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Health Care Is Getting Recognition as a Mainstream Concern

June 23, 2003|George Skelton

SACRAMENTO--It's no longer dismissed as "health and welfare" -- as a pejorative -- and derided with a scornful sneer.

It's now just "health care" -- a positive, even when talking about medical coverage for the poor. Unlike decades past, this isn't mainly a welfare issue, but a mainstream concern most people can relate to.

Voters are supportive. Demagogues are disappearing.

"There's a recognition, even on the part of Republicans, that money going directly to people in need probably is the last thing we should be cutting," says Assemblyman John Campbell (R-Irvine). "What we want to be looking at [for cutting] is the bureaucracy....

"There's a recognition by society that we want to have a safety net available for those who need it."

Campbell is the Assembly Republican negotiator on the joint conference committee that is drafting a new state budget to staunch $30 billion-plus in red ink. Republicans still suspect, he says, that there's too much fraud in the Medi-Cal system of health care for the poor and disabled.

But signs of attitudinal change have been evident in the Capitol. Several Assembly Republicans refused to vote for the Democratic governor's proposed cuts in Medi-Cal, social services and old-age benefits, although the GOP loudly preaches the principle of spending cuts.

One such Republican was Assemblyman Jay La Suer, 63, of La Mesa, a conservative former San Diego County undersheriff. Explaining his "no" votes, La Suer says: "I represent an area with a lot of hard-working people, getting by day-by-day, and a huge retired population.... A cross section of America and not a bunch of leftist socialists....

"I am not going to take health care away from them. I'm not going to cut education, local government, Medi-Cal. Just not going to do it.... Get all the money out of pork projects -- the 'fish-in-cities' programs, the Italian cultural centers, the Aleutian Goose festivals."

Yes, the state does feed such pork. But the state could dump all of it and the entire bureaucracy and still not balance the budget because 70% of the general fund flows out to schools and local government.

So far, the Legislature has not been willing to whack spending for health care, despite Gov. Gray Davis' attempts.

Medi-Cal currently covers 6.5 million poor people and costs the state $10.9 billion. Federal Medicaid kicks in a matching amount. In January, Davis proposed cutting back $1.4 billion.

Among the governor's draconian recommendations: Eliminate payments for oxygen tanks, wheelchairs, walkers, catheters, artificial limbs, adult diapers.... It's a long list. "All the things people don't choose to need," notes Heather Campbell, lobbyist for the California Medical Assn.

Plus, Davis proposed tightening eligibility requirements and reducing provider fees by 15%.

The Legislature refused, not only Democrats, but some Republicans. Faced with opposition and trying to appease Democrats while fighting off a recall effort, the governor backed away from many cuts in his May budget revision. And the Legislature has been resisting the rest.

But deeper slashes in state spending still will be needed to balance the budget, so Medi-Cal remains vulnerable.

The lawmakers' reluctance to pare back health care reflects the voters' mood.

Pollster Mark Baldassare says he was struck by a finding in his recent survey for the Public Policy Institute of California. Health and human services ranked second -- although a distant second -- behind K-12 schools as the one program voters most wanted to protect from cuts. (K-12 63%, health 21%, higher education 8%, prisons 6%.)

Also, nearly two-thirds of voters opposed cutting health and human services.

A survey by the Field Institute for the California Health Care Foundation last summer found that people would accept some tax increases -- on high income earners, liquor, cigarettes and even auto licenses -- to avoid Medi-Cal cutbacks.

"There was a time when health and human services to voters meant welfare and welfare meant government waste," Baldassare says. "That doesn't seem the case anymore....

"My impression is it has to do with people's own sense of economic vulnerability and concerns generally about the health care system."

People nervously watch their own health costs rise and realize that one reason is they're paying, through higher premiums, to care for the uninsured. There are 7 million uninsured in California -- mostly working poor -- who aren't eligible for Medi-Cal.

Baldassare also cites two other factors: President Bill Clinton's 1996 welfare reform, which cleaned up welfare's image. And the fact California no longer is fighting over benefits for illegal immigrants.

Health care has become a mainstream issue, and that's healthy. But it makes budget-cutting a lot more painful.

The remedy is a bitter pill Republicans reject: a tax increase.

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