Healthcare is a headache for GOP candidates in California

Republican candidates across the nation are confident that opposition to President Obama’s healthcare law will deliver them electoral victories. But in California, the three GOP Senate candidates vying to take on Sen. Barbara Boxer face a much more daunting task: convincing a majority of Californians who support the bill that they are wrong.

The issue is a stark reminder of the difficulties facing Republican candidates in this highly partisan state, even in a year when the political winds are at their backs. The primary voters Republicans are courting are a conservative lot who fiercely oppose the new law. But in November, the winner of the June primary will have to sway voters who by and large support the plan, and who continue to hold Obama, its architect, in high regard.

Former Rep. Tom Campbell, Assemblyman Chuck DeVore and former Hewlett-Packard chief Carly Fiorina differ in their approaches to fixing healthcare, but all have said the measure is unconstitutional and must be repealed.

Their stance aligns them with the state’s registered Republicans. In a recent L.A. Times/USC poll, 59% of registered Republicans surveyed said they would be less likely to support a candidate who supported the healthcare legislation.

But come November, the Republican nominee will need independent and Democratic voters if he or she is to defeat Boxer. About 46% of California voters surveyed in the same poll said they would be more likely to vote for a politician who had supported the health bill, while 29% said they would not. Just over half said they believed the country would be better off because of the package.

Democratic operatives, who began laying the groundwork last year for challenging GOP candidates about the bill, are counting on this belief.

“We will absolutely hold Republicans accountable for looking voters in the eye and making it clear they want to kick people off health insurance, reinstate the doughnut hole for seniors, eliminate tax credits for small businesses and restore preexisting conditions,” said Eric Schultz, spokesman for the Democratic Senatorial Campaign Committee. “If Carly Fiorina or anyone else is going to make that argument, then good luck to her.”

The most controversial piece of the package is the requirement that nearly every American purchase health insurance by 2014 or face fines. Some leading Republicans argue that it is unconstitutional. In addition, the law requires that states set up marketplaces where people without access to coverage from employers can buy policies. All but the smallest businesses would be fined if they failed to provide coverage.

But these mandates are several political cycles away. The bill was crafted so that some of the least controversial portions kick in before this November’s mid-term election, when many Democrats who supported the bill, including Boxer, will face difficult reelection battles.

Boxer said that by fall, voters will see tangible benefits, such as being able to purchase coverage for a child with a preexisting medical condition or add their young adult children to their policies.

“At the end of the day, people will be so much better off,” she said.

Political strategists said the winning Republican candidate will probably moderate his or her stance to avoid turning off swing voters.

“There’s plenty of time for the primary winner to adjust his or her message over the summer,” said Dan Schnur, director of the Jesse M. Unruh Institute of Politics at USC and a former Republican operative. “My guess is that the nominee decides at some point over the summer that there are some aspects worth saving and others worth replacing.”

Yet the candidates say they expect voters to change their views as the effects of the bill become more apparent. They particularly cite the effect on California, which expects to take a multibillion-dollar budget hit from increased numbers of poor residents who sign up for Medi-Cal.

“As people learn more and more about this healthcare bill, I think support for it will erode, not grow,” Fiorina said. “It will become clear as the bills become due that we can’t pay them.”

Although the three candidates agree on repeal, they offer different alternatives to reform the system. They share some similarities; all call for changing the legal system to limit lawsuits over medical injuries, saying that would reduce malpractice insurance and defensive medical costs. They favor allowing insurers to compete across state lines, and they call for an eventual shift from an employer-based system of insurance to an individual-based system, similar to what Sen. John McCain (R-Ariz.) proposed in his unsuccessful 2008 presidential run.

Campbell has laid out the most detailed proposal to insure the poor and people with preexisting conditions, with a complex system in which providers would bid for contracts limited to a set amount of government dollars.

Unlike DeVore and Fiorina, Campbell has declined to sign a pledge to repeal the Obama healthcare law because he said he wants to not only repeal the bill but replace it.

“I don’t wish to be simply against,” he said. “I wish to be for.”

Campbell and Fiorina support additional use of state high-risk pools for people with preexisting conditions who can’t get coverage on the market. Existing pools in many states, including California, have long waiting lists and cost much more than private insurance.

Fiorina has also called for increasing access to community primary-care clinics, emphasizing prevention and use of existing programs that are not well known, such as state programs for the poor who have breast or prostate cancer. She said once some reforms have been implemented, she could see a small role for government in subsidizing insurers who carry people with preexisting conditions, if there is still a need.

DeVore has proposed using the tax system to encourage people to buy health insurance coverage, perhaps a tax credit that is close to the cost of a catastrophic plan.

Several who have studied healthcare dismissed these proposals.

John Holahan, director of the nonpartisan Health Policy Research Center at the Urban Institute, said that although some of the concepts make sense in theory, they would be difficult to implement and would represent a greater overhaul of the healthcare system than the reform legislation just signed into law. For example, shifting away from a system in which many Americans receive coverage from their employers to one in which everyone buys insurance on the free market could work if one were creating a system from scratch, Holahan said. But now, such a move would disrupt a system on which 170 million people rely.

The proposals are “all incredibly unrealistic,” he said.

But Robert Book, a senior research fellow in health economics with the Heritage Foundation, called Campbell’s proposal an “intriguing idea.”

“I think that proposal could lead to better healthcare for low-income people at a lower cost,” he said.

The details of the three candidates’ proposals ultimately may not matter, Schnur said. The subject is complex, and most voters are not likely to dig deep into the differences in the three plans.

“The essence of any Republican healthcare plan this year in California or elsewhere in the country is ‘I’m going to do something better and cheaper than Obama,’ ” he said. “My guess is a relatively small number of Republican primary voters are going to differentiate between the Republican alternatives.”

seema.mehta@latimes.com