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Health Care Tops Votersí Busy 2008

By Mark Baldassare, president and CEO, Public Policy Institute of California
This opinion article appeared in the Sacramento Bee on September 30, 2007

After five straight years of statewide elections, California voters were supposed to get a breather in 2007. Instead, they are busy prepping for an election extravaganza in 2008: Voters will go to the polls three times. They can expect to face a long and diverse list of state policy initiatives, the highlight of which will likely be a ballot measure on universal health care.

Since 2000, there have been 86 propositions on the state ballot -- and the 46 approved by voters reflect an unprecedented level of public policymaking by California voters. When asked in Public Policy Institute of California (PPIC) Statewide Surveys, Californians say they like being the "deciders" because they have little respect for the legislative process in Sacramento. And since the Schwarzenegger era began in 2003, Californians have had a governor who relies on their support as a way around the partisan gridlock and interest-group battles that have led to policy stalemates.

In the most recent installment, the governor along with his legislative allies are working in a special session this fall on the heady goal of bringing health insurance coverage to all Californians. But the fate of any legislative agreements will likely remain unsettled until 2008, when the voters will decide what to support or oppose. The recent budget stalemate left little doubt that this deeply divided Legislature would not be able to muster the two-thirds vote needed to pass a law that includes new revenues to pay for health coverage. So, elected officials are passing the buck to voters who can make new laws by approving a proposition with a simple majority.

Ironically, the Legislature and governor are now working overtime on health care reform because a few years ago the voters rejected an employer-mandated health coverage bill. That landmark bill was passed by the Democratic-controlled Legislature and signed into law by Democratic Gov. Gray Davis but had stiff opposition from GOP lawmakers and business groups. Schwarzenegger favored the referendum to overturn the law and Proposition 72 (titled "Health Care Coverage Requirements") fell short of the majority needed to keep the law in place in November 2004. Now, the GOP governor is seeking compromises with Democratic legislators in order to bring together business and labor interests and defuse a massive campaign to defeat the expansion of health coverage.

So, once again, voters are studying the issue as they await a chance to pass or fail the next round of health care legislation. But the drive today may be more intense. In the PPIC Statewide Survey of 2,003 adults earlier this month, Californians, for the first time, named health care as the most important issue facing the state -- ahead of even jobs and the economy despite turbulence in stock prices and the housing market. As the chance for health care reform becomes ever more real, a solid majority of Californians across party lines are steadfastly holding to the view that major changes are needed in the state's health care system. Indeed, a solid majority of likely voters say they are very or fairly closely following news about the governor's and Legislature's efforts to reform the California health care system.

This level of interest may be partly because the public has been widely exposed to the health care debate in California from reform advocates outside the Capitol. In early summer, the documentary film "Sicko" by filmmaker Michael Moore put a spotlight on the flaws of the U.S. health care system. In our poll, taken during the week after Labor Day, more than half of Californians say they are aware of "Sicko" and many report that the film has made them more likely to support an overhaul of U.S. health care.

Moreover, about half of all adults say they are aware of the paid advertisements on health care reform that were sponsored by health foundations as part of a multimillion-dollar issue campaign. Many who saw or heard the ads say that their messages have made them more likely to support changes in the California health care system. And recently, health care reform has become the dominant domestic issue in the 2008 presidential race. Candidates are finding an American public that is eager to talk about plans for health care coverage instead of the divisive and depressing topic of Iraq.

PPIC's latest survey shows that the major components of both the governor's and the Legislature's plans for expanding health coverage enjoy strong support from the public. While voters are unlikely to delve deeply into the details that health care reform will require, they will be intensely interested in knowing what they are being asked to pay in exchange for more certainty about medical costs and health coverage. The real challenge for lawmakers is whether or not they can nail down a specific, complex health care reform plan and then present a unified front to voters on Election Day. In this era of "hybrid democracy," voters are most willing to support elected officials' plans if they are bipartisan agreements that reflect the public's broad interests -- as shown in the passing of the four infrastructure bonds in 2006.

But voters won't hesitate to rebuff elected officials' ideas if they are viewed as self-serving -- as shown in the rejection of the governor's four reform initiatives in 2005.

Does state health care reform have a chance of passing next year? Voters signal a strong willingness to support bold initiatives as long as their GOP governor and Democratic-controlled Legislature can find common ground. But without that alliance, Californians will join other Americans in waiting for a new president and Congress to take action in 2009.

Related Publications

PPIC Statewide Survey: Californians and Their Government

Just the Facts: Californians' News and Information Sources

Just the Facts: California Voter and Party Profiles