Dan Walters: Big Capitol fight on Medi-Cal looms among Democrats

dwalters@sacbee.comMay 20, 2013 

As he presented his revised 2013-14 budget to the Legislature last week, Gov. Jerry Brown warned against expanding spending beyond his administration's conservative revenue estimates.

Citing darkening economic and revenue forecasts, Brown called on fellow Democrats in the Legislature to restrain themselves – and indirectly threatened to veto anything he considers to be too expansive.

"That's what this place (the Capitol) is – a big spending machine," Brown observed tartly, saying of simmering plans for new taxes and spending, "They can push and I can push back."

In theory, the Legislature's Democratic supermajorities could override a Brown veto, but the political reality is that vetoes would stand. Democrats' more realistic hope for new spending is that the Legislature's budget analyst is forecasting higher revenue than Brown's advisers.

Medi-Cal – the immense federal-state-local program of health care for the poor – is one major point of friction between Brown and his fellow Democrats.

The state spends $60-plus billion on Medi-Cal each year to provide medical care to more than 8 million Californians, from the cradle to virtually the grave.

As massive as it may be, Medi-Cal is on the verge of a huge expansion that could add a couple of million more Californians to its rolls, some of them from expanded eligibility under the federal Affordable Care Act and some from signing up those who now qualify but aren't enrolled.

The federal government will cover 100 percent of costs for the former initially, and then 90 percent there- after, but if there's a major enrollment of the latter, the state would be on the hook for potentially heavy costs.

Brown endorses expansion, but wants to proceed incrementally and carefully, clearly worried that a steep jump in state costs could upset his intent to keep income and outgo in balance through the rest of his second governorship.

But that go-slow approach clearly irritates liberal legislators who have sought for decades to expand medical coverage to nearly every Californian, especially the millions of working poor who have not qualified for coverage in the past.

Brown's budget envisions a relatively modest expansion of Medi-Cal rolls by about a half-million people in 2013-14 and conflicts with a much more ambitious legislation carried by Assembly Speaker John A. Pérez.

Brown also wants to offload some welfare costs onto counties under the theory that they will save money from placing more of the medically indigent on Medi-Cal rolls, which raises the hackles of county officials.

And he's not backing down from sharp reductions in payments to Medi-Cal providers that they and their unions want to overturn.

It's shaping up as an eyeball-to-eyeball political confrontation among Democrats.

Call The Bee's Dan Walters, (916) 321-1195. Back columns, www.sacbee.com/walters. Follow him on Twitter @WaltersBee.

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