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This Isn't the End (Trust Me, I've Been There Before)

 Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.

As an advocate for health reform in California, I’ve seen health reform proposals die. I’ve seen it die by vote, and I've seen it die by veto. In 2004, an expansion of employer-based coverage narrowly lost in a referendum, getting an excruciating 49.2 percent of the vote. In 2005 and 2006, Governor Schwarzenegger vetoed bills for universal children’s coverage, and a framework for a single-payer system. All of these were final blows.

This doesn’t seem to be one of those times. Not yet, at least.

I admittedly have déjà vu from our most recent effort. After years of opposing health reform--a position to which he has returned--Governor Schwarzenegger made 2007 his year of health reform, spending much of that year trying to involve Republican legislators despite implacable ideological opposition. Only by late summer did he give up, and start to negotiate directly with the Democratic majority. A proposal--with structural similarities to the federal bills--was finally negotiated through the fall and passed out of one legislative house in a special session in late December. But the proposal struggled in the second chamber, with opposition from both the left and right, as some argued it was time to move on and focus on budget and economic issues. The proposal died in a Senate Health Committee vote two years ago, in late January.

The similarities are a bit eerie, but the differences are why I have hope.

Some differences are that rank-and-file members of both chambers seem to have invested more heavily in the reform effort; that centrists, in particular, can take heart in rigorous cost estimates predicting that reform will reduce the deficit; and that most Democratic legislators understand the political consequences, for their president and their party, of failure to pass a bill.

The clearest reason the California State Senate voted down the proposal was that it was a take-it-or-leave-it proposition. The proposal sought to raise the needed revenue for health reform through a companion ballot initiative--it was the only way to circumvent the Republican opposition to taxes, empowered by California’s ridiculous supermajority requirements to pass budget-related items. In order to have the time to collect the signatures to qualify for the November 2008 ballot, the initiative had to be filed in December 2000. Neither it, nor the companion legislation, could not be changed. That meant no opportunity for amendment for the proposal negotiated between Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez.

Legislators don’t take well to being told that they can’t have any input into a proposal, so I am not surprised that some House members are reluctant to simply adopt the Senate bill. Nor am I surprised that stakeholder groups continue to advocate for changes. That's their job and, in many cases, those changes have merit. (Improvements to affordability protections are one example.) But both should be able to live with a deal to pass the Senate bill and then amend it through the budget reconciliation process, in which a determined minority of Republicans couldn't block a congressional majority from passing bills.

This calls for one last negotiation--no more work than what was already anticipated, and much less than any proposal to dramatically change or scale back reform, or break it into pieces.

This approach could also take some new factors into account. Insofar as the Massachusetts results reflected populist anger, the reconciliation bill may take out the "Cornhusker swindle"--a special package for Nebraska inserted to win over that state's Democratic senator, Ben Nelson. And since the Massachusetts vote also reflected economic anxiety, a reconciliation bill could include more immediate help to states, small businesses, and families struggling to afford health care. As President Obama did during the State of the Union, the entire project of health reform can be recast, as it once was before the teabaggers made it about death panels, as a central pillar of our economic recovery and providing financial security and stability to families through tough times.

In California, reform failed in part because legislators worried there'd be no opportunity to change it. Members of Congress shouldn't have such concerns. They'd have myriad opportunities to improve the bill, starting with reconciliation. But they can't change a bill that never gets passed in the first place.