Health Care Pushed to Fore By Calif. Vote

Senate to Debate House-Passed Bill As the Feb. 5 Primaries Draw Near

LOS ANGELES, Dec. 21 -- The universal health insurance package that one chamber of California's legislature passed this week looks a lot like the one Massachusetts not only passed but put in place a year earlier: Every resident will be required to have insurance, every employer must pitch in, and no one can be denied coverage because of a pre-existing condition.

It also resembles the health-care proposals of front-running Democrats campaigning for the presidency.

But this being California, the $14 billion package was presented with the luster of something spanking new and the irresistible momentum of a trend.

"We are in a marathon here in California that the whole country and the whole world is watching," said Gov. Arnold Schwarzenegger, the Republican who made common cause with the Democratic legislative majority to pass the complex package after more than a year of negotiations and setbacks.

"After today, we can see the finish line."

The nation's largest state has led the way in so many fields -- higher education, energy conservation, combating global warming, personal pizzas -- that its claim of leadership on a public issue that has confounded policymakers for decades sounded familiar.

"Culturally and politically, California prides itself on being a leader, on being on the cutting edge," said Darry Sragow, a Democratic strategist who lobbied for the health-care package for AARP.

"We're big and we're important, and what happens here matters. And if it can be done here, it probably sets the stage for it happening nationally," Sragow said.

The health insurance plan may not be a first, but the political calendar has the potential to push it smack into the middle of the presidential campaign.

Having been approved on a party-line vote, 45 to 31, by the General Assembly, the plan is likely to be debated in the Senate during the runup to the presidential primaries on Feb. 5, dubbed "Tsunami Tuesday" because it involves votes in more than 20 states. California is the biggest of them, having moved its primary up from June, when it historically served chiefly as a coronation.

"If we have a competitive primary in California -- which we're not used to having -- health care certainly will be front and center for voters, as it is now," Sragow said. "It amplifies the issue nationally."

Bill Carrick, a Democratic consultant who has studied voter attitudes toward health care, said the California package is likely to draw the ire of Republican candidates because it places new obligations on businesses. And though the measure resembles health-care proposals put forward by presidential contenders Sen. Hillary Clinton and former senator John Edwards, it will not necessarily unite Democrats. Some traditional Democratic constituencies favor a single-payer plan that covers everyone, rather than one requiring individuals to purchase insurance.