If, as several experts anticipate, the Supreme Court strikes down some or all of the Patient Protection and Affordable Care Act (PPACA), California will find itself in the untenable position of having promised services it cannot possibly provide without federal funding.
California policymakers, in a rush to lead the nation in implementation of the federal law, have given little attention as to how California will address issues like funding should the PPACA fail to pass the Constitutional sniff test.
The California Health Benefit Exchange is a case in point. Created in 2010, the Exchange will operate under the assumption that massive federal subsidies will be available to accommodate the needs of low- and middle-income earners needing assistance to afford the health coverage offered through the Exchange.
Based on their public comments, it is my belief the Democratic leadership has every intention of fully implementing any legislation concerning the PPACA, regardless of the U.S. Supreme Court's decision.
As vice chairman of the Senate Health Committee, I have heard hours of testimony on legislation seeking to implement some facet of the PPACA. These measures are irresponsibly moved forward, often in the absence of definitive federal guidance, and without any plan to unwind the implementation that has taken place thus far, should the court reject the PPACA.
For example, we recently heard a bill dealing with Medi-Cal eligibility for former foster youth. The measure was amended to include language stating that it "is the intent of the Legislature to ensure full implementation of the Affordable Care Act so that millions of uninsured Californians can receive health insurance coverage and those that have already obtained coverage under its provisions can keep that coverage.
"It is further the intent of the Legislature to enact into state law any provision of the Affordable Care Act that may be struck down by the United States Supreme Court and that is necessary to ensure all Californians receive the full promise of the act."
Some California legislators have long attempted to move the state in the direction of single-payer health care and expanded mandates for coverage of services — an effort that has been largely resisted until now because of the high price tag. Leveraging the PPACA as cover to expand state-run health care — as does another Democratic-authored bill that would allow the insurance commissioner to approve the creation of government-subsidized health plans to compete against private plans and insurers — the Legislature is moving forward on programs we frankly can't afford on our own.
Once the PPACA is struck down or cut back, it appears the Legislature will continue on this path, with or without funding, and, more importantly, with no plan for this state — in perpetual budget crisis — to fund these programs.
While I am convinced that my colleagues' hearts are in the right place, moving ahead with programs we can't afford is the wrong course of action — especially with something as important as health care. I believe the Legislature should slow down and proceed more cautiously on PPACA implementation.
Accordingly, I have introduced legislation that would give the Exchange 90 days to submit a plan to the Legislature documenting how it is going to continue operating if the PPACA is struck down by the Supreme Court, or is otherwise changed. In essence, the Exchange will have 90 days to share with the Legislature its "Plan B" — including alternate sources of financing — or implementation of the Exchange grinds to a halt. Additionally, my bill will prohibit state funds from being used to replace federal dollars dedicated to Exchange operations or related functions.
The majority party's rush to implement the PPACA has put California on a potential collision course where no one wins, not the medical community, the people in need of health care nor the taxpayers. Let's get back on the rails.
TOM HARMAN is a state senator covering the 35th District, which includes Huntington Beach and Fountain Valley.