By Santiago Munoz and Terry Leach

Recent state legislative activities, the presidential election focus and new polling suggest that meaningful health reform may become a mainstream imperative in 2008.

A December Field Poll indicates that more than 60 percent of all Californians, irrespective of age, gender or income, now support the general principles underlying ABX 1 1 - a health care reform deal struck between Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nunez currently pending in the state Legislature. If passed and adequately financed, the law would provide public and private insurance coverage to nearly 4.5 million currently uninsured Californians.

Along with the coverage expansion, the reform package emphasizes disease prevention and health care coordination, including chronic disease management and the use of technology as a means to improve the delivery of care. An initiative outlining the financing mechanism is slated to go before California voters in November 2008.

All of the presidential candidates have a health reform platform as health care continues to poll as one of the top issues of concern to voters.

The UC Health System is deeply committed to ensuring the best possible health care for all Californians and is grateful for the efforts of policy-makers -- the Schwarzenegger administration and Legislature in particular -- to improve health care delivery, expand insurance coverage and lower costs. While ABX 1 1 and many of the national proposals hold enormous promise to address these issues, it is essential that Californians really do get the health care they need, and not just an insurance card. To that end, a major part of our ability to improve health care under any of the health reform proposals depends on the fiscal soundness of our health care infrastructure, including the UC clinical enterprise.

The UC clinical enterprise provides an essential infrastructure for much of the research and teaching that underpins the quality of, and the ability to provide, health care throughout the state. Moreover, as the fifth-largest health care delivery system in the state, UC serves a large fraction of California's population, including our most severely ill and medically vulnerable residents. UC also plays critical roles in serving low-income Californians. Today more than 40 percent of UC's total patient population is either covered by Medi-Cal or is uninsured.

Over the last months, UC faculty and representatives from the Office of the President have provided advice to various policy-makers working on health care reform to help ensure that proposals under consideration in Sacramento provide adequate funding for the unique and essential services that UC's academic medical centers perform for Californians. These services include patient care not often available elsewhere, such as trauma, burn, cancer centers, high-risk obstetric programs, neonatal intensive care units, cardiac care and organ transplant centers. UC inpatients have illnesses that are 63 percent more complex then the national average. Since providing this essential specialty patient care, in addition to standard hospital services, is commensurately more expensive, it is important that UC not lose funding under state health care reform.

As various stakeholders work on individual aspects of reform, it is imperative that we keep in mind the total financing picture to ensure that critical institutions such as the UC clinical enterprise maintain financial sustainability and maintain vital services that effectively meet the health care needs of their communities.

The health care reform protections UC needs include:

• Payment levels that ensure our vast array of highly specialized clinical services, including health professions training, are maintained.

• Maintenance of payments specifically earmarked to help underwrite the cost of serving the remaining uninsured patients (These are commonly referred to as the "disproportionate share payments.")

• Special protections for the UC Medical Centers to ensure any fee levied on hospitals to help fund the reformed system is equitably applied and proceeds equitably distributed across hospitals.

Recognizing the inextricable link between reform and the financial viability of the clinical infrastructure will ensure that UC maintains the supply of regional clinical services that support its education and research role.

Santiago Munoz is associate vice president of the UC Division of Clinical Services Development and Terry Leach is manager of Health Policy.