Insurance rate hikes, medical malpractice and water tunnels might not generate the kind of passionate water-cooler debate you'd find over marijuana, abortion and the death penalty.

But this fall, California voters will be besieged by arguments about those weightier issues in the run-up to November's general election. With the governor's race looking like a snoozer, the big campaign spending and hard-fought battles will be focused on statewide ballot measures -- even though this year's crop won't generate the kind of buzz that drives up voter turnout.

The issue of in-home health care workers, which has recently brought protesters to Sacramento, could be a hot item on the November ballot.(AP Photo/Rich
The issue of in-home health care workers, which has recently brought protesters to Sacramento, could be a hot item on the November ballot.(AP Photo/Rich Pedroncelli) ( Rich Pedroncelli )

For now, the big money is coalescing around two health-related measures: One would raise the $250,000 cap on punitive medical-malpractice damages; the other would give the state insurance commissioner the authority to reject health-insurance premium hikes. Foes have already put up at least $71 million to oppose them. The sparring has already begun.

"This is all about the balance of powers between insurers and consumers, and putting some money back in people's pockets," said insurance measure proponent Jamie Court, president of Consumer Watchdog.

"The devil is always in the details, and it's clear that this measure has a lot of unintended consequences that hurt patients" by increasing costs and reducing access to care, retorted Dr. Amy Howell, chief medical officer of the California Association of Physician Groups.

Voters also will weigh in on one of the drought-plagued Golden State's most pressing issues: water. Lawmakers are still haggling over the size and scope of a multibillion-dollar water bond, and with so much at stake and so much dissension, the bond measure promises to be contentious.

Just a few months ago, it looked as if Californians might vote in November on white-hot issues such as legalizing marijuana, speeding up executions, a voter ID law and even a plan to split California into six states.

But "because there's a feeling that this might be a low-turnout election, some of the people who otherwise might've put their measures on this ballot are doing the calculations and deciding to wait two more years," said Mark Baldassare, president and CEO of the Public Policy Institute of California.

Others -- like the voter ID measure -- failed to get enough petition signatures.

For now, the only other things on November's ballot are a proposed change to the state budget's rainy day fund -- which has bipartisan support and will probably face only token opposition -- and a referendum to overturn the state's gaming pacts with two Native American tribes in Madera and Humboldt counties.

A few more measures might still qualify before the June 26 deadline. Perhaps the most notable, backed by the deep-pocketed SEIU-United Healthcare Workers West, would boost wages for In-Home Supportive Services workers serving the elderly, blind and disabled; it would also require that they have at least 75 hours of training. County registrars are reviewing the signatures now, but it's unclear whether that will be done in time for this year.

"There's nothing here to get pulses racing, to get people really worked up," said Shaun Bowler, a UC Riverside political-science professor and expert on the ballot initiative process.

Yet these measures could touch most Californians' lives, and will certainly generate a lot of campaign spending.

Malpractice cap

The medical-negligence measure comes from Bob Pack, of Danville, whose two children were killed in 2003 by a drugged driver; it's backed by Consumer Attorneys of California and law firms across the state.

It would force doctors to consult an already-existing prescription database to weed out doctor-shopping drug abusers like the one who killed the Packs' kids and also would require random drug testing of doctors. But its most controversial part would raise the $250,000 cap on noneconomic damages in medical malpractice cases set in 1975 by the Medical Injury Compensation Reform Act, indexing it to inflation; the cap would be about $1.1 million now.

Pack said it's less about money than about holding doctors and hospitals accountable for their actions; 11 years after his children died, the hospital where the deadly driver got her prescriptions still hasn't enacted safety measures he believes would've prevented the tragedy. Insurers "are fighting it because they want to keep those profits -- they don't want to pay victims of medical negligence," he said.

But medical organizations, insurance companies, unions, business groups and others claim it will significantly increase costs for consumers and taxpayers, reduce health access, and relies on a massive government-run database. "Ultimately," said Dr. Thomas Sugarman, an Alameda Hospital emergency room physician, "it would benefit trial attorneys at the expense of everyone else."

Insurance rate fight

Backers of the insurance measure led by Consumer Watchdog, the California Nurses Association and hedge-fund billionaire Tom Steyer say 35 states already require insurers to justify rate hikes and get prior approval. And Court, from Consumer Watchdog, said Covered California, the new health insurance exchange created under the national health care reform law, isn't empowered to stop such hikes: "You can't let a marketplace go unregulated, because that will lead either to too limited of a doctor and hospital network or too high of a price."

But foes led by big insurance companies say Covered California can negotiate rates with insurers -- preferable to giving veto authority to an elected politician like the insurance commissioner who relies on campaign contributions to win and keep office.

The measure "was conceived long before Covered California was created, and would create a conflicting bureaucracy," said Robin Swanson, the opposition's spokeswoman, adding the measure also would let Consumer Watchdog earn tens of millions of dollars through rate-regulation lawsuits, as it already does with auto insurance.

Water bonds

In 2009, legislators and former Gov. Arnold Schwarzenegger approved putting an $11.1 billion water bond on the state ballot. But it's been pulled off twice over concerns that it would fail, because it was too big and laden with pork. Now, Democrats and Republicans in Sacramento are trying to find a smaller compromise measure to replace it. It would need a two-thirds majority, however, which has proved difficult. If no compromise is found, the original $11.1 billion measure will stay on the November ballot.

Decades-old battles between farmers -- who want more money spent on large dams -- and environmental groups -- who call for more conservation, water recycling and groundwater storage -- have left the outcome unclear.

At least nine different bond measures have been floated this year in Sacramento. Three or four are still considered in play. Gov. Jerry Brown, said to be working on his own version, has not yet made public what language he supports. A vote is expected by June 26, although the debate could continue through the summer.

Staff writer Paul Rogers contributed to this report. Josh Richman covers politics. Contact him at 510-208-6428. Follow him at Twitter.com/josh_richman. Read the Political Blotter at IBAbuzz.com/politics.

November ballot measures

With the June 26 deadline fast approaching, only a handful of measures have qualified so far for November’s ballot. They are:

Medical malpractice awards: A measure that would raise California’s decades-old $250,000 limit on noneconomic medical-negligence awards, and also force doctors to check a statewide database before prescribing narcotic drugs, put forth by a Danville couple whose two children were killed by a drugged driver in 2003.
Health insurance rate hikes: A measure that would give the state insurance commissioner authority to review and either approve or deny all health insurance rate changes.
Rainy day fund: A measure that would double the state budget reserve’s size from 5 percent to 10 percent of the General Fund; the state would set aside 1.5 percent of the general fund each year, and supplement that with extra capital-gains revenue. For the next 15 years, half of what’s set aside would help pay down the state’s debt and unfunded liabilities, including public employee pensions and retiree health care.
Indian gaming: A referendum to overturn the casino deals that the state made with the North Fork Rancheria of Mono Indians and the Wiyot Tribe.
Water bond: Right now it’s an $11.1 bond measure for water storage, Delta sustainability and other projects, but the Legislature is still haggling over its size and scope.