Doctors Plan Ballot Measure on Health Care : Medicine: All businesses would have to provide insurance for full-time employees. Physicians admit that they are trying to pressure the Legislature to enact a law instead.

Declaring that they will spend “whatever it takes” to win, California doctors announced Thursday that they intend to qualify an initiative for the November ballot that would require all California businesses to provide health insurance for their full-time employees.

The California Medical Assn. said it will wield its initiative as a club over the heads of state lawmakers, who have struggled for years over how to extend health coverage to the 6 million residents who lack it.

“If the Legislature enacts this bill, we shut down the initiative,” said Dr. Richard Corlin, the association’s president-elect.

Standing beside Corlin as he spoke at a Capitol news conference were Senate Republican Leader Ken Maddy of Fresno and Democratic Assembly Speaker Willie Brown of San Francisco, who said they will introduce the doctors’ proposal as legislation and then work toward a compromise to head off the ballot battle.

Brown and Maddy, who have criticized the initiative process, said they believe the give-and-take that can happen in the Legislature would produce a better law.

“We are now finally on the road to building a consensus on some plan,” Brown said, adding that he hoped the health insurance legislation would become the “crowning achievement” of his career.

Maddy acknowledged that the insurance requirement will be vigorously opposed by small businesses, whose lobbyists say the added cost would put many companies out of business or force them to lay off workers. But the Republican leader said the political climate makes it clear that some type of government-required insurance program is on the horizon.

“Something is going to come down the pike,” Maddy said.

The measure might also encounter opposition from the insurance industry, depending on the wording that goes before voters, and by groups that have been pushing for a more sweeping program that would cover every resident, employed or not. Critics on Thursday were complaining that doctors stood to gain the most from the plan.

The doctors’ plan, even if approved by California voters, could not take effect without the approval of Congress and the President, because federal law prohibits states from requiring employers to provide health benefits. It also could be preempted if Congress passes and President Bush signs a Democratic-sponsored plan to require businesses to provide insurance or pay a tax to finance coverage for those who cannot afford it.

Because they are starting late, the doctors will have to mount an aggressive signature-gathering effort to qualify the measure for the November ballot. They need to collect more than 380,000 valid signatures by April 17.

Once on the ballot, the measure, depending on the level of opposition, could cost the association millions in advertising fees. Corlin said the 40,000-member doctors group has not set a budget for the campaign, but the association is reported to have $7 million in reserve for the effort.

“The California Medical Assn. is prepared to spend whatever it takes to see to it that this insurance plan is enacted,” said Corlin, a Santa Monica physician.

The plan, dubbed “Affordable Basic Care,” would require a basic benefit package of physician and hospital services, limiting hospital stays to 45 days and doctor visits to 20 in any year. The mandatory benefits would not include services, abortions among them, which are considered elective.

The association estimates that the benefit package would cost about $100 monthly for an individual and $250 for family coverage, with employers paying at least 75% of the cost and workers paying the rest. The coverage would be provided by all companies with 25 or more employees beginning Jan. 1, 1994, and by every company beginning in 1997.

The insurance would go to employees working at least 17 1/2 hours weekly and on the job for at least 2 1/2 months, a group estimated to include about 70% of those now uninsured.

The proposal includes no new taxes to subsidize premiums for low-wage employees or low-profit companies. Corlin said about 1 million employed Californians now served by Medi-Cal would be shifted to private insurance, saving the state $500 million a year. He said he hoped that the Legislature would allot some of that savings to cushion the cost of premiums charged to workers and companies.

The measure would require insurance companies to charge similar rates to similar companies and allow small employers to join pools in an effort to give them the clout now enjoyed by large corporations. Insurers would be forced to cover everyone who applied, regardless of their health history.

The initiative would establish several commissions to review physician practices, suggest controls on new technology, and establish standard procedures for doctors to follow in specific situations. All these panels would be advisory only.

It is this “cost containment,” which even Corlin said was “admittedly not dramatic,” that leaves the doctors open to criticism that they are only trying to increase their incomes at the expense of businesses and their workers.

Martyn Hopper, Sacramento lobbyist for the National Federation of Independent Businesses, said the proposal does nothing “to get to the root of the problem”--increasingly higher medical costs.

Health Access, a coalition of consumer, labor and religious groups that supports a Canadian-style, universal system supported by taxes, called the doctors’ plan a “cruel hoax” intended to stymie changes that would slow the growth in doctors’ incomes.

“This is an effort to undermine other, more far-reaching proposals that would make health care more affordable,” said Maryann O’Sullivan, executive director of Health Access. “It’s selfish and unfair on the part of the physicians.”

The association’s announcement reversed a decision made only four months ago, when the organization called off negotiations with several competing interest groups and declared that it would not go forward with a health insurance ballot proposal this year.

Since then, health care has emerged as a major political battleground, and the doctors sensed that the time is right to act.