OAKLAND, Calif. — With Californians more likely to be uninsured than people in 45 other states, it’s no surprise that poll figures show 81 percent of voters think the government should guarantee that all residents can get affordable health coverage. It’s also no surprise that the issue is prominent on the state Legislature’s agenda.

Besides a plan proposed by Republican Gov. Arnold Schwarzenegger earlier this year, bills have been introduced by Senate President pro tem Don Perata and by Assembly Speaker Fabian Nuñez, both Democrats. Additionally, in late February state Sen. Sheila Kuehl (D-Santa Monica) reintroduced her single-payer bill that overwhelmingly passed the Legislature in 2006 but which the governor vetoed.

By far the most comprehensive measure is Kuehl’s SB 840, which would cover all Californians for all medical, dental and vision care, along with hospitalization and prescription drugs. A health insurance fund would pool all money now spent on health care by federal, state and county governments together with affordable insurance premiums from employers and consumers. There would be no deductibles, co-pays or out-of-pocket payments.

Health care providers, hospitals and pharmacies would continue as private businesses, and patients would choose their own providers. A 2004 study found Kuehl’s plan could cover the state’s 6.5 million uninsured and still save $8 billion through establishing a single streamlined claims and reimbursement system.

The measure is supported by the California Nurses Association, California Federation of Teachers, SEIU, California Association of Retired Americans, League of Women Voters, Friends Committee on Legislation and many more labor, community and faith-based organizations.

While the California Pan-Ethnic Health Network supports the principle of meaningful health care reform, Kuehl’s bill is “the only measure we are committed to now,” CPEHN’s policy director, Martin Martinez, said in a telephone interview. The other proposals, he said, cobble together previously proposed reforms, which may or may not add up to an effective program.

“We have a great window of opportunity this year,” Martinez said. “We hope we will be able to take advantage of it.”

Together with other members of the “Having our say!” coalition it helped found, CPEHN is working for universal, affordable care for all Californians, with comprehensive benefits and timely access to services. Martinez said that high on the list are coverage for all immigrants regardless of status, and culturally and linguistically competent care.

Kuehl has said that besides promoting her own bill, her role as Senate Health Committee chair is also to work closely with legislative leaders and the governor for “incremental” plans to help cover the uninsured. In that vein, she is a co-author of SB 48, introduced by Sen. Perata, which would cover all working Californians and their dependents. Employers would be required to “pay or play,” either spending a percentage of their payrolls toward worker health coverage or paying the equivalent into a health care trust fund, and workers would be required to buy insurance. Insurance companies would have to provide a basic level of benefits and keep administrative costs down. More children would be eligible for public programs.

A similar proposal has been introduced into the Assembly by Nuñez.

Meanwhile, the plan announced by Schwarzenegger, which is still not associated with specific legislation, continues to play a key role in the discussion. Among its provisions: a requirement that all residents carry and show proof of health insurance, and that all employers of 10 or more workers “pay or play.” All children who are below 300 percent of the federal poverty level would be covered, and the state would help low-income adults get coverage. A minimum policy would have a $5,000 deductible and $10,000 maximum out-of-pocket cost per family per year.

At an April 2 press conference, California Nurses Association members in Bakersfield charged that in their Central Valley community, where the median household income is about $37,500, the average family could be forced to spend nearly one-third of its income on health care before the required insurance would kick in.

After criticizing the other proposals, including the governor’s, Republicans in the Legislature late last month announced a series of measures largely based on so-called health savings accounts and high-deductible plans, which health policy analysts point out mainly shift health care costs to individuals.

mbechtel @ pww.org