Proposition 52 is a rare initiative for which there should be little debate or dissent. The measure would extend an existing fee on hospitals to provide health care to poor people, guarantee that the federal government will match the state’s share, and inhibit the Legislature from diverting the money to other programs.
We often oppose using ballot measures to tie legislators’ hands on fiscal matters. But Proposition 52 is an exception to our general admonition against ballot-box budgeting, and the vast majority of lawmakers agree.
The California Republican and Democratic parties support the initiative, as does most of organized labor, business groups and the hospital and health care industry, which is funding the Yes-on-52 campaign. Passage is a must for the San Joaquin Valley, which is home to many of California’s poorest residents.
Opponents include the Service Employees International Union-United Health Care Workers West, which had proposed but withdrew a ballot measure limiting hospital executive pay. Executive pay should be decided by hospital governing boards and market forces – not a ballot initiative. Proposition 52 is hardly the stuff of high drama. It would help stabilize hospital funding for poor people, and ensure that Uncle Sam will continue to help California pay for their care.
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As a result of an agreement by then Gov. Arnold Schwarzenegger and the Legislature in 2009, hospitals impose the Hospital Quality Assurance Fee on themselves. The fee netted $3.7 billion last year. With the feds’ match of $4.4 billion, California’s 450 private, public and rural hospitals received $8.1 billion to care for poor people covered through the state Medi-Cal program, the Legislative Analyst’s Office says. That’s a significant part of the $95 billion state and federal cost of providing health care for roughly 13.3 Californians who depend on the Medi-Cal program.
Public hospitals would be among the biggest beneficiaries – they received a net benefit of $235 million last year – as would rural hospitals. Hospitals use the money to pay for children’s health care services, which otherwise would come from the state general fund.
The Legislature has extended the 2009 arrangement four times. If voters approve Proposition 52, there would be no need for further legislative action. Nor would lawmakers be tempted to seize money that is earmarked for the care of poor people.
In an election dominated by Donald Trump, the fight for control of Congress, gun control and marijuana legalization, Proposition 52 is an outlier. It doesn’t generate fierce debate. But Proposition 52 does make fiscal sense, and it is worthy of voters’ support.