The statistics from the U.S. Census Bureau and the federal Centers for Disease Control make it clear there's as compelling need for health care reform in California as anywhere in this country.

Since 2000, for example, average health insurance premiums paid by and for families in this state are up 114 percent to about $13,000 per year, with more than one in five families forced to spend 15 percent of their income on health care.

President Obama contends his health care plan would ease those problems greatly, with the competitive insurance exchange he envisions -- with or without a publicly-owned choice -- holding down premiums both for employers and buyers of individual policies and for more than 5 million California families who would suddenly become eligible for tax credits on premiums they pay.

He also claims his plan would greatly up the number of small businesses providing insurance to employees. Where only about 46 percent of small businesses offer coverage now, the claim is that would rise by at least 10 percent under a reform plan.

But there remain some holes Obama needs to fill in his estimates of how California would benefit from reform; these mostly involve illegal immigration.

Obama adamantly insists his plan would in no way benefit illegal immigrants, but it's hard to see how one of his central claims can be accurate so long as he ignores the large populace of illegals in this state, variously estimated at between 1.8 million and 2.5 million persons.

"Right now," says the White House position paper on how the Obama reforms would help Californians, "providers lose over $5.1 billion in bad debt which often gets passed to families in the form of a hidden premium 'tax.' Health insurance reform will tackle this financial burden by ... covering the uninsured, allowing the 355 hospitals and 115,740 physicians in California to better care for their patients."

That "hidden tax" amounts to about $1,400 per year in added expense for every current policy holder in California. The clear implication is that pass-through charges for indigents using emergency rooms will disappear if and when everyone has health insurance.

But that can only be true if everyone is covered. As long as the plan excludes illegals -- and there's no way any plan covering them could get through Congress -- it won't eliminate a major portion of the expenses creating the "hidden tax" in California.

For very few illegals have health insurance. But courts have ruled repeatedly that hospitals cannot turn them away from emergency rooms, the venue they generally must use because doctors and ordinary hospital admissions officials usually demand proof of insurance before providing care.

This makes it plain a healthy chunk of the $5.1 billion "hidden tax" will still be out there even if some form of the Obama plan takes effect. What remains unknown is who will pick up that tab: Will it be the federal or state government or will hospitals and emergency room doctors still be stuck with those billions of dollars, which would likely be passed on to insurance customers much as they are today? There can be no accurate assessment of the Obama plan's California effects unless he addresses the illegal immigrant expense.

Then there are his claims that preventive care will reduce the California health care tab. His report correctly notes that 15 percent of children here are obese, while 17 percent of women over 50 in this state have not had mammograms in the past two years and 40 percent of men over 50 have never undergone a colonoscopy. Getting more Californians health coverage, the paper claims, will reduce expenses caused when illnesses become advanced because they went undetected in their early stages.

Two problems here: First, no one knows how many of those un-scanned men and women are illegal immigrants who would not be covered under the Obama plan and whose coverage would therefore not change. Second, the Congressional Budget Office maintains things like free mammograms, diabetes and colon cancer tests for all would likely end up costing more than treating problems as they arise. And third, no one knows how many of the untested men and women would opt for those exams even if they were completely free.

Still, there's little doubt that, as Obama claims, many Californians need more preventive care and better insurance coverage overall, at a price they can afford.

With at least 60,000 children due to be dropped from the state's Healthy Families program by Oct. 1 and as many as 610,000 more set to be dumped by next July, there's little doubt California needs something new and better.

But it would be wrong to portray the current Obama estimates of what his plan would do for California as anywhere near accurate and complete, if only because they ignore at least one gigantic elephant that's seated right in the middle of the state's living room.

Thomas D. Elias is a syndicated columnist on California issues.

(Sept. 8, 2009)