s session.

A recent daylong conference in Sacramento on the issue of uncompensated health care served to demonstrate that this is not an impossible task. The conference explored what other governments are doing, and reviewed a half dozen bills introduced in the legislature to address all or parts of the problem. The conference was a useful and instructive contribution.

Above all, the sessions served to remind professionals that the situation is desperate, with 5.2 million Californians without health insurance, more than half of the state’s hospitals operating with deficits and with further cuts in state funding proposed. “We are reaching the breaking point,” the meeting was told by Assemblyman Bruce Bronzan (D-Fresno), who presided over the sessions in his capacity as chairman of the Assembly Health Committee.

The session was at once sobering and encouraging. It was sobering because it demonstrated that there is no easy solution or perfect model that can be readily transposed to solve California’s problem. It was encouraging because all of the speakers were government officials actively engaged in successfully solving the problems, in stark contrast to the absence of initiatives on the part of Gov. George Deukmejian and the declining support he has budgeted for the crisis areas of health care.

Hawaii already has in place a program mandating that employers provide health insurance, and the state is in the process of closing the last hole in the safety net to assure at least basic protection for the unemployed. To determine the real costs of a statewide program, the state of Washington is launching a demonstration project that will extend basic health insurance to as many as 30,000 of those not now protected. Massachusetts is beginning the process of drafting details of a program of universal-mandated health care that will be phased in over the next three years and already includes operating demonstration programs. British Columbia, like all the provinces of Canada, is delivering high-quality basic universal health care at half the cost in the United States.

A review of six bills pending in the California Legislature followed the presentations on what others are doing. The bills range from a limited proposal to protect those now unable to obtain health insurance because of prior illness to a bill providing an ambitious global program that would emulate the universal protection of the program in Hawaii and the program being initiated in Massachusetts. It is those bills that will have a first hearing Tuesday before the Assembly Finance and Insurance Committee.

Having heard what is being done by other governments, none with the wealth and resources of California, it will be harder for those who govern California to condone continued inaction.