Politics of Health: Voters Will Get to Decide on Cures HEALTH CARE By Brad Smith Among the 16 ballot initiatives California voters will have to sort through on Election Day in November, almost one-third deal with health care or health-related issues. That may not be exactly what the Progressives envisioned as the purpose of the initiative, referendum, and recall when they got them into the state Constitution in 1911. Back then, Hiram Johnson, a progressive Republican, ran for governor on the pledge that he would smash the political machine, dominated by railroad interests, which ran the state. Johnson convinced voters to allow recalls of public officials, referendums, and initiatives put forth by the people. The result was that it did not take long for the ballot measure process to become a business, according to historians. As early as 1914, records indicate that initiative campaigns were hiring paid signature gatherers, so there’s nothing new about complaints that money drives the process, not citizens. The topics addressed by ballot measures have ranged from state pensions for senior citizens, which made it on the ballot twice during the Great Depression; to the death penalty and school busing; to property taxes with Proposition 13 in 1978; and to limits on affirmative action and public services for illegal immigrants in the 1990s. Legislating important public policy through ballot measures is truly not anything new in California: neither is the use of the initiative process by groups that are far from the concerned citizens envisioned by Johnson and his supporters. And that is made crystal clear by the supporters of the five health-related ballot measures voters will consider in November. – Proposition 61 would create a $750 million bond issue, to be repaid from the state’s general fund budget, for hospitals in the state that care for children. Twenty percent of the bonds would provide grants to University of California hospitals that provide such services, and 80 percent would go to other children’s hospitals. The measure’s total cost would be $1.55 billion over the 30-year life of the bond, to pay off both the principal and the estimated $800 million in interest on the bonds, at a cost of $50 million a year. Sponsors include Susan Maddox, president and CEO of the California Children’s Hospital Association; it is opposed by the California Republican Party. – Proposition 63 would impose a one percent tax on incomes over $1 million a year to provide funding for mental health programs. The tax would raise approximately $250 million in 2004-05, $680 million in 2005-06, $700 million in 2006-07, and increasing amounts annually. Existing mental health programs could not be funded by the new tax. The proponents include Sherman Russell Selix, a lobbyist for the California Council of Community Mental Health Agencies and the Mental Health Association in California; it is also opposed by the California GOP. – Proposition 67 would raise $550 million for emergency medical services by imposing a 3 percent addition to the surcharge rate on telephone use within California, with a 50 cent monthly cap on residential users. The sponsors include Dr. John Whitelaw, immediate past-president of the California Medical Association and Kacey Hansen, with the Emergency Nurses Association. – Proposition 71 would sell $3 billion in state bonds, at a cost of $6 billion including interest over 30 years, to provide $350 million a year in grants for research and facilities to research stem cell research. The initiative is backed by a coalition of medical research firms, technology executives, and business groups, including the Los Angeles Chamber of Commerce and the Valley Industry and Commerce Association. It is opposed by California Republicans. – Proposition 72 is actually a referendum, not an initiative; it would overturn state law, scheduled to take effect Jan. 1, 2006, that would require employers with 200 or more employees to provide health insurance to workers and their dependents by 2006 or pay into a state fund to provide such coverage. By 2007, employers with 50 to 199 employees will have to provide health insurance to workers only, while companies with fewer than 20 workers will not have to comply with the law; and the law also will exempt employers with 20 to 49 workers unless the state provides them with tax credits to offset the cost of health coverage. The referendum to overturn the law is co-sponsored by Allan Zaremberg, president of the California Chamber of Commerce; the initial law, signed into law by former Gov. Gray Davis but put on hold by Gov. Arnold Schwarzenegger, is supported by Consumers Union. Predictable politics Overall, most of the face-offs over the measures described above break into a predictable pattern of Democrats, aligned with labor, against Republicans, aligned with business. But not Prop. 71. The stem cell research initiative does an interesting bit of political judo, driving a wedge between the California Republican Party and the business community. Business leaders in California, exemplified by the Los Angeles Chamber, the Silicon Valley Chamber of Commerce, and VICA, have all signed on to support the initiative. The reason is simple, according to activists like VICA board member Richard Katz, a former Democratic state legislator. “We see it from the standpoint of growing the next Silicon Valley, as a business issue,” Katz said. “It is a business decision. But Katz, a veteran of decades in California politics, understands why VICA finds itself apart from many traditional GOP allies on the issue. “Why isn’t Gov. Schwarzenegger front and center on this?” Katz asked rhetorically. “Because the Republican centrists have an internal problem with the religious right.” And, as evidenced by the decision by Sen. John Kerry to play up the Bush Administration’s opposition to federally-funded stem cell research, apparently the Democrats think they have found a way to turn the business community against its most constant political ally. Hiram Johnson, the old anti-railroad reformer with a capital “R”, would be proud. Staff Reporter Brad Smith can be reached at (818) 316-3124.