IN THE STATES: Californians are Still Dreaming

Apparently, a lot of Californians shared our disappointment when the state's health reform efforts fell apart earlier this year. A new Field Health Policy Survey shows that Californians are none too confident about the future of health care in their state after lawmakers killed Gov. Arnold Schwarzenegger's plan to cover all Californians in January.

The survey, commissioned by the California Wellness Foundation, found that voters are even more worried now (quite possibly because as the economy worsens, people get more nervous about health costs and job-related insurance). For instance, 59 percent are "very concerned" about not being able to pay all of the costs for a major illness or surgery, up from 48 percent in late 2006. Other findings:

• 58 percent report being very concerned about having to pay more out of pocket for their health insurance coverage (up from 40 percent).
• 57 percent are very concerned about either not having or potentially losing their health care coverage (up from 48 percent).
• 59 percent are very concerned about the possibility of their insurance provider canceling or severely limiting their coverage due to a health condition.
• 51 percent are very concerned about not having access to quality doctors and health care services (up from 40 percent).

Field reported that three times as many Californians expect the health care system to be worse in five years as think it will be better. The poll found no consensus, however, on whether the solution lies in Sacramento or Washington. The poll of 1,202 registered voters was conducted March 12-30.

The voters were asked specifically about the state's health reform package—including how to pay for it. After hearing a description of the main provisions of the plan Schwarzenegger negotiated with state legislative leaders, more than seven out of ten (72 percent) approved overall. In addition, large majorities backed these specific components:

• 84 percent favored requiring health insurance companies to offer coverage to anyone without regard to their health condition.
• 78 percent supported providing state tax credits to moderate-income people if they need to buy health insurance in the open market.
• 77 percent endorsed the idea of providing state-subsidized health insurance coverage to low-income adults.
• 73 percent favored an "employer mandate," which would require all employers to help pay for their employees' health coverage on a sliding scale, with larger companies paying more and smaller companies paying less.
• 68 percent supported the idea of an "individual mandate," that would require all Californians to have a minimum level of health coverage either by purchasing it themselves or by obtaining it through an employer or government agency.

The toughest part of expanding coverage is often how to pay for it, but by large margins (70 percent or more) the California voters surveyed approved of all these funding mechanisms: getting the uninsured to pay more themselves (depending on family income); requiring employers to provide a minimum contribution toward their workers' health coverage, and increasing cigarette taxes by $1.75 per pack. The only unpopular item on the fiscal menu: increasing hospital fees by 4 percent. More than three in four voters opposed that.

We can't predict when health reform will return to policymakers' agenda in California; obviously we don't expect the governor to try again tomorrow. But as the voters made clear, the problem isn't going away. But as voters' concerns about the future intensify, it may be easier next time around to reach consensus on solutions—whether in Sacramento or Washington.