Sacramento Democrats have centered attention around a shot at universal health care for all Golden State residents. 

“In a surprise move made in response to President Donald Trump’s push to repeal and replace the Affordable Care Act, two California lawmakers Friday introduced legislation to replace private medical insurance with a government health care system covering all 38 million Californians — including its undocumented residents,” the San Jose Mercury News reported. 

Joined by state Sen. Toni Atkins, D-San Diego, state Sen. Ricardo Lara, D-Long Beach, introduced the Californians for a Healthy California Act, offering “a comprehensive universal single-payer health care coverage program,” as KPCC confirmed. “Under this approach, private health insurance would be replaced with a single state-run program. Lara said his plan would guarantee coverage to all Californians and would bring down the cost of health care.” But advocates and critics hungry for specifics, the lawmaker conceded, will have to wait. “At the moment, Lara’s bill only says it is the ‘intent of the Legislature’ to establish a single-payer system. It does not say exactly how the program would work or how much it would cost.”

“It’s far from the first time this kind of system has been proposed in California. In 1994, voters rejected a ballot measure that would have established a single-payer system. The Legislature passed single-payer bills in 2006 and again in 2008, only to have Gov. Arnold Schwarzenegger veto the measures.” 

Past stumbles

Schwarzenegger’s veto was fueled by grim projections. “When the Legislature passed a single-payer bill in 2008 […] the legislative analysts found that those revenues would fall $40 billion short in the first year,” HotAir recalled. 

Although the bill has created a sensation among California Democrats looking to make a national point with a state-level effort, precedent for success is weak. “In 2011, Vermont became the first U.S. state to agree to establish a single-payer program, but the effort fizzled three years later over concerns about the cost,” KPCC noted. And in Colorado, “voters overwhelmingly rejected a similar proposal last fall amid widespread concerns about the cost,” according to the Mercury News. “Within the first decade, Colorado — a much smaller state than California — would have been $7 billion in the hole,” HotAir observed.

Cost and complexity

Any program along Lara and Atkins’ lines would need to be built from the ground up, according to rules no legislative body has had to contend with in doing so. “A single-payer system would have to overcome unique hurdles in a state where millions of dollars in federal funds are spent on health programs like Medicaid and treatment for veterans,” ABC News reported. “Other countries, like Canada, may have single-payer systems that differ slightly by state or province, he said, but the U.S. is more complicated. Nothing like this plan — a state-run single-payer system that must also comply with federal government rules — currently exists.” 

But public support among California progressives would likely remain high enough to encourage Sacramento Democrats to give a substantive bill a try. “The Legislative Analyst’s Office says the overall cost could be upwards of well over $100 billion,” Atkins recently admitted to KPBS. “But, here’s the difference, since we had those discussions a decade ago, we have implemented the Affordable Care Act in which we’ve looked at the cost and how to take advantage of the numbers. I mean California is the largest state in the country. We have large numbers to put into the risk pool. We put into place the individual mandate and we talked about businesses participating. So this is the next step to put together a financial package of how we can pay for it.”

Time to work toward 100 percent renewables?

Good morning! TGIF. It’s inauguration Day. So, in honor of the festivities, whether you’re watching in adoration of the incoming president, in morbid curiosity, or just plain ol’ hate watching, we’ll keep it short this morning.  

• Environment: “It’s time to talk 100% renewable energy, California Senate leader says,” writes the Los Angeles Times. 

• NFL: “The Oakland Raiders have made good on a threat that loomed over hometown fans for months, filing paperwork Thursday to move the National Football League team to Las Vegas.” SF Gate has more. 

• Trump: “Scientists in California have named a newly discovered moth species after President-elect Donald Trump, saying the white and yellow scales on the insect’s head are reminiscent of Trump’s blond hairdo.” Capital Public Radio/AP have more. 

• Pensions: “San Diego county and city pension funds have nearly $7 billion less in the bank than they need to cover benefits already earned by current and former employees, a deficit that’s risen 90 percent in just two years, new reports show.” Voice of San Diego has more.

• Obamacare politics: “Democratic legislators took their pro-Obamacare message on the road Thursday, convening a hearing in Bakersfield to examine the repercussions of repealing the Affordable Care Act. The state Senate health committee pointedly held its hearing in the Central Valley — far afield form the state Capitol and the home districts of most members in attendance, but the home turf of key Republican members of California’s congressional delegation including House GOP leader Kevin McCarthy.” The Los Angeles Times has more. 

Legislature:

• Gone till Monday. 

Gov. Brown:

• No public events announced. 

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mflemingterp

New follower: @JonathanArambel

Short-term pain with ACA repeal

Good morning! TGIT. Republicans in Washington appear poised to repeal the Affordable Care Act, better known as Obamacare, some time after Donald Trump is sworn in as president.

With premiums on the rise and consistently poor polling, repeal is music to the ears of many, as evidenced by every federal election since the measure was passed in 2010. But California would suffer major economic consequences if Congress repeals the ACA without an adequate replacement, according to a new study by the UC Berkeley Labor Center. 

A partial repeal (as a full repeal still seems out of reach) would cause Californians to lose hundreds of thousands of jobs, billions of dollars in annual federal funding and kick millions out of coverage. Some of the losses would be offset by gains elsewhere, but it’s impossible to give a complete analysis of the offsetting effects without Republicans’ replacement plan.

CalWatchdog has more. 

In other news:

• Budget: “California’s state auditors recently released an unflattering look at the state’s finances, part of their annual report. Issued several years in arrears, the assessment showed nearly $2 billion in deficit spending for the 2011-2012 fiscal year, piling more borrowed money onto what Gov. Jerry Brown has called a figurative ‘wall of debt.’” CalWatchdog has more. 

• CPUC: “Gov. Jerry Brown has chosen two of his closest advisors on environmental and climate change issues to fill positions on the California Public Utilities Commission, the powerful state agency that regulates energy companies and the telecommunications industry.” The Los Angeles Times has more. 

• Trump Transition: “Abel Maldonado, California’s former lieutenant governor, the Central Coast’s former assemblymember and state senator, and Santa Maria’s former mayor, was in Florida on Wednesday, reportedly interviewing with President-elect Donald Trump to discuss a possible appointment as Secretary of Agriculture.” Santa Barbara Independent has more. 

• Lobbying: The Sacramento Bee looks at how a top Democratic donor pushed a major environmental bill through the Legislature. 

Legislature:

• Gone till January. 

Gov. Brown:

• No public events announced. 

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mflemingterp

New follower: @LGullyborn

Republicans in Washington appear poised to repeal the ACA, better known as Obamacare, some time after Donald Trump is sworn in as president. With premiums on the rise and consistently poor polling, repeal is music to the ears of many, as evidenced by every federal election since the measure was passed in 2010.

However, a partial repeal would cause Californians to lose hundreds of thousands of jobs, billions of dollars in annual federal funding and kick millions of people out of coverage. Some of the losses would be offset by gains elsewhere, but it’s impossible to give a complete analysis of the offsetting effects without Republicans’ replacement plan.

What we know

Even with Republican majorities in Congress and a Republican president, a full repeal of the ACA is unlikely, due to a 60-vote threshold in the Senate that would require at least a handful of Democratic votes.

UC Berkeley Labor Center analysts used a 2015 partial-repeal bill that was ultimately vetoed by President Barack Obama to estimate the effects. Under that bill, California would lose $20.5 billion annually in federal funding for low-income subsidies and expanded Medi-Cal coverage.

As a result of that lost funding, 3.7 million Californians would lose Medi-Cal coverage, while another 1.2 million would lose subsidies, which may or may not make coverage unaffordable. 

Offsets

The billions in lost federal funds would be offset by smaller gains elsewhere, like $6.3 billion in tax cuts to California insurers and high-income earners. A repeal could also remove the requirement to have coverage, saving $1.3 billion in penalties for the uninsured. 

The study estimates approximately 250,000 jobs would be lost from repeal. However, approximately 41,000 jobs would be created through tax cuts, as well as through eliminating fees on insurers, penalties to companies for not providing coverage and penalties for the uninsured.

Popularity

Polling and electoral results have repeatedly shown the law to be unpopular with the public nationally, and Californians are facing an expected average increase in premiums by 13.2 percent next year. 

Nationally, the public is divided on the law. In November, 45 percent of adults had an unfavorable impression of the law, compared to the 43 percent who had a favorable impression, according to a Kaiser Family Foundation tracking poll.

Republicans have incrementally seized power in Washington on a repeal platform ever since Democrats passed the ACA in 2010 with their own congressional majorities and president, Barack Obama. In 2010, Democrats lost the House. In 2014, they lost the Senate. And in 2016, they failed to regain the Senate and lost the White House.

How Obamacare repeals would affect some Californians

Good morning. Happy Monday. It seems like both the country and state are in a holding pattern until January when Trump will be sworn in, a new Congress starts and the California legislative session begins. 

Democrats in the Legislature have made it clear in recent weeks that everyone should expect fights with the feds over immigration, while Republicans in D.C. are prioritizing an Obamacare repeal. But details are sketchy. 

One thing is for sure: Even though Republicans have taken control of D.C. on an anti-Obamacare platform, there could still be many upset people, depending on how the replacement system is structured. 

In fact, Bakersfield.com/Kaiser Health News talked to some of those upset people in the Bakersfield district of House Majority Leader Kevin McCarthy. But no matter what happens, there will be people both upset and pleased. 

In other news:

• Fate of the CA GOP: “Many say the party needs to soften its posture on undocumented immigrants and social issues in order to attract more Latino, Asian and young voters. Others, particularly in the GOP’s traditional voter base, counter that Trump’s victory nationwide is proof that a stronger stance is called for. At stake is the very relevance of the Republican Party in California.” The Orange County Register has more. 

• Mismanagement of a gov’t program?: “The Metropolitan Water District’s massive $340-million turf rebate program — which helped thousands of Southern Californians rip out their lawns in favor of drought-tolerant landscaping — was plagued by poor planning and oversight by the agency, a new audit found.” The Los Angeles Times has more. 

• Racial profiling: “Police officers in California will soon track the race of those they pull over for traffic stops or encounter in the street, according to proposed guidelines released Friday by Atty. Gen. Kamala Harris,” reports the Los Angeles Times. 

• Drought: “October was wet, November dry. And December? The soft but steady rains this weekend were enough to push the Sacramento region to 155 percent of normal precipitation for the season. … And there’s more to come. … So what does that mean for California’s drought, now entering a sixth year? While Northern California has seen a wet start to winter, the situation is more complicated across the state. Central and Southern California continue to experience unusually dry conditions. And even in the north state, it’s not clear how the rest of the rainy season will shape up.” The Sacramento Bee has more. 

Legislature:

• Gone till January. 

Gov. Brown:

• No public events announced. 

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mflemingterp

New followers: @SpokeAna

Parole measure’s success depends on CA Department of Corrections and Rehabilitation

Good morning! TGIF. As votes are still being counted and we wait for some of the closest contests to be decided, we can start looking forward as to how some new policies will work.

Proposition 57, which amends the California Constitution to make it easier for some felons to win release from state prison, coasted to victory Tuesday, winning more than 60 percent of the vote in initial statewide tallies and giving Gov. Jerry Brown a triumph on an issue — criminal justice reform — that he sees as crucial to his legacy.

The Brown-orchestrated, well-funded Yes on 57 campaign crushed lightly funded opponents, led by the California District Attorneys’ Association. A ballot measure description that used technical, arcane definitions to say the proposition only applied to “nonviolent” felons made victory close to a sure thing. District attorneys’ argument that the definition included many crimes involving violence, including sexual violence — while factual — got little traction.

But for Proposition 57 to be the policy triumph that Brown envisions, it will require improved performance from a state agency that’s faced frequent criticism from oversight agencies, judges and activists for decades: the California Department of Corrections and Rehabilitation.

CalWatchdog has more. 

In other news:

• “Republican Rep. Darrell Issa is claiming victory in his hotly contested re-election bid, but Democratic opponent Doug Applegate says the numbers are too close to call while there are still 1 million ballots left to count in Orange and San Diego counties. The congressional district straddles the two counties’ border,” writes The Orange County Register.

• Prop. 66, which would speed Death Penalty appeals, is leading in the results but hasn’t been called yet. Regardless, opponents are already challenging it. The Los Angeles Times has more.

• “If Antonio Villaraigosa can cut a path to the California governor’s office, for which he announced his candidacy on Thursday, his widest opening may have come in Tuesday’s election of a polar opposite, Donald Trump. California Latinos voted at a higher rate on Tuesday than in previous elections, according to exit polls, turning out in record numbers to oppose the president elect. If they turn out again in 2018, whether because of the gubernatorial race or broader forces of midterm discontent, more than a decade of voting history suggests Villaraigosa will benefit more than most.” Politico has more. 

• The San Jose Mercury News/Kaiser Health News looks at what a Trump presidency means for Obamacare coverage in California. 

Legislature:

• Gone till December.

Gov. Brown:

• No public events announced. 

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mflemingterp

New follower: @HavikenHayes

On several fronts, California Democrats have used the tail end of this political season to push for advances on their health care agenda — with mixed results. 

In Sacramento, they succeeded in passing legislation targeting health care cost sticker-shock after several recent misfires. “The unexpected charges come when patients are treated by an out-of-network provider at an in-network facility,” NPR explained. “After several failed attempts in recent years, the California legislature last week passed Assembly Bill 72, which aims to protect patients’ pocketbooks when they’re hit by these surprise bills. Gov. Jerry Brown has until the end of September to sign or veto the legislation. He is expected to sign it into law.”

“A 2015 Consumers Union survey suggests the surprise bill phenomenon is fairly common,” the station added. “It found nearly 1 in 4 Californians who’d had hospital visits or surgery in the prior two years reported receiving an unexpected bill from an out-of-network provider.”

Waiver wanted

In Washington, D.C., meanwhile, a who’s who of members of Congress hailing from California tried to flex their muscle around California’s unlikely request that the federal government allow unlawful and undocumented immigrants in state to access health benefits under Obamacare. “In a letter announced Wednesday, 37 members of California’s congressional delegation asked Treasury Secretary Jack Lew and Health and Human Services Secretary Sylvia Burwell to accept California’s request for a waiver that would allow the state to offer health care to an estimated 50,000 undocumented immigrants,” TPM reported. 

“The letter is just the latest in the fight to expand health care coverage to California’s undocumented population. In June, California Gov. Jerry Brown signed a bill passed by the state’s Legislature that allowed California’s undocumented population to buy their own health insurance on the state’s exchange, Covered California. However, a special federal waiver — a 1332 waiver — is needed before the state is allowed to enact its law.”

It hasn’t been clear whether President Obama could be moved to take action before the end of his term in office. He has already wound up under immense personal pressure to convince insurers to remain committed to the Affordable Care Act’s health care exchanges, despite a growing sense in industry that doing so will be harmful.

Unaffordable care

“With no lifeline coming from the divided Congress, Obama and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage,” Politico observed. “The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers and narrowing insurance options.”

“But six years after passage of Obama’s signature domestic achievement, the litany of woes afflicting the Obamacare marketplaces is formidable. Enrollment has plateaued at half of what was projected. Three major insurers have largely quit, citing big losses. Double-digit rate hikes are the norm for plans across the country. And roughly one in five Americans may find just one insurer selling plans in their area when they shop for 2017 coverage.”

At the same time, although California’s exchange program has been one of the biggest relative success stories for the ACA, the state’s health cost burden has continued to rise over time. A new study released by the University of California Los Angeles Center for Health Policy Research revealed that “spending is projected to total more than $367.5 billion in 2016, with about 71 percent covered by public funds when additional resources such as the Affordable Care Act subsidies and county spending are included,” according to U-T San Diego.

Indeed, California Democrats pushing the White House used the problem as ammunition for their own waiver goal, arguing before the press “that denying undocumented immigrants health care was only driving up the long-term costs of health care,” as TPM recalled. “Without insurance coverage, many immigrants have been forced to depend on emergency services to be treated.”

Good news for Brown’s twin tunnels project

Good morning. Happy Hump Day. 

The California Supreme Court cleared a big obstacle to Gov. Jerry Brown’s plan to tunnel more Delta water out of Northern California, allowing the Southland’s Metropolitan Water District to proceed with the purchase of estuary islands that would be key to speeding up construction.

CalWatchdog has more.

In other news:

• “Orange County congresswoman Loretta Sanchez let loose on President Obama for endorsing her rival in California’s U.S. Senate race, accusing him of being part of the ‘entrenched political establishment’ that has failed California voters,” writes the Los Angeles Times. 
• Premiums for health insurance plans purchased through state-run “Obamacare” exchanges are projected to rise more than 13 percent statewide next year, with some premiums doubling in certain areas of the state. The San Jose Mercury News has more.
• “(Gov. Jerry Brown) has proposed legislation to streamline approval for housing with units for low-income residents. The state Building and Construction Trades Council, which represents ironworkers, roofers, electrical workers and other construction unions, wants Brown to force home-builders to pay construction workers at rates often equivalent to union wages to qualify under the plan, something the governor is resisting,” reports the Los Angeles Times.
• The California Republican Party confirmed that the staffers who fell ill this week at the Republican National Convention in Ohio had norovirus — also known as the winter vomiting bug — but reported there have been no new outbreaks in the past 24 hours.

Legislature:

• Gone ’til August.

Gov. Brown:

• No public events announced.

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mfleming

New follower: @RSI

State Democrats forged ahead with legislation designed to fill out Covered California’s enrollment ranks with unlawful and undocumented immigrants. 

Following the state Senate, the Assembly has “passed a measure that would remove a critical barrier to Covered California and allow all Californians to access the state health insurance marketplace, regardless of immigration status,” as State of Reform noted. The legislation, introduced as Senate Bill 10 by state Sen. Ricardo Lara, D-Bell Gardens, “would authorize the state to apply for a federal waiver that would allow undocumented immigrants to buy unsubsidized health coverage through Covered California.”

“Currently, undocumented immigrants are barred from using the state marketplace under the Affordable Care Act even when using their own money and instead must go directly to a broker or health plan to purchase health insurance. During its April board meeting, a Covered California staff report gave the green light to pursue this waiver from the federal government, and is now awaiting direction from the Legislature and governor.”

Republican rollover

Despite massive Republican resistance to the implementation of Obamacare, with a “repeal and replace” approach adopted by elected officials at the state and federal level, California’s GOP quietly folded in the face of the expansion plan. SB10 sailed through both houses of the Legislature with bipartisan support, as the San Jose Mercury News recalled.

Prior to the vote, key Republicans tried to keep a low profile. Leaders “in both legislative chambers declined to comment on whether the bill has enough support to pass,” according to CALmatters. “But a Republican strategist said the California GOP might be more likely to support the measure than its national counterpart, to avoid ceding the state’s Latino vote to the Democrats.”

The ins and outs of the complex Affordable Care Act have lent some circumstantial evidence to the notion that, despite President Obama’s claims to the contrary, at least some enrollment by the undocumented was envisioned or prepared for. An ACA provision “called the ‘innovation waiver’ allows states like California to change portions of the law as long as the state makes coverage available to more people and as long as the federal government doesn’t get stuck footing the bill,” reported Fox News. And though the impact of that population on Covered California has not been fully estimated, it would be significant: Lara suggested nearly 400,000 unlawful immigrants “would be eligible to receive health insurance,” according to the channel.

Federal hurdles

But the political landscape has become uncertain enough at the federal level to create an extra layer of difficulty — and urgency — for Lara and his allies. “The proposal needs federal approval, an involved bureaucratic process that could be thwarted under a new presidency. So California advocates are acting swiftly to get their application to President Obama before he leaves office, and to do so must win support from at least a few California Republican lawmakers,” Capital Public Radio noted. “Lara put an urgency clause on the bill, which requires a two-thirds majority vote to pass the Legislature. At least one Republican state senator has indicated his support” — Andy Vidak, R-Hanford — “a cherry grower in the Central Valley’s Kings County, which has a 53 percent Latino population.”

Even with adequate Republican support for urgency, however, SB10 could be stymied inside the Beltway. Public comment review requirements left some analysts skeptical that the new rules could be approved before a change in administrations, CALmatters reported. “And even if the proposal works its way through that maze and is reviewed by the Obama administration, he said, it may not be approved because of current federal guidelines. The U.S. Department of Health and Human Services has strict rules for modifying the Affordable Care Act marketplaces. They might have been put in place to avoid creating a precedent that opens the door to future changes the current administration would deem” problematic.

Struggling to prove that it has stabilized its business model, Covered California rebuffed criticism from industry leaders burned by their Obamacare experience, while a new state report called the exchange’s own practices and plans into question.

Most recently, Covered California fired back at charges that it shared responsibility for hundreds of millions in losses incurred last year nationwide. “In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss in 2015 on individual policies across the country,” NPR reported. “The company estimates a similar exchange-related loss of $500 million in 2016.”

“Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.”

Leveling off

The company’s tortured relationship with California’s health exchange culminated in an analyst conference call where CEO Stephen Hemsley warned UnitedHealth “can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.” Observers interpreted the call as a signal that other insurers were getting nervous about the health exchanges’ prospects for self sustaining.

Analysts have tangled over the likelihood that Covered California’s numbers have already begun to plateau — that is, add participants at around the same rate as the previous year. “Despite Covered California’s $29 million marketing campaign to publicize the exchange, many uninsured Californians continue to say they can’t justify paying for health insurance, even if they have to pay a large fine for remaining unprotected,” according to the San Jose Mercury News, which suggested numbers could come in just 100,000 above the previous enrollment period. “The exchange set a goal of enrolling 295,000 to 450,000 Californians who had never bought insurance through the exchange before.”

Audited

Even the state’s own auditor, Elaine Howle, has joined the fray with a sobering judgment on the stability of Covered California. In a report that calls the exchange “high-risk,” the auditor noted that its business model must now shift away from Washington subsidies, increasing the pressure to make up the difference by taking a cut of sales. “Federal funding will expire this year,” Capital Public Radio noted. “That will leave Covered California to rely solely on revenue from health insurers. The amount they pay is dependent on how many people enroll in insurance plans through Covered California.” The exchange has applied a charge of $13.95 each month on each plan it sells. “The audit says, with limited data from the program’s short history, it’s hard to know if Covered California’s enrollment projections will be correct,” according to CPR.

The auditor also focused attention on the issue of competition. It “criticized the exchange for not sufficiently justifying its decision to award a number of large contracts without subjecting the contractors to competitive bidding,” as CNBC reported. “The audit found that 9 of the 40 justifications for sole-source contracts the exchange issued ‘were insufficient’ according to the policy adopted by the exchange’s own board.” According to the Sacramento Bee, Howle questioned the exchange’s spending habits:

“Without competition between prospective firms, the health insurance exchange couldn’t be assured its contractors were the most qualified — or cost-effective — auditors said. They cited the example of the agency’s third-largest overall contract, a marketing and outreach pact with Weber Shandwick for nearly $134 million.”