This report provides a comprehensive examination of political, policy, and economic factors that contributed to the failure of California's 2007 health care reform effort.

From the report:

Skyrocketing health insurance costs were renewing concern about access to insurance among the middle class, not just among low-income Californians. Some evidence even suggested a crack in the iceberg of traditional opposition—among insurers and large employers—to coverage expansions. If not pushed too far, these interests might support approaches they had long opposed. Nevertheless, health reform in California was not to be. What happened? Why did reform fail again? Our effort to answer these questions focuses on the intersection of four factors, all central to the world of legislative politics and policymaking. The first factor encompasses the impacts of long-term systemic forces or limitations—including economic forces, constitutional provisions, and federal statutes—over which state decision makers may have little control. These forces often set the parameters within which policymaking and political choices are made. The second factor is critical policy challenges and the efforts to overcome them. The third factor involves the perceptions, positions, and impact of major interest groups. Finally, the fourth factor is the role of political and legislative leadership in defining, promoting, and mobilizing support for reform goals.

Full report:  Swimming Upstream: The Hard Politics of Health Reform in California (PDF | 433.75 KB)

UCLA Center for Health Policy Research. (2009). Swimming upstream: the hard politics of health reform in California. Zelman, W.