Swimming Upstream: The Hard Politics of Health Reform in California
This report by State Coverage Initiatives, a national program of the Robert Wood Johnson Foundation, describes California's efforts to initiate health reform in 2007. Through analyzing the role of political leadership, financial challenges, the limitations imposed by constitutional provisions and federal statutes, and efforts to overcome policy hurdles the report tells California's story.
The report specifically identifies many major challenges for achieving health reform including: (1) political advisors want simple solutions that don't exist; (2) cost containment is necessary for coverage expansion, but powerful stakeholders resist cost control; (3) comprehensive reform takes significant time which legislators often do not have; (4) politically moderate reform is the most likely to succeed, but the middle ground often lacks energy and loses the support of those strongly committed to health reform.
Click here to read the full report.