This year could bring a sea change in California politics. Reshuffled congressional districts, new election rules and some key retirements set the stage for potentially significant changes in Washington, D.C., and Sacramento.
A couple of key health care issues -- a controversial Medicare proposal in Congress and a state ballot initiative to regulate health insurance premiums -- could play a part in how those changes come to pass if they become volatile campaign issues.
"This election year may have the most profound impact on California than any election since Proposition 13," according to Mark Standriff, former communications director for the California Republican Party, now a GOP strategist.
"Redistricting has gotten most of the attention, but Proposition 14 and the changes it brings will be important, too," Standriff said.
Proposition 14, approved by California voters in 2010, establishes the June ballot as a non-partisan top-two primary in which voters can choose candidates from any party. The top two vote-getters meet again on the November ballot.
"Having the general election in June and a run-off in November, coupled with redistricting, term limits forcing some people out and retirements makes this a very important year for California's future," Standriff said.
Medicare, Insurance Premiums in Spotlight
Some Republicans -- and at least one Democrat -- want to make Medicare restructuring a national campaign issue this year. A controversial proposal by House Budget Committee Chair Paul Ryan (R-Wis.) and Sen. Ron Wyden (D-Ore.) would give Medicare beneficiaries a fixed amount of money to purchase coverage from private insurers.
Last year, a similar plan by Ryan was passed by the House as part of a budget resolution but was defeated in the Senate. The new version -- with co-author Wyden from the other end of the political spectrum -- has two important differences from Ryan's first attempt. The new proposal includes a public insurance option similar to traditional Medicare and includes provisions that would keep beneficiaries' out-of-pocket expenses lower than the original plan.
Rep. Steve Israel (D-N.Y.), chair of the Democratic Congressional Campaign Committee, predicted Medicare would be "a defining issue in the 2012 elections."
California Democrats are leaning against the new proposal.
Rep. George Miller (D-Martinez), a veteran of the California delegation and ranking member of the Education and Workforce Committee, said Democrats welcome the debate.
"Seniors and the American people are firmly against Republican attempts to end the Medicare guarantee for seniors in order to cut taxes for millionaires and billionaires," Miller said. "If Republicans want to re-debate this issue, we're certainly willing to stand up for ensuring seniors have access to quality and affordable health coverage that comes with the Medicare guarantee."
An issue making its way to the California ballot could have a similarly polarizing influence on voters. If it gathers enough signatures to get on the November ballot, the initiative to give state regulators the power to approve or reject health insurance rate increases will probably spark a heated, expensive campaign.
Sen. Dianne Feinstein (D), one of California's longest-serving and highest-profile politicians, supports the initiative. In an email to more than two million California voters last week, she endorsed the proposal and encouraged people to download the petition from the Internet, sign it and mail it in.
Feinstein, who has represented California in the Senate since 1992, is running for re-election this year.
Mini-Exodus From Congress, Redistricting Mean Change
No matter who gets elected, there will be change in Washington in 2012. At least 39 members of Congress are leaving this year -- either retiring, resigning or running for other office. Seven of them (four Democrats and three Republicans) are from California. More may decide to leave before campaign season shifts into high gear.
Change is also predicted in Sacramento, where redistricting has given Democrats hope they may get the two-thirds majority needed in the Legislature to end a long-lived stalemate with Republicans on financial issues.
Compared with the economy, health care issues -- including Medicare and regulation of health insurance -- will probably play secondary roles in national and state races this year.
But there's no question the outcome of those races will have significant influence on how California's health care system evolves after voters have their say this year.