Last year, Massachusetts was the first state to want everyone to have health insurance. Proposals in California could lead to an even bolder test, since the Golden State has so many more problems. "It's now more visible in California," says Marian Mulkey, a senior programme officer at the non-profit think tank California HealthCare Foundation. "That doesn't mean it can't be solved."
In California, where 4.9 million people don't have health insurance, this is a known fact. Before the plan began in Massachusetts, it was thought that 500,000 people would move there. That's why politicians from other states, policy experts, and members of Congress are keeping a close eye on what California does, since it could become a model for the rest of the country. Some people want the government to pay for and run a worldwide programme. Some states say that everyone should have to buy health insurance, but others say that this is too harsh when premiums are so high.
Few people are surprised that California's health insurance hit a wall. The problem is big, and there are many different ways to solve it, which is causing lawmakers to disagree. Republicans don't back either of the two Democratic health-improvement plans in play in California, nor did any of them back the plan from the governor. Even though their plan has some of the same ideas as the governor's, Democrats disagree with him in two important ways: they don't want to force people to buy health insurance, and they want employers who don't offer insurance to pay more than the governor suggests.
Larry Levitt, a health insurance policy forecaster for the Kaiser Family Foundation, a non-profit study group based in Menlo Park, California, says that any change in California would make a big difference in the number of uninsured people across the country. "Actions in California would give the presidential debate and other states a real boost."
Health reform in Massachusetts took years of planning before it was passed by the government, which was almost unanimously in favour of it. "If you're going to refinance one-sixth of the world's economy, you shouldn't do it with a 50-to-49 vote," says Jon Kingsdale, head of the state agency in Massachusetts in charge of rolling out the programme. "Getting something done is only half the problem."
