With more uninsured Americans than any state in the nation, California begins a debate about health-care reform. Republican Gov. Arnold Schwarzenegger has announced a dramatic and detailed plan with potential appeal to both Republicans and Democrats.
Its a big plan with big goals: to bring the state's 6.5 million uninsured citizens into the health-care system.
"There's a lot of people on the table," Schwarzenegger says. " A lot of stakeholders and everyone — some people will not be pleased with some of the things — other people will be very pleased with other things. But it's perfectly OK, because there's no package that is perfect."
The plan would cost billions, but Schwarzenegger says it can be done. Everyone will pay something and — in return — everyone will benefit.
"We mean individuals, employers, government, health plans and health professionals all have a responsibility to be part of solution," says state Health and Human Services Secretary Kim Belshe. If California's gonna fix its broken health-care system, its gonna require changes from all of us."
Under the plan, businesses with ten or more employees would be required by law to provide health benefits. Those with less than ten employees would be exempt. But all state citizens would be required to have insurance. Those without it would have to buy it. They'd get a tax break. And if they're low income — but not low enough to qualify for Medical, California's version of Medicaid — there would be subsidies.
For instance, a family of four, making $20,000 a year, would have to contribute about $800 over the course of a year for health coverage. And that's a significant discount, considering that today's average family of four policy runs about $10,000.
Overall, Schwarzenegger's plan would cost about $12 billion. State officials say that cost would be covered by the new contributions from employers and individuals, as well as a tax on doctors and hospitals.
The debate has already begun — starting practically the minute the plan was unveiled to members of the press and a variety of special interests.
Joel Fox of the Small Business Action Committee says he's concerned about the proposal's "unintended consequences."
"For instance, will some businesses opt out of covering employees?" Fox asks. "Will they cherry-pick employees to find employees who are more easily covered by insurance rather than old guys like me who are starting to fall apart?"
But Belshe says there would be new rules preventing insurers from refusing to sell coverage to anyone, or dumping coverage or driving prices up when people get sick.
Len Nichols is an economist with the New America Foundation, which has worked with the governor over the past year or so to help craft the plan. He says it's a well-thought-out plan with bipartisan appeal: for Democrats, it meets a goal of accomplishing univeral coverage; for Republicans, it's the impact on Schwarzenegger's record.
"He has credibility to speak from the right about the nature of the situation on the ground in California," Nichols says. "The nature of the health-care crisis they face and the reluctance he has always shown to spend new money."
But in the case of health reform, Nichols says, the governor determined that the cost was worth it. As a result, he adds, Schwarzenegger is locking arms not only with Republicans but with Democratic centrists and even liberals.