SACRAMENTO — With California’s deficit wiped out and its economy starting to hum, this was to be a year when Gov. Jerry Brown was free of the budget logjams that have paralyzed the Capitol.
But instead, the governor has a fight on his hands — with his fellow Democrats. He is on a collision course with them over how to reshape the state’s sprawling, complicated healthcare system to conform with President Obama’s national overhaul.
The sticking points in extending public healthcare to more Californians include how many to add to state insurance rolls, how much to pay doctors and hospitals, and how much money to give counties for their care of the indigent.
The Democrats who control the Legislature — with a veto-proof supermajority — want to make it easier to obtain public insurance than Brown does and send more money to the doctors, hospitals and counties than the governor wants to part with.
Lawmakers have been pressing Brown administration officials for more information in legislative hearings, making clear that they find the governor’s plans lacking. The strains underscore the divisiveness of healthcare issues even in a state that has moved aggressively to implement President Obama’s signature legislative achievement.
The dispute is growing increasingly tense as the governor prepares to release his revised budget blueprint Tuesday. The new plan will trigger the Capitol’s most intense spending negotiations this year, resulting in the budget that is due to take effect July 1.
Despite opposition from the administration, a handful of bills are moving through the Legislature. The lawmakers are bolstered in their position by a coalition of activists and county officials alarmed by the administration’s call for a more restrained healthcare expansion than they say is needed.
“Everyone is on the same page,” said Assemblywoman Holly Mitchell (D-Los Angeles), who chairs a subcommittee on health and social services. “It’s the governor who seems to be out of the loop.”
The major bill that would expand public insurance under Medi-Cal is from Assembly Speaker John A. Pérez (D-Los Angeles). The measure would make it easier for Californians to enroll in the program by allowing people to sign up online and eliminating requirements that recipients file semiannual financial reports to prove they are still eligible.
Administration officials have said the governor opposes those changes out of concern that the easier enrollment process could lead to fraud.
Democratic and Republican lawmakers alike want to reverse some of the cuts made in recent years in how much the state reimburses doctors and hospitals who treat the poor — as many as 4 million of whom could remain uninsured. Legislation to reimburse the providers about $1 billion more annually has passed a Senate committee with unanimous, bipartisan support.
A proposal by Senate leader Darrell Steinberg (D-Sacramento) to restore dental benefits for poor adults — cut as a cost-saving measure in 2009 — was approved by a Senate committee with Republican support.
Brown, saying he is wary of overcommitting taxpayers, wants the reductions to stay in place to keep state spending in check and has vowed to hold the line against lawmakers’ efforts to restore these and other cuts made to close budget deficits in recent years.
“The costs down the line are substantial, and predicting them with absolute precision is not possible,” Brown told reporters this week. “So we want to proceed cautiously, and we don’t want to bite off any more than we have to chew. The state can only take on the burden if it has the money to pay for it.”
Because counties will have fewer indigent patients to care for in public emergency rooms, they could save hundreds of millions of dollars a year, according to preliminary estimates by the nonpartisan Legislative Analyst’s Office. Brown wants that savings to pay for social services such as child care, leaving less for local public health programs but relieving pressure on the state.
County officials are fighting that idea, calling it another effort by Sacramento to unfairly shift responsibility to local governments. The state has already routed many low-level criminal offenders to county jails rather than state prisons, to reduce overcrowding in the state lockups.
“It’s a heavy load on the counties,” said Los Angeles County Assistant Chief Executive Ryan Alsop. “We’re tired of it.”
County officials say it’s far too early to know exactly how much less money they will need to care for indigent patients. One study says that up to 4 million Californians will remain uninsured even after the federal overhaul is fully implemented.
It remains unclear how Brown wants to balance costs between Sacramento and the counties, and lawmakers are growing increasingly frustrated with his lack of detail. At a three-hour hearing this week, Mitchell grilled Brown’s director of Health Care Services, Toby Douglas, whose office oversees Medi-Cal, asking if lawmakers could expect more specifics from the administration in the revised budget.
Douglas would say only that, for now, the administration was standing by the January budget proposal.
In previous negotiations, Brown has tended to work with legislative leaders on major bills rather than with individual lawmakers, ultimately folding his decisions into a mega-deal on the state budget.
The strategy can be risky. Brown will need the support of rank-and-file lawmakers for other policy initiatives. And healthcare activists note that the deadlines for implementing the vast changes needed in the state’s healthcare system are fast approaching.
“It’s long past when these decisions should have been made,” said Jerry Jeffe of the California Chronic Care Coalition, which advocates for people with long-standing health problems.
As the June 15 budget deadline draws closer, lawmakers say they are frustrated by Brown’s lack of attention.
“The Legislature is moving forward,” said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee.