Expansion of health coverage should start with helping children

The most volatile subjects in California politics today, arguably, are taxes and illegal immigration.

Either or both could trip up Gov. Arnold Schwarzenegger and Democratic legislative leaders in their ambitious quests to overhaul California’s healthcare system.

Republican lawmakers are warning that they won’t support any bill that raises taxes to help pay for universal healthcare or subsidizes medical insurance for illegal immigrants.

Without GOP help, Schwarzenegger and Democrats won’t be able to obtain the necessary two-thirds majority vote in each house to pay for a substantial expansion of healthcare coverage.

If the governor and Democrats decree that Schwarzenegger’s proposed taxes really are “fees” -- and thus require only a majority vote -- then they will have failed to achieve the necessary broad, bipartisan support to make their healthcare concoction politically sustainable. That will invite inevitable court challenges and/or a ballot referendum to repeal the measure.

That’s what happened in 2004. Business interests -- backed by Schwarzenegger -- sponsored a referendum that repealed a Democratic act requiring employers to offer their workers health insurance or pay into a state coverage pool. This time, the Republican governor is advocating a similar “play or pay” scheme.

Schwarzenegger persists in living in denial about his proposed tax increases, apparently spooked by his campaign pledge not to raise taxes. He wants to seize 2% of doctors’ receipts and 4% of the hospitals’ to help pay for universal, affordable healthcare, and has been spinning it as a “fee.”

Now, the governor also is contending that he’s merely digging into the medical providers’ pockets for a “loan” because, in the end, they’ll be getting back higher Medi-Cal rates and more patient business.

“It’s not a tax, just a loan, because it does not go for general [spending],” the governor told the Sacramento Bee last week. “It goes back to healthcare. I think it’s the important fact here, that you take it for healthcare.”

No, governor, the important fact is that you’d “take it.” To take is to tax when you’re talking about people’s incomes.

And every loan I’ve ever heard about is voluntary. A forced “loan,” it seems to me, is either a tax or a stickup.

Schwarzenegger should shelve the semantics games and focus his attention on defending the proposed tax hikes and promoting universal healthcare, even for illegal immigrants. As he points out, employers and families already are hit with a “hidden tax” amounting to 17% of premium costs to care for the uninsured and compensate for miserly Medi-Cal reimbursements.

Illegal immigrants are entitled, by federal law, to costly care at clogged emergency rooms even if they’re not insured. Schwarzenegger logically contends that they should be cared for in a clinic or doctor’s office where it’s less expensive for taxpayers and premium buyers.

But good luck selling that politically.

A recent statewide poll by the Survey and Policy Research Institute at San Jose State University found that only 32% of registered voters favor guaranteeing health insurance for illegal immigrants; 58% are opposed.

That poll, however, did not ask specifically about illegal immigrant children. And there’s other polling evidence that indicates California voters have a soft spot for undocumented kids.

Asked how they’d react to a state program assuring that every child has health insurance “regardless of their immigration status,” 55% were supportive; 40% opposed.

The vast majority -- 83% -- agreed with this statement: “The reality is there are children who are undocumented immigrants who live in our communities now and attend local schools. Their health affects us all, especially our own kids, and we should make sure every child stays healthy.”

The pollster, Ben Tulchin, conducted the survey for United Way of California. He also has conducted focus groups on the emotional issue.

“Voters make a distinction between adults and kids,” Tulchin asserts. “They say kids are kids, you can’t blame them. They didn’t choose to come here. They followed their parents. You shouldn’t punish the kids by denying them health insurance.”

There are wide ranges of numbers circulating, but I like these from the California HealthCare Foundation: Of the 6.6 million uninsured Californians, 1.3 million are children. Of these kids, 763,000 could be eligible for some government program -- Medi-Cal or Healthy Families -- but aren’t enrolled. Most of the rest are illegal immigrants and ineligible.

The Schwarzenegger proposal -- and one by Assembly Speaker Fabian Nunez (D-Los Angeles) -- would expand Medi-Cal and Healthy Families eligibility, simplify enrollment, subsidize where needed and bring in the undocumented kids. The feds would pay most of the bill. The state would kick in perhaps $400 million.

So that particular feature of Schwarzenegger’s healthcare revamp looks doable. It’s low-hanging fruit that should be picked.

But the governor doesn’t like it when somebody suggests that perhaps the Capitol should move incrementally on healthcare and start with insuring all children.

“No, absolutely not,” he told the Sacramento Press Club last week. “We should take it as a comprehensive approach. We have the talent here; we have the intelligence in our Capitol to get our act together.”

I’m not so sure. Not with term limits, extremist lawmakers produced by gerrymandering and special interests ganging up on all sides.

Meantime, kids’ germs aren’t conservative or liberal, documented or undocumented. They spread indiscriminately, regardless of immigration status or tax brackets.

If nothing else, the politicians should protect every child.

*

George Skelton writes Monday and Thursday. Reach him at george.skelton@latimes.com.