Striving until the last moment to make a deal on California healthcare reform this year, Republican Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nunez (D-Los Angeles) suggested that they might release details of a bipartisan plan in mid-December, according to the California Medical Association, which has maintained close contact with both sides.

At press time, the proposal was not yet public, and the end of the 2007 state legislative session on Dec. 21 was only a week away. "The holdups are the employer fee, affordability and the scope of the mandate," Aaron McLear, a press secretary for Schwarzenegger told the Ventura County Star in early December.

In physicians' favor, the proposal was not expected to expand physician assistant or nurse practitioner scope of practice, nor will it have physician taxes, CMA officials said.

According to public comments by Nunez in mid-December, the plan will likely include requirements that all Californians carry health insurance and that the state provide subsidies or tax credits for poor and middle-income families.

The deal will also likely require that Californians have access to coverage regardless of pre-existing conditions and that employers provide workers' insurance directly or pay into a pool on a sliding scale topping out at 6 percent of payroll.

Lastly, the bipartisan plan would probably receive at least part of its funding from new hospital taxes and tobacco taxes, with voter approval of the taxes needed in November 2008.

According to CMA officials, financing for the $14 billion healthcare reform proposal remained fluid at press time, as legislators continued to work to close a nearly $1 billion revenue shortfall.