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You can only defer gratification – or consequences – for just so long. Now that Election 2012 is done, here are some reflections on what’s happened and things you might expect:
Prop. 30 passed, hiking sales and some income taxes. Schools are happy, but so are healthcare providers. Although schools faced a potential funding disaster if it had failed, the next head on the chopping block would have been Medi-Cal and other public health programs.
Prop. 32 failed. Unions plowed tens of millions to avert a prohibition on using payroll deductions for political contributions. Many unions also supported passage of Prop. 30, encouraging voter turnout and boosting Democratic Gov. Brown’s top initiative. A level of expectation of political payback is certainly in order, especially because ...
Apparent super-majority of Democrats in next Assembly and Senate: That means taxing and spending decisions can be made by Democrats without trying to sway some Republican support. It also means that Brown may be challenged to use the referee’s whistle (aka veto) quite a lot.
Special session of the Legislature: Brown has promised to call a special session in December or January to focus on healthcare reform. Some of the bills he vetoed last session may be revived with a tweak or two – and may, in fact, be passed in the special convocation. California is among a handful of states that are way ahead of the pack in implementing the Affordable Care Act. The state’s health benefit exchange, now called Covered California, is where individuals and small businesses will buy health insurance. The combination of Supreme Court’s ruling earlier in the year and the election results convey a sense of certainty about the federally funded expansion. The knot that remains – and one that President Obama's team certainly hasn’t unraveled – is educating the public about this complex, history-making transformation. And, oh yeah, for the Valley, there's also shortages of MDs and inpatient hospital beds and abundant chronic health problems.
Union redux: Unions, particularly the California Nurses Association which has many allies in the statehouse, are likely to target nonprofit hospitals with legislation on charity care, community benefits and standards for maintaining non-profit status. And a heavier enforcement stick on nurse ratios.
Fiscal cliff: A 2% across-the-board cut to reduce the federal deficit is in the offing, without congressional action. It would hammer Medicare (Medicaid is excluded). And some say it could push the nation back into recession. Tack onto that the pending expiration of the Bush/Obama tax cuts, a 27% reduction in Medicare physician reimbursements – all to commence in January 2013 – and you might ask, who is going to blink first in the partisan conflicts/negotiating.
Affordable Care Act: As someone said, it’s off the operating table but still needs lots of follow-up care until it more fully unfolds in January 2014. Expect a gully-washer of regulations to come soon, rules that had been in abeyance until after the elections. Rules in the works include health insurance exchanges, essential health benefit requirements, minimum employer coverage requirements, Medicaid pay increases for providers and perhaps something for religious employers that have objected to mandates to provide contraceptive coverage to their employees.
Parade to the door: Familiar names either are or may be heading to the door, including Health and Human Services Secretary Kathleen Sebelius (overseer of Affordable Care Act implementation), Treasury Secretary Timothy Geithner and Secretary of State Hillary Clinton.
It’s Lame Duck time: Lawmakers, a chunk of whom are packing their belongings having lost bids for re-elections, will be called back into session after Veterans Day. They may well punt the vexing issues to their colleagues and newcomers when the 113th Congress convenes in January. Temporary extensions have been the vogue. Of course, delays have a way of compounding both the political problems and the fiscal costs.