The November elections are history now, yet advocates of the Healthy Kids Program remain in shock over its defeat by Oregon’s voters. An Oregon student at Princeton University has written and requested I answer 10 questions on why I believe the Healthy Kids Program failed both in the 2007 Legislative Session (House Bill 2201), and again at last month’s election (Measure 50).
Many Oregonians who favor government supported health insurance for children have spent the past month asking these same questions. After all, doesn’t everyone want children to have health insurance? Yet, with the Democrats in control of the Senate, the House and the Governor’s office, this key Democrat legislative issue went down in flames — first at the hands of the Republicans in the Oregon legislature’s 2007 session, and then by a 59% trouncing from Oregon voters. (Out of Oregon’s 36 counties, only Multnomah passed Measure 50).
How did this happen? Why was the Healthy Kids Program so soundly defeated? As the House Republican Whip in the 2007 session, as a member of the Republican Leadership Team, and as ranking Republican on the House Health Policy Committee, I thought you might be interested in my answers to the 10 questions on why the Healthy Kids Program failed in Oregon. The answers are my own opinions; I speak only for myself. So, here’s my Healthy Kids Program, Measure 50 Post Mortem.
Question 1(a). In General, why did Healthy Kids fail to pass the legislature?
Answer: In my opinion, the Healthy Kids Program (HKP) failed to pass the Oregon House in the 2007, primarily for 3 reasons:
a. HKP expanded eligibility for tax-supported subsidies to middle class families earning 300% of the Federal Poverty Level (FPL), instead of focusing on providing government sponsored health benefits to poor families. The majority of Oregonians want to help poor children who come from poor families, and not subsidize families that can afford cable televison and other non-essential expenditures. A couple earning 30,000 per year under HKP would have paid taxes to subsidize health insurance for a family of four earning more than $64,000. In 2007, the Federal Poverty Level for a family of four was $20,652. I believe most Oregon voters would not approve state subsidization of health care insurance for families earning more than twice (200%) the FPL””which for a family of four would be $41,304 in 2007.
b. HKP failed to provide a funding stream that would accommodate the perennial 7-10% increases in health care costs. Funds from the proposed tobacco tax increase could not sustain the cost of HKP over time.
c. HKP failed to acknowledge the key health care issue for children is access to health care, not health insurance for children. Although never discussed in the HKP, health access of Oregon’s children includes federally qualified health clinics (FQHC’s) and other clinics that provide health care to the poor who are not insured. The President’s Health Centers Initiative has made FQHC’s a priority, and in Oregon there are 124 clinics that serve more than 250,000 Oregon patients. More than 1,000,000 medical examinations and treatments were provided by Oregon’s FQHC’s this year, and many of those visits were children.
Question 1(b). Did institutional rules play a part and if so, how?
Answer: As mentioned above, institutional rules that raised the threshold to qualify for government subsidization of health care insurance premiums played a part in Oregon’s opposition to HKP.
Question 1c. How did legislators make their decisions regarding support for this legislation?
Answer: Politics is a team sport and no team player can be proficient in all positions. Likewise, Legislators cannot become expert on all issues. A Legislator studies deeply the issues confronted by his or her committees. To decide how to vote on complex issues faced by other committees, Legislators often rely heavily on knowledgeable and trusted fellow legislators and staff members in their party’s caucus. Health care and the HKP are complex issues.
Question 2(a). What role did partisanship play in the inability to pass HB 2201?
Answer: Politics are always an issue in the legislature. To say the legislature is political is to state the obvious. When the majority/leadership party wants something that is in the power of the minority to grant or to withhold, the majority needs to negotiate, so the minority gets something important in return for its cooperation. Power is a two-edged sword. In the case of healthy kids, the Democrats (who support expanding government-subsidized health care), wanted the Republicans (who do not support expanding government-subsidized health care or the increased taxes required to implement the expansion), to negotiate on the provisions of the Healthy Kids Program. Thus, the Democrats focused on trying to get the Republicans to help design a program and tax increase the Republicans did not agree with in the first place. In my opinion, it was a failed attempt to use power to coerce the minority to agree to something contrary to the minority party’s interests, when there was insufficient motivation to do so. In short, when the minority has power to prevent a majority’s victory, the outcome will either be win-win or no-win.
Since inadequate legislative incentives were offered in the Healthy Kids Program negotiations, the Republicans refused to vote for an expensive program expansion that contained a “poison pill” tax increase.
Question 2(b). What factors contributed to partisanship and how did they help or hurt the prospects for passage?
Answer: The Democrat leadership miscalculated the cohesiveness of the Republican caucus. Repeatedly, House leadership brought HB 2201 to the House floor for a vote, and every time the bill failed to garner the 36 votes needed for the tax increase component. Regardless of which party is in control, controversial legislation should rarely be brought for a floor vote merely because the majority party believes it can coerce a party-line vote and squeak through a victory. Oregonians deserve better than on-going political polarization. The HKP was repeatedly defeated because it did not have sufficient support to represent both “blue” and “red” districts. It may be politically unrealistic, but most Oregonians think important legislation should not become law until it can receive support from a clear majority. Obviously, broad-based legislative support was not obtained with HB 2201’s Healthy Kids Program and Tobacco Tax Increase.
Question 3. Could political capitol have been spent in a way that made the passage of Healthy Kids, either in the legislature or on the ballot, more likely?
Answer: When there is concerted effort by the majority party’s leaders to build a trust and mutual respect with the minority party, less partisan wrangling will occur. In the 2007 session, although the Democrat majority was only held by the thinnest margin — 31 to 29 — the Democrats gave little consideration to the needs, desires and interests of the 29 Republicans who had been elected by their constituents in the same way the 31 Democrats had been elected by their districts. So why would the majority party’s leaders expect cooperation from the minority party on one of the few bills that the minority party had the power to kill””especially when that bill contained a tax increase, expanded socialized medicine and did not have a sustainable source of funding? There is a tendency””by Republicans and Democrats alike””to believe that once their party has the power of the majority (even if only by a vote or two), the majority party leaders can act as if their politics and policies are the only ones that matter. A two vote majority is not exactly a mandate of the people to implement only one party’s policies.
Wise legislative leaders remember that in a narrow balance of power, a majority of voters in nearly half of the state’s districts voted for the other party’s candidates. Political power is fragile in Oregon. In a few “swing” districts victory is determined by only a few hundred votes either way. Thus, Oregon is almost equally divided between “red” and “blue” districts. When this fact is appreciated, legislative policy will become more bi-partisan, and the system can function for the benefit of all citizens–not just for the benefits of ideologues whose party happened to squeak into the majority party’s power position.
Question 4. In General, why did voters defeat Measure 50? How did the campaigns frame Ballot Measure 50? What became the central salient issues?
Answer: When the success of the Healthy Kids Program depended on a Constitutional Amendment to implement a tax increase, the outcome was predetermined. We Oregonians take our Constitution seriously. All that was required to defeat Measure 50 was sufficient funding to inform Oregon voters that our Constitution was to be used to implement a program and a tax increase that their elected representatives had refused to pass. The tobacco industry was more than willing to provide the money to inform Oregon voters of what was going to be done to their Constitution.
Question 5. How was public opinion on this issue formed and changed over time?
Answer: Informing the general voting public through television and radio commercials, mailers, etc. was the media needed to inform 59% of Oregon voters of the fallacy inherent in amending the Constitution to increase the tobacco tax.
Question 6(a). Why couldn’t necessary majorities be created for HB 2201?
Answer: See # 2 and 3 above.
Question 6(b). Why couldn’t necessary majorities be created Measure 50?
Answer: See # 4 above.
Question 7(a). What changes to the legislation (amendments, etc.) could have changed the outcome?
Answer: See # 1 and 2 above.
Question 7(b). How did existing policy affect HB 2201/Measure 50?
Answer: The proponents of HB 2201/Measure 50 repeatedly bombarded the public with the statistic that 117,000 Oregon children were languishing without health care insurance. The Healthy Kids Program failed to inform Oregon voters that (1.) more than Â½ of those uninsured children already qualify for SCHIP benefits, and their families have, for whatever reason, not enrolled them, and (2.) the lack of health “insurance” does not equate to a lack of “access to health care” through Federally Qualified Health Clinics (FQHC) or other “safety net” clinics, physicians or hospitals. (See 1(a)c. above.)
Question 8. What advantageous or disadvantageous role did the governor play?
Answer: The Governor is Oregon’s Chief Executive. He has a cadre of advisors and millions of dollars at his disposal. His signature alone is worth as much as the combined “majority vote” of 16 Senators or 31 State Representatives. In my opinion, the Governor’s failure to broker an agreement between the Democrats and the Republicans resulted in the defeat of HB 2201, as well as other important legislation.
I strongly believe the Governor would more effectively serve Oregon if he were personally involved in brokering compromises on important issues facing our state. I am not talking about rewarding a couple of Senators with high paying government jobs for their key votes on PERS reform bills; I am talking about using the Governor’s status and resources to bring about consensus with both caucuses in the Senate and the House in order to solve issues vital to Oregon citizens. In fairness to Governor Kulongoski, I know he made several phone calls and held meetings with Senate and House leaders of both parties on the HKP. Unfortunately for HB 2201, it was too little, too late.
Access to health care for children is an important issue to most Oregonians, and the proponents of the HKP failed to deliver. It was an admission of legislative failure when the Healthy Kids Program was sent for voters’ approval after their elected representatives refused to pass it. Such Referrals to the voters should be rare and then only with a bipartisan vote — both parties agreeing the issue is so important that it should only be decided by a common vote of the people.
Once again, in my opinion, HB 2201 failed because the Democratic majority and the Governor refused to effectively negotiate for its passage. When they would not bend sufficiently to negotiate a compromise package of legislation, and they lost on the floor of the House, they sought to pull an “end-run” on the legislative system by forcing a Referral to the people. As a result, the voters handed the majority leaders their heads. In the future, I would hope Governor Kulongoski will spend more time working with legislators helping the system work. The Legislators were elected by citizens, just like the Governor was, and he should make time to talk with legislators and not delegate so much to his staff.
I have no plans to be Governor, but If I were, I would regularly meet with the majority and minority caucuses in both the Senate and the House. I would make my case with the caucuses as to why I felt key legislation should be passed or abandoned. I would hold Q and A sessions in those caucus meetings and I would ask what the Governor’s office could do to help make the Legislative session more successful for everyone. Representative democracy is only successful when all representatives have a voice for their constituencies, not just those who happen to be in power at any given time.
In sum, the Governor and legislative leaders should honor and work within the system and ensure it represents all Oregonians, not just the special interests advocates whose party happens to prevail at any given election. This applies to whichever party is in charge–Republicans as well as Democrats.
Question 9. Was timing part of the problem? Was the timing right to try to advance this issue? Was it too soon or too late? How did this issue get so high on Oregon’s policy agenda?
Answer: The time to address health care access and affordability is now. Oregon, and, in fact, America, has a sick care system not a health care system. Its incentives reward income based on the number of patient visits and procedures prescribed. In short, medical providers are financially penalized for having healthy patients. Health care costs for decades have been skyrocketing at more than twice the general inflation rate. Add to the financial disincentives and perennial cost increases the aging of the “baby boomers,” and the conclusion is clear. Our health care system is financially unsustainable. Regardless of good intentions, health care reform is impossible without addressing the power of those who control it. Addressing underlying power in any field is difficult at best. I think it was Tolstoy who in War and Peace, observed that in politics one must, “feed the wolves and protect the sheep.” Dealing with issues of institutional power and its hold on our health care system is a complex discussion better left for another time.
For whatever reason, the Democrat’s top health care priority for 2007 was the Healthy Kids Program and Increasing the Tobacco Tax. Instead of focusing all available resources on solving Oregon’s health care crisis, the focus was on buying more health insurance for middle class children with inadequate funding from an increased tobacco tax. Thus, the Healthy Kids Program diverted focus and resources from a very real health care crisis, and all Oregonians lost as a result. If it were not for the creation of Senate Bill 329’s Oregon Health Policy Commission, Oregon health care reform would have nothing to show from the 2007 legislative session, and another two years would have been wasted.
Question 10. What role (if any) did the media play in both defeats?
Answer: There are those who suspect Oregon’s key media outlets have a strong liberal political bias. A survey of most of Oregon’s reporters and editorial boards would show they favored the Healthy Kids Program and the tobacco tax increase to implement it. I believe most members of Oregon’s media did what they could to promote passing M-50. Measure 50 was defeated by an informed electorate, notwithstanding the media bias.
In conclusion, the defeat of House Bill 2201 by the Republicans and the defeat of Measure 50 by Oregon voters may be a hard pill to swallow for advocates of the Healthy Kids Program. Nevertheless, I hope these defeats can open minds and create opportunities to improve the way business in conducted in the Oregon legislature and in the Governor’s office. If that occurs, the death of the Healthy Kids Program and its tobacco tax increase could result in a healthier State government and greater confidence in Oregon’s legislative process.