Launched in January, Gov. Schwarzenegger's ambitious health reform plan for "shared responsibility" has received some traction in the last few weeks, with local Chambers of Commerce in Los Angeles, San Diego, and San José endorsing the deal - tax increase (sorry "fee"), and all.

Nevertheless, he was entirely unsuccessful in gaining Republican support in the legislature, and he vetoed the Democrats' bill, AB-8, because its mandatory "fee" was too high.  Nevertheless, they were close enough to commit to negotiating after the regular session recessed last month.

The governor has now released his draft legislative language, and I am given to understand that it is the result of negotiations with Democratic legislative leaders. So, if they do make a deal, it will likely look something like this.  Unfortunately, there's not much good to report.  The Governor is still committed to so-called "universal" coverage via employer and individual mandates.  The employer mandate is 4 percent of payroll, and the individual one yet undetermined.  It also imposes guaranteed issue and community rating in the individual market, and enforces an 85 percent medical loss ratio (MLR), which will drive many insurers from the market.

However, it is not all bad.  Some provisions increase competition on the provider side, and insurance side, too:

1. Allowing MediCal managed care organizations to give e-prescribing technology to providers without risking anti-kickback rules.
2. Loosening up restrictions on health professionals' scope of practice, especially ratios of physicians to physician's assistants and nurse practitioners.
3. "grandfathers" existing insurance policies if they don't comply with all the bells & whistles of forthcoming ones under "universal" plan.
4. Eliminates the requirement that individual carriers offer HIPAA portability plans.

Others are harder to give a simple thumbs up or down to, and some are breathtakingly simple, such as the requirement that the Department of Health Care Services keep better track of beneficiaries - but the department will likely still fail to do it!

I have no idea how long the Governor and the Democrats can keep this thing ticking along without either voting on it or calling it a day and going home.  Now, the special session is dealing with water bills.  Will they have enough energy for health care?

And they will not be able to pass a funding mechanism without Republican votes, which they do not expect to get. So if they do pass legislation, we still have to trot off to the ballot box next year to vote for a tax increase - or not, let's hope.