Critics say such a requirement could place an unrealistic burden on small businesses and the poor.

The San Diego Union-Tribune

Last year, Californians struck down a proposition requiring employers to provide health insurance. Now a push is under way to require residents to provide it themselves.

The concept of mandatory health insurance for individuals has gained support recently from powerful voices including the California Medical Association and Gov. Arnold Schwarzenneger.

Critics say such a requirement could place an unrealistic burden on small businesses and the poor. But proponents say a well-conceived plan could alleviate the financial burden the uninsured place on the community.

“Addressing the issue of the uninsured isn’t just important for people who lack health insurance but to bring stability to the entire health care system,” said state Assemblyman Keith Richman, who is a physician.

Richman, R-Granada Hills, and Assemblyman Joe Nation, D-San Rafael, have proposed a bill that would require residents to insure themselves the same way drivers must insure their cars.

Richman said Californians would have to provide proof of insurance when they file their taxes.

A state legislative committee is scheduled to review the bill this month. If approved by the Legislature, the health insurance mandate would be the first of its kind nationwide.

More than 6 million Californians lack health insurance. The uninsured suffer from poorer health and lower life expectancies because of lack of access to health care. But the problem has enormous spillover effect, according to health experts — hurting hospitals, communities and even the insured, who pick up costs shifted to them when others can’t pay.

The problem of the uninsured has become a hot topic in Sacramento. But the bill and several other pending proposals to address the uninsured face significant political and economic challenges for approval.

“I think conceptually there is an intuitive appeal to the notion that everyone should be participating and bearing some responsibility.” said Jill Yegian of the California Healthcare Foundation, an independent health care philanthropy. “The problem is when you look around at the cost trend, it’s just completely out of sight.”

Under the Nation-Richman bill, residents would have to carry a minimum amount of insurance. If they don’t already have coverage and don’t qualify for public programs, they would have to purchase a policy, either on their own or from newly created purchasing pools.

The pools, open to individuals and employers, would use their collective size to bargain with insurers. Subsidies would be provided to small businesses that employ a large number of low-income workers to help pay for coverage.

An early version of the bill called for residents to provide proof of insurance when they file their taxes. But Richman said tax and revenue details were removed from the most recent version to speed the bill through its first committee hearing and would be reintroduced.

While the medical association and Schwarzenegger have said they support the concept of individual mandates, they have not endorsed the bill directly.

“We do support the direction that the authors are taking in trying to expand access to health care,” said Fred Harder, senior vice president of public policy for the California Hospital Association, which did not take a position on the bill. “We do believe that there’s a role for individual responsibility.”

According to Richman, multiple groups that opposed employer-sponsored coverage have supported the effort.

But the bill faces a number of critics and competition for attention from other health care bills working their way through the system.

“All this will do is make small business and individuals purchase health insurance they can’t afford,” said Barry Fowler, a self-employed consumer who is working with Foundation for Taxpayer and Consumer Rights to fight the bill.

At a minimum, residents would have to carry a plan that provides coverage for preventive care and has no more than a $5,000 deductible. Richman estimated that the kinds of plans he envisions would cost $50 to $160 a month.

But some said a deductible of that size is too high for people who can’t afford insurance. And others criticized the four-page bill’s lack of details.

Richman and Nation proposed the individual mandate as part of a multibill health-reform package that they say, taken as a whole, will help control costs and increase access.

“Of course (people think) health plans are going to be in favor of it because it’s more business for them,” said Bobby Pena, spokesman for the California Association of Health Plans, which represents insurers statewide. “But we don’t think enough of the details have been fleshed out.”