The Democratic Piece

A total of 6.5 million people — one fifth of the state’s population — do not have such insurance, far more than any other state in the nation, and at least one million of those uninsured are illegal immigrants, according to state officials. Under Mr. Schwarzenegger’s plan, which requires the approval of the Legislature, California would become the fourth and by far the largest state to attempt to provide near-universal health coverage for its citizens. The other three are Massachusetts, Maine and Vermont.

The governor outlined his proposal to an audience of health-care experts and reporters via satellite from Los Angeles where he is recuperating from a broken leg. He made it clear that a variety of plans would be used to provide all Californians with insurance, and that the onus would fall on government, employers, health care providers and the uninsured themselves. “Everyone in California must have health insurance,” Mr. Schwarzenegger said, in a tone that seemed as much a threat as a promise. The plan includes elements that only an hour after his announcement provoked opposition from many powerful interests, including doctors, and his Republican colleagues in the state’s legislature.

Over the last two years, state legislatures have grown increasingly concerned with how to provide health insurance to its citizens as the number of employers offering coverage has fallen and the number of workers entering fields where health insurance is not an option have grown.

In many states, spending on Medicaid, the federal government’s health program for the poor, has surpassed that for education in the last few years. In New York, Gov. Eliot Spitzer has vowed to insure all of the state’s children and enroll all eligible adults in Medicaid; and New Jersey is among a handful of states considering some form of universal coverage.

Because of its sheer enormity, California — a state where many social policy debates begin — is likely to set the stage for the national conversation about health care this year.

“This it a very significant proposal,” said Karen Davis president of the Commonwealth Fund a nonprofit foundation. “It is not just children he is talking about. It is really dealing with the whole problem of the uninsured, with concrete positions to raise revenues to pay for that coverage and the philosophy of shared responsibility. I think this shows health care is going to be a major issue in the 2008 presidential election.”