Mandatory Health Insurance Is Urged
SACRAMENTO — The concept of requiring all Californians to carry their own health insurance is gaining momentum in the Capitol, as some lawmakers and healthcare advocates see it as a politically viable way to deal with the state's 5.3 million uninsured.
With the November defeat of Proposition 72 halting efforts to require employers to provide healthcare coverage, the concept looks likely to be part of next year's legislative debate. But it faces huge hurdles over how to make it financially feasible for the poor and enforce it.
Gov. Arnold Schwarzenegger has spoken supportively of the notion in recent months, and that has spurred the California Medical Assn., as well as some lawmakers, to draft their own plans.
"We have too many people that are uninsured in this state," Schwarzenegger said in October at the Panetta Institute in Monterey. "We have to really address this once and for all, and figure out a way of how we do it, like with car insurance, where we make it law that people carry insurance and that they are really insured, because it's unfair to so many people when you have people using the hospitals for emergency, and then creating a huge cost."
But healthcare experts say enacting what they call an "individual mandate" would be challenging. Requiring all Californians to carry their own insurance would have to involve some sort of subsidies for those too poor to pay the premiums -- a difficult task for a state deep in debt.
It could also have seismic reverberations in the insurance market, possibly encouraging some businesses to stop providing health insurance, experts say. Ensuring that everyone takes out insurance and guaranteeing that the very ill are able to obtain coverage could be difficult, they say.
"An individual mandate has to be backed up by extremely generous subsidies," said E. Richard Brown, director of the UCLA Center for Health Policy Research. "You are pushing people into the individual market, which is a very expensive way to cover people."
The medical association, one of the Capitol's most influential players, is devising an individual health insurance mandate that would combine a high deductible with preventive services, such as mammograms, prenatal care and annual exams to catch illnesses before they become overwhelming. Experts view that approach as the only way to create a mandate that is affordable, though it would require subsidies for the poor.
