Debating Health Care Effects of Prop. 31

by David Gorn, California Healthline Sacramento Bureau

TOPIC ALERT:

It's complicated.

Those are pretty much the first words out of the mouth of Jim Mayer, executive director of California Forward, the organization that drafted a ballot initiative aimed at reshaping and streamlining the way politics works in California.

"Yes, it's complicated, because these are complicated systems we have in California," Mayer said of Proposition 31. "But that doesn't mean we shouldn't try to change the status quo," he said. "Certainly this idea that everything out there [in California politics] is perfect, that just isn't true."

As with any complex proposal, there are strong opinions about how the measure will or won't work, and those opinions include health and human services policy issues. Questions have been raised about how Prop. 31 might affect state health care programs, particularly senior health programs.

"We are very concerned about the impact on health and human services programs in California," said Michael Herald, legislative advocate for the Western Center on Law and Poverty. "And significantly, one of the populations we should be most concerned about is seniors."

Senior health programs such as In-Home Supportive Services and adult day health care are precisely the types of programs Mayer said will benefit from the proposition.

"Will health and human services programs be impacted by Prop. 31?" Mayer asked, and then answered his own question. "We certainly hope so," he said.

"We think current health care programs have been severely harmed by the current system," he said. "We hope this measure has a significant impact on that."

Critics See Too Much Clout for Counties

Proposition 31 would establish two-year state budgets, create new rules for offsetting new expenditures and give the governor new power to make budget cuts in fiscal emergencies. The initiative would also give counties new authority to alter the way they deal with state statutes or regulations on state-funded programs.

Two provisions in Prop. 31 are of the most concern for some health care advocates. The first is the added flexibility for counties that, according to Herald, could give counties the right to circumvent state regulation.

"By allowing counties to eviscerate or ignore existing law," Herald said, "that means you could maintain different levels of services and benefits from one county to the next, with no state oversight."

That's the provision that also has prompted concern from some environmentalists, who worry that building projects could skirt building limitations. "We view Prop. 31 as dangerous to the environment," said Tom Adams, president of the League of Conservation Voters. "There's no reason why environmental regulation should be exempted this way."

The other provision that worries health care advocates, according to Herald, is the requirement to ensure that any new program has to have funding in place.

"This would essentially require existing programs to be cut to fund any new programs," Herald said. In the case of the senior population, which will grow dramatically in California in the next decades, that kind of requirement could limit what programs can be expanded or created.

"This really would pit seniors and other needy groups against each other for use of a smaller and smaller pot of state funds," Herald said.

Objections 'Overstated or Misstated'

This is an unusual initiative, Mayer said, in that it was developed over a long period of time by a large group of stakeholders, and now it's being picked at by some of those same people -- so the arguments against it may be overblown, he said.

"Most of the objections are overstated or misstated," Mayer said. "The opponents know they're dramatically overstating it. They're trying to protect the status quo around this budget; they're fear mongering."

For instance, he said, the contention that current senior health programs couldn't be expanded, or that new senior health programs would be difficult to create, is just not true, Mayer said.

"That does not apply to caseload growth. If enrollment in a program changes, then it can be expanded," Mayer said. "As the population ages, this [initiative] doesn't apply to expansion of existing services."

In fact, he said, making sure new programs are properly funded actually may be the best way to protect existing programs. "In good years, [legislators] cut taxes and health and human services programs don't benefit. And during bad years, that's what takes a disproportionate number of hits."

Mayer said innovation is the important element that has been squelched in state government. He said Proposition 31 would allow counties to innovate through integrated approaches that could apply resources in the smartest way possible for that county.

"Our challenge [in government] is getting people to collaborate and cooperate," Mayer said. "Now when you talk to the public about that, the answer's always the same."

A series of surveys showed it, he said. "We asked people, when you see government work, what does that look like? And when you see government fail, what does that look like?" Mayer said. "People routinely said government failure is when people were fighting each other, and when it works, that's when people are working together."

Giving counties the flexibility to put together a collaborative effort is essential to progress, Mayer said, as long as it's balanced by state oversight.

"In California, we have a lot of pilot projects that work, but we never can get beyond the pilot project phase," Mayer said. "We have to figure out how to give counties more flexibility, so they can try to provide the same or better services at a lower cost."

Summing It Up

Opponents said Proposition 31 started out well-intentioned but, if enacted, would end up opening too many loopholes and having too many unintended consequences for their taste -- including indirect but significant effects on health and human services programs.

"I think the direct health impacts are somewhat limited, because federal law controls most of health care," Herald said. "But any health and human service program the state wants to create to serve emerging needs would be impacted."

Seniors are the most obvious example, he said. "But what happens if a new disease like AIDS surfaces and D.C. is slow to react?" Herald said. "Prop. 31 would make it very hard to develop responses to the scale needed since Prop. 31 will not allow more than $25 million in new costs without an offset. And the local plans are an invitation to mischief in conservative areas of the state, especially for programs like CalWORKs."

Mayer said the current routine of government is not working, and it needs to change.

"This is about trying to get a critical mass of local government agencies to come up with new ways of doing things," Mayer said. "This is a question of whether we're stifling innovation or whether we're striking the right balance. We need to regulate problems and innovate at the same time."


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