State legislators passed a major piece of the federal Affordable Care Act on Saturday, opting to expand Medicaid to 1.4 million low-income Californians, as it rushed to meet its deadline to complete a state budget.
The action came a day after lawmakers passed the main budget bill outlining a $96.3 billion spending plan for the fiscal year that starts in July.
Saturday's votes were on a handful of targeted bills. They included ones that would provide college scholarships for middle class families, increase grants for those in the welfare-to-work program, restore dental care for low-income adults, distribute money for school energy projects and strengthen oversight of the California Public Utilities Commission.
The centerpiece legislation was the expansion of Medicaid, which is called Medi-Cal in California. Broadening the entitlement program to reduce the number of uninsured people in the country is one of the cornerstones of President Barack Obama's national health care reforms.
Several Democratic lawmakers called Saturday's vote historic.
"We don't know for certain that this will contain the costs; that's certainly the goal. But ... we also make sure that health care is not considered a privilege of the fortunate few but as a basic human right," said Sen. Mark Leno, D-San Francisco. "That's what we're implementing today. This is a big deal."
Republicans raised concerns about whether California can afford the expansion over the long run, especially once the federal government drops its commitment from 100 percent to 90 percent.
Democrats included a provision in the legislation that allows for future lawmakers to reconsider the expansion if the federal government's share drops below 70 percent.
The federal government will pay the full cost of expanding the low-income health program, which is called Medi-Cal in California, for the first three years. It will gradually reduce payments to 90 percent starting in 2020, putting the rest of the cost on the states that adopt the expansion.
Legislative Analyst Mac Taylor has estimated that by taking on new enrollees, the state could be responsible for between $300 million and $1.3 billion a year starting in 2020.
"I worry about expectations that we set out for individuals with ACA in California and having the rug pulled out from underneath us without a funding mechanism. Can we as a state handle that financial burden? I'm very concerned about this," said Sen. Ted Gaines, R-Rocklin.
Democrats said the expansion would help save lives, keep workers healthy and attract billions of dollars from the federal government into the state. Senate President Pro Tem Darrell Steinberg, D-Sacramento, noted that taxpayers and those who have health insurance already are paying for the medical care of those who currently go without insurance. The Medicaid expansion will cover many of those who now receive uncompensated care, he said.
While the Affordable Care Act has led to deep partisan divisions across the country, the bills that passed Saturday had a sliver of bipartisan support. Katcho Achadjian of San Luis Obispo was the lone Republican to support the expansion when it passed the Assembly on a 55-24 vote, while two Republicans, Joel Anderson of San Diego and Anthony J. Cannella of Ceres, joined Democrats in passing the legislation 28-8 in the Senate.
Achadjian said he opposed the federal health care law but believed he should vote to implement it in California now that it has been upheld by the Supreme Court.
"There are many of those who cannot afford it otherwise in my district who will benefit from this act," he said after the vote.
Anderson, vice chairman of the Senate Health Committee, acted for similar reasons but also had pressed for a provision that would allow the state to back out of the Medicaid expansion if the federal government reduces support in the future. He acknowledged that politics can sometimes make strange bedfellows.
"I opposed it for two years," he told The Associated Press after the vote. "Now I'm a champion trying to ensure that it has a fighting chance for survival."
The Medi-Cal vote came a day after the Legislature passed the main bill to enact California's spending plan for the fiscal year that starts July 1. Lawmakers approved so-called trailer bills that implement certain parts of the budget on Saturday, their deadline to send a balanced budget to the governor.
One bill reduced state funding to counties to provide indigent care and public health services as a result of moving more people into Medi-Cal. The move was met with strong opposition by lawmakers representing rural counties who worried about being shortchanged.
Another action concerned a proposed constitutional amendment seeking to lower the vote threshold from two-thirds to 55 percent for cities and counties to pass bond measures, primarily to support local law enforcement and fire protection. The lower threshold already applies to school districts.
Republican lawmakers said the amendment was meant to get around the provisions of Proposition 13, which caps property tax assessments.
The proposal, which requires voter approval, passed in the Assembly but will be considered later in the Senate, meaning it was not part of the budget process.
Buoyed by supermajorities in both chambers and higher-than-anticipated tax revenue, Democratic lawmakers have been able to restore some of the money that was slashed during the recession for mental health treatment, health care for the poor and higher education.
Those partial restorations were possible even as they stuck to Democratic Gov. Jerry Brown's more-conservative revenue projections.
Republicans were largely excluded from the budget negotiations and blasted the Democratic agreement as too costly given California's debts, including tens of billions of dollars in unfunded public employee pension and retiree health care liabilities.
Under the spending plan, K-12 school districts will receive more money, particularly those with high levels of students who come from low-income families, who are not proficient in English or who are foster children. Districts also will have more control over how they spend state aid and will receive a one-time infusion of $1.2 billion to implement "common core," a more rigorous academic standard intended to better prepare students for college and a career.
Another measure that passed Saturday will set aside $305 million annually for college scholarships for students whose families make less than $150,000 a year. The so-called middle class scholarships would be available starting in the 2014 academic year.
Associated Press writer Tom Verdin contributed to this report.