From its inception, the Affordable Care Act has faced withering attacks from conservatives who denounce it as a government overreach, even socialist.
Now, California’s version of Obamacare faces a threat from the left, personified by backers of Proposition 45, a far-reaching initiative on the Nov. 4 ballot that would regulate health insurance but also disrupt the nascent program that has provided health care coverage to millions of previously uninsured Californians.
Proposition 45 backers say they embrace the Affordable Care Act, though some fought it as Democrats pushed it through Congress. Wittingly or not, they would undercut the Affordable Care Act with their initiative, which is reason to vote against Proposition 45.
California Insurance Commissioner Dave Jones is the initiative’s main proponent, along with Consumer Watchdog, a Santa Monica advocacy group that is responsible for writing it.
Opponents include top House Democrats, who helped write the Affordable Care Act in 2009, officials in Gov. Jerry Brown’s administration, who are implementing it, and physicians’ groups. Kaiser, Anthem, Blue Shield and other health insurance companies are funding the No-on-45 campaign, $37.5 million.
Proposition 45 would not apply to health insurance provided by large employers such as the state or major corporations. Rather, it would apply to individual and small group policies used by 6 million people, 16 percent of the population, the Legislative Analyst Office says.
For the past year, many of those individuals have been buying insurance through Covered California, the health exchange established by lawmakers and the governor to implement the Affordable Care Act. California’s exchange has received national attention for its early success.
As it is, the Department of Managed Health Care, run by gubernatorial appointees, and the elected insurance commissioner can review health insurance rates, but not reject them. Proposition 45 would change that.
The initiative would grant Jones and all future insurance commissioners broad authority to approve anything affecting health insurance including prices and probably coverage for Californians who buy their insurance in small group or individual plans.
We don’t doubt that the commissioner should have some say over rates, but not sole authority. Commissioners change. Republican Chuck Quackenbush was commissioner until 2000 when he resigned in disgrace amid investigations into his relationships with insurance companies.
California politics being what they are, the next commissioner and the one after that probably will be Democrats. But Democrats differ. One might side with consumers. Another might side with the insurance industry.
The question of the insurance commissioner’s authority over health insurance is complicated and best left to the Legislature, not the blunt instrument of an initiative written by partisans.
Adding to the uncertainty that would be created by Proposition 45, private parties would gain the right to intervene before the commission and ultimately in the court to block insurance company rate requests, and would collect payment for their efforts.
Consumer Watchdog regularly intervenes in auto and homeowner insurance rate cases. The group’s actions have helped keep rates down. Consumer Watchdog has collected $8 million in intervener fees over the years. Consumer Watchdog likely would start challenging health insurance rates. But the right to intervene would not be limited. Anyone with standing could challenge rates, including individuals and organizations dedicated to killing Obamacare.
Opponents of Proposition 45 include some of the greatest champions of the Affordable Care Act, Rep. George Miller, D-Martinez, and Minority Leader Nancy Pelosi’s chief policy adviser, Wendell Primus, one of the act’s architects.
“This is wildly open-ended. That’s my concern,” Miller said of Proposition 45.
California Health and Human Services Secretary Diana Dooley, the Brown administration official most responsible for implementing the act, said Proposition 45 would “throw a monkey wrench” into Covered California.
Dooley chairs the five-member Covered California board, which oversees the health care program. It already exerts broad regulatory authority over health insurance by deciding which insurance plans can participate.
In its first year, Covered California enrolled 1.2 million people in health insurance, plus 2.2 million others who now are covered by Medi-Cal. That’s a success of generational proportions.
If Covered California had been a flop, there might have been an argument for Proposition 45. But the Affordable Care Act is working in California. There is no reason to pile on a new layer bureaucracy envisioned by Proposition 45, and subject the health care law to more litigation and threats to its existence.