Health Care Reform Goes to Voters
By John Gramlich, Staff Writer
As presidential contenders John McCain and Barack Obama push different plans to help cover more uninsured Americans, voters in Arizona, Colorado and Montana will have the chance to make dramatic changes to their own states' health care systems when they go to the polls Nov. 4.
All three measures are unprecedented, but would affect these three states in very different ways.
In Colorado, voters will decide whether to require businesses with more than 20 workers to provide health insurance. In Arizona, the " Freedom of Choice in Health Care" initiative takes the opposite approach and would prohibit state lawmakers from passing legislation that would require Arizonans to join a government-run health care system. And in Montana, the question is whether to include more uninsured kids under the state's Children's Health Insurance Program (SCHIP) and the Montana Medicaid Program - a move that many statehouses have done on their own.
Experts say it's the first time that voters are being asked to tackle the country's fractured health care system at the ballot box. "I'm not aware of any other ballot measures [like these], said Jennifer Tolbert, principal policy analyst at the Kaiser Commission on Medicaid and the Uninsured, a Kaiser Family Foundation project.
Meanwhile, the White House hopefuls are campaigning on their health-care solutions. For the Republicans, McCain's plan focuses on lowering costs, offering tax breaks as incentives to buy insurance and including state-based programs to cover the medically needy. Obama, McCain's Democratic challenger, wants to guarantee universal access to health insurance by making employers share costs. He supports mandatory health coverage for children, but not adults.
Eric Novak, an orthopedic surgeon, said the Arizona measure he helped put on the ballot "is not against health care reform in any way whatsoever," but would insist the cornerstone of any future health care system reform be "the preservation and protection of the right of individuals to make their own health care choices."
Novak said the measure doesn't take aim at any particular action that other states have tried. However, if approved, it would appear to prevent Arizona from following in the footsteps of Massachusetts, where lawmakers in 2005 required nearly all residents to get health insurance.
The Arizona measure specifically prevents state lawmakers from imposing a penalty or fine for health care decisions. The Massachusetts plan penalizes both employers who don't offer insurance and the uninsured who don't sign up for the state plan.
While the health care measure is one of eight questions that Arizonans will consider Nov. 4, Novak said he realizes the main attraction on the ballot will be McCain, the state's U.S. Senator, at the top of the GOP ticket. But with health care such a big issue in the campaign, Novak said, "It wouldn't surprise me that as we get closer to the election, a bright light will be shone on all the ballot measures, particularly this one."
The health care question in Colorado requiring employers with more than 20 workers to provide health insurance also could get lost in the shuffle amid the presidential campaign and because it is among 18 statewide measures, the most of any state. It will compete against more high-profile initiatives including whether to ban affirmative action and to define "personhood" at the time of conception.
Ernest L. Duran, Jr., president of the United Food and Commercial Workers Local 7, said the coalition of labor unions, called Coloradans for Middle Class Relief, might be willing to withdraw the health care measure if business groups would remove their "right to work" question that would allow workers to opt out of joining a union in workplaces that are already organized. "There are still a lot of discussions about that," he said.
This fall's ballot in Colorado has an unusually high number of measures pitting organized labor against business. Besides the health care measure on the Colorado ballot, unions are supporting initiatives that would make employers liable for failing to provide a safe workplace, bar employers from firing workers without just cause and make executives liable for corporate fraud. Businesses also are backing a measure that would require unions to get annual written approval from every member before spending any dues on political activities.
Meanwhile in Montana, some 30,000 uninsured children would be added to government-funded programs under a ballot measure that expands eligibility for SCHIP and Medicaid coverage. It also would help low-and middle-income parents pay the premiums to cover their children in employer-sponsored health plans.
"We tried doing it in the Legislature and it didn't work, so we went to the ballot," said Montana Rep. Mary Caferro, a sponsor of the " Healthy Montana Kids Plan."
Gov. Brian Schweitzer (D) told his budget director to assume the measure will pass and put its $20 million cost into the next state budget, The Helena Independent Recordreported.
One health-care initiative that had been closely watched won't be on the Ohio ballot after all. Supporters voluntarily removed their initiative that would have guaranteed full-time workers paid sick leave. Gov. Ted Strickland (D) helped persuade backers to drop the measure to prevent a divisive campaign between labor, which backed the measure, and employers that complained it would drive business out of the Buckeye State. Strickland has promised to push for federal legislation that would establish paid-sick days nationwide.