LOS ANGELES (FinalCall.com) – Gov. Arnold Schwarzenegger’s words rang like music to the ears of many uninsured residents, January 8, when he presented his comprehensive plan to reform California’s health care system to provide coverage for the state’s uninsured.

At issue is how the coverage plays out and impacts the poor, who have no or limited access to employment and reasonable and necessary medical aid, examinations, treatments, diagnoses, evaluations and services. Other factions to be impacted are gainful employees who are uninsured by choice and the working poor, who have just enough means for daily, basic survival.

If approved by the Legislature, the governor’s plan would play out utilizing three key areas. First, through prevention, health promotion and wellness, residents would earn incentives and rewards for evidence-based, self-promotion of healthy lifestyles and behaviors. Rewards for residents in public programs, such as Medi-Cal, would amount to gym memberships or weight management programs. Commercial plan members would receive premium reductions.


Next, the plan would require that all individuals carry a minimum level of coverage–a $5,000 deductible plan with maximum out-of-pocket limits of $7,500 per person and $10,000 per family. This would cost an individual approximately $100 and $200 for two persons. Access is questionable, according to a California Budget Project Sep. 2006 press release entitled, “Los Angeles’ Workers and Families Left Behind.” Incomes are lower and poverty is more prevalent in Los Angeles alone, where nearly 40 percent of the residents had incomes below twice the federal poverty level in 2004.

Third, among other things, the plan would give pre-tax and tax shelter contribution breaks for residents and employers to purchase insurance.

Other contributors to the cost of coverage include increased Medi-Cal rates (by way of a two percent dividend on doctors and four percent on hospitals), as well as an “in lieu of” dividend of four percent to payroll of employers of 10 or more who do not provide coverage.

Atty. Nana Gyamfi of Human Rights Advocacy, a community-based organization dedicated to education, advocacy and policy making rights of African people around the world, cautioned that granting a four percent payroll dividend to individuals will not guarantee health coverage. “Republicans always put forth the programs that appear to be helpful to you, but they actually give businesses an out that enables them to pass the responsibility of providing basic rights or needs to the individual. This is just another example of that,” she opined.

Akili, a senior political and community organizer for Service Employees International Union (SEIU) Local 1000, told The Final Call that he is not convinced after reading the plan and speaking with people in the Assembly, that it will be broad and deep enough to complete what the governor has set out to do, however, it will expand the basis of coverage and capture those just on the border.

“He wants to cover at least between two and two-and-a-half million people. There are between six and six-and-a-half Californians who have no insurance coverage. Even if he’s 100 percent successful, that will still leave anywhere from three-and-a-half to four million without coverage. The $64,000 question is what will happen to them?” he added.

The community activist pointed to Massachusetts’ approach to health care, which he said calls for health care insurance to be the same as car insurance with state assistance for those who cannot afford it. In a sense, it could work, he added, “but over time, the cost becomes such that the insurer, you and I, can’t afford it. In the short term that is two years, if it goes into effect, that there will be more people covered, but in four to five years, there will be less people covered because they won’t be able to afford it and we will be faced with the same situation again.”

Akili charged that the health care proposal is another indication that people in power really do not want to do what is necessary to create universal healthcare. “We have a health care system tied to your employer. No other industrial democracy does that and unless health care is seen as a right to all citizens, we will continue to have these problems and pay more for it. Healthcare in America is not affordable,” he insisted.

“Massachusetts had a large surplus because they taxed insurance, but we don’t in California. Working poor families will find themselves having to struggle to keep what they have and unless there is a something equivalent to Social Security where everyone pays, everyone benefits, we will keep tinkering around the edges of health care, but not really solving the problem,” he continued.

Akili went on to say that state politicians would like to see additional money allocated to community-based and federally funded health clinics. “It can be a small step toward getting to the universal coverage and if you look at what’s happening nationally, state by state, for the average working person, this will give more people access and spread the cost over a greater number of people, which presumably, will lower the cost,” he said.

Thomas Tran, a representative of L.A. Care, a nonprofit, community-accountable health maintenance organization that serves nearly 800,000 L.A. County residents, labeled the reform plan bold and fairly comprehensive. “I think that it has a lot of parts to it that will definitely invite a lot of debate and we hope that the debate that will ensue is that nobody forgets that the children’s health coverage issue is not only important in 2007, but will be really important in 2027. Do you cover children who are undocumented as well as documented and the governor has said we cover all children? This is something that we agree with as really making an investment in California’s future,” Mr. Tran stated.