BUDGET VS. BALLOT: A deal to pull a health care tax initiative from the November ballot looks increasingly unlikely just a few hours before the deadline. Already, ads encouraging voters to approve “the health care initiative” are appearing on social media, a clear sign that the initiative will continue, and the coalition running the measure is firm that it isn’t going anywhere. The ballot campaign — to funnel billions from a tax on health insurance plans to improve Medi-Cal — creates some awkward dynamics both within the health care world and between the campaign’s proponents and state leaders, who would rather determine how that money is spent — and who laid out a different plan for the money in the state budget. (A former top aide to Gov. Gavin Newsom recently left the campaign, stressing that he didn’t want to be associated with a campaign the governor was concerned about, as did a few other former Newsom officials.) “Me, personally, I don't want the ballot to pass because it would then negate everything that we fought for in the past year and a half worth of advocacy,” state Sen. Caroline Menjivar told POLITICO. Last year, some of the biggest players in California’s health care scene came together to work out a deal on how to use the tax’s enormous proceeds — upwards of $20 billion plus federal funds. Groups who are often at odds, like SEIU and the California Hospital Association, united behind the idea that the money needed to stay in health care and strengthen the state’s Medi-Cal system. That deal became the ballot initiative. But Newsom upended the agreement in May when he proposed using billions of the proceeds to backfill the state’s budget deficit — exactly the kind of decision the ballot measure aims to prevent. That opened the door for players who weren’t at the table, like legislators and smaller health care names, to assert their power in budget negotiations. Notably, the final budget agreement included raises for professions that were left out of the ballot measure, including those with less lobbying sway such as private duty nurses, adult day center and community health workers. Suddenly, those groups have something to lose if the ballot measure passes in November, nullifying the budget deal that included long-sought rate increases. “It’s a hard spot to be in. I have always seen this through the really big lens of what’s best for the people we’re serving,” said Lydia Missaelides, the executive director of the California Association of Adult Day Services. “This sets up an uncomfortable dynamic, to be honest.” The coalition that’s pushing for the ballot measure says it offers the system some much-needed predictability, and that there’s enough flexibility in the deal to contribute to spending what they want and still provide for the professions who may be “losing out.” But the conflict between the budget and the ballot has created more room for dissent, potentially fracturing support for a measure that was expected to face little opposition. Ronald Coleman Baeza, executive director of the California Pan Ethnic Health Network, said he was thrilled that the governor and legislators opened the tax deal back up in the budget, instead of just deferring to what the major players wanted. “Having an initiative that hoards money to industry sponsors will ensure that their businesses can stay open and keep running,” Coleman Baeza said. “We remain concerned about locking down this money.”
| 
