I wonder if ever in U.S. history, healthcare was as much as a political football as it is today?

Case in point: Next week (on Nov. 4) Californians will vote on Proposition 45, a ballot initiative that essentially changes who has the power to make final decisions on regulation of health insurance rates in this state.

At my home just south of San Francisco, we've been bombarded with slick mailers from groups for and against, all claiming they are protecting consumers. Doctors are even taking pot-shots at each other, claiming their opponents are "breaking their hippocratic oath" by supporting the measure.

Frankly, it's confusing as all get-out, because it sounds so good: The new initiative would give our elected state insurance commissioner the power to regulate health insurance rates for small businesses and individuals, including veto of rate increases deemed excessive. This veto power already exists in 35 other states, and is similar to the commissioner's authority to deny auto and property insurance premium hikes.

Proponents say it would make the rate-setting process more transparent. Good stuff, right?

But wait: A powerful coalition of hospitals, doctors and health plans are claiming it would give too much power to one person, and add red tape to an already overregulated system.

Everybody's making it look like they're in it only to protect the average citizen:


Prop 45



The deal, as explained by the LA Times, is this: health insurance, under current CA law, is regulated by two agencies -- the Department of Insurance and the Department of Managed Health Care. Both agencies can review proposed rates but cannot deny them.

The new measure would require the approval of the insurance commissioner (an elected official) before health insurance companies can change their rates or other benefits for small-group and individual health insurance. It also calls for public notice and disclosure, and safeguards like judicial review and litigation when necessary.

Proponents praise these changes, claiming that Prop 45 is the only logical way to keep the cost of individual health insurance in check. Opponents call the initiative an overreach that would give too much power to the insurance commissioner and create a complex and costly new bureaucracy. Ugh!

In the spirit of demystifying these purposefully confusing political measures (see Vote Yes on No), I'm grateful to the League of Women Voters for putting this little video together to make sure people understand what their votes mean here:




Note that the measure will impact only about 6 million of California's 38 million residents -- those who purchase their own health insurance or get it through a small employer; it doesn't apply to large employer plans or people on Medicare or Medi-Cal.

Still, this is a big deal because California is of course a trendsetter state, and it has the largest population with of PWDs (people with diabetes) and therefore the highest D-related costs, at $27.6 billion annually, according to the ADA. One in three hospitalizations in my fair state is due to due to diabetes, KQED reports. So no matter how you slice it, Prop 45 is going to have an impact on life with diabetes -- of which such a big part is already grappling with insurance to assure decent coverage for the supplies and treatments we need!

I contacted the Diabetes Coalition of California for a statement, but was told that as a nonprofit 501C3 organization, they're required to limit their involvement in government affairs, "thus we have not discussed or taken a position on Proposition 45." Frustrating, since this healthcare "football" has turned into a huge power play -- worthy of a television drama series.

Just a small smattering of the lineup -


  • United States Senator Dianne Feinstein
  • California Nurses Association (CNA)
  • California Federation of Teachers (CFT)
  • California School Employees Association (CSEA)
  • Consumer Federation of California
  • California Alliance for Retired Americans
  • California Democratic Party


  • House Minority Leader Nancy Pelosi
  • A majority of California newspapers
  • California Hospital Association
  • California Medical Association
  • California Children's Hospital Association
  • The Civil Justice Association of California
  • CAPG - The Voice of Accountable Physician Groups

"You have interest groups lined up on both sides, all making a case that they are on the side of consumers. It's hard for voters to sort out who actually is on their side," Larry Levitt, senior policy analyst at the nonprofit, nonpartisan Kaiser Family Foundation (unrelated to insurer Kaiser Permanente) told the LA Times. No kidding!

As a PWD concerned about affordable access to the best tools and treatments, I'll be watching this race closely -- I can assure you.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.