Proposition 45 and Proposition 46

Posted by Sappho on October 21st, 2014 filed in California Ballot Propositions

It’s getting close enough to the election that I should probably suspend posts about issues on which I won’t be voting, and instead try to figure out how I’m going to vote on all the propositions and down ballot races. (For any of my readers who are bored with politics, I’ll try to work in a post about genetic genealogy, triangulation of cousins, and tools like Genome Mate.) This year, we have six statewide propositions to vote on. I’ve already posted links to some general sources of information, so for this post, I’ll just link Ballotpedia on California ballot propositions in 2014. Let’s start with the two propositions related to healthcare, Proposition 45 and Proposition 46.

“Prop. 45 Attacks President Obama’s Affordable Care Act,” announces a flyer sent to my house. The flyer warns that “Right-wing groups will use Prop. 45 as a legal tool to dismantle Obamacare in California.”

On the face of it, this warning sounds plausible enough. After all, opponents of Obamacare have been pulling out all the stops to scuttle the law ever since it was passed: votes to repeal it in the House, lawsuits in court to have it ruled unconstitutional, attempts to use the debt ceiling vote to get Obama to surrender his signature legislative achievement. Why not a ballot proposition in California to dismantle it?

A look at the list of who supports and opposes Proposition 45 shows that the story isn’t quite so simple. The proposition, which “Requires changes to health insurance rates, or anything else affecting the charges associated with health insurance, to be approved by Insurance Commissioner before taking effect,” is supported by the sort of people you’d expect to want insurance rate changes regulated (mostly Democrats) and opposed by the sort of people you’d expect not to want an added layer of rate regulation (insurance companies). Whether or not you buy the argument that Proposition 45 will undermine Covered California, it’s not likely that this particular set of people intended for the proposition to dismantle Obamacare or Covered California.

The flyer’s not entirely wrong, though. Though Proposition 45 isn’t meant to undermine Covered California, some do fear that the proposition may in fact have that effect. Some Covered California board members have expressed concern about the proposition, and some newspapers have endorsed a No vote. The Los Angeles Times, for example, writes

Proposition 103 has saved consumers an enormous amount on auto, home and other policies while still allowing insurers to make a profit, so the idea of extending its purview to health plans is appealing. But now would be the wrong time to pass such a measure. Thanks to the state’s implementation of the 2010 federal healthcare reform law, buyers of individual health plans have a new ally that other insurance shoppers don’t: an independent state exchange, Covered California, that negotiates with health insurers for better deals. Although many people don’t shop for insurance through Covered California, insurers have to offer their Covered California plans to all state residents. Yet Proposition 45, which was written before Covered California opened for business last year, doesn’t acknowledge the exchange or any of the other major changes wrought by the 2010 law.

The paper believes that there are conflicts between the proposition, as written, and Covered California, and that we’re better off waiting to see how the new system works out before adding an additional layer of rate regulation.

I’m leaning toward a no vote right now, as “make one major change to the healthcare system at a time” appeals to the quality assurance professional in me (it’s easier, that way, to judge the effect of your changes, and know what you may need to tweak). But feel free to try to persuade me that I’m wrong (or right), since I haven’t voted yet, and I find figuring out how to vote on such propositions tricky.

Proposition 46 has a different set of complications.

Proposition 46 will do three different things: 1) Dramatically increase the cap on non-economic damages that can be assessed in medical negligence lawsuits to over $1 million from the current cap of $250,000. 2) Require drug and alcohol testing of doctors. 3) Require doctors prescribing certain controlled substances to consult the state prescription drug history database.

Pretty much all newspapers who are making an endorsement on this one are against it. Friends Committee on Legislation of California, a Quaker legislative organization whose recommendations on ballot propositions I often follow (particularly as they relate to criminal justice) is for it. An old college friend tells me that her daughter, a lawyer, is urging her to vote for the proposition (the current malpractice limit is so low, her daughter says, that no lawyer will take such a case), while her college roommate, a doctor, is urging her to vote against it, objecting to the drug testing for doctors.

I’m leaning against it. I don’t like potpourri ballot propositions that stick several logically distinct changes in the same initiative; there’s a good chance, in such cases, that at least one of them will be badly written. I’m not wild about random drug testing of people who haven’t offered grounds for suspicion (particularly since the drug detection window for marijuana can be so much longer than the amount of time for which it actually impairs a person). It’s true that there are extra safety issues with doctors, but do doctors in all specialties equally need to be drug tested?

But I’m not quite sure yet. Different people that I normally respect seem to be arguing for each side. So, if you have a strong opinion on this one, feel free to try to convince me.