SACRAMENTO — The Senate Health Committee, perhaps fulfilling its chairwoman's promise of conducting "the world's longest hearing," gave California's proposed comprehensive healthcare reform plan a thorough examination Wednesday, even as it put off making its life-or-death diagnosis until next week.

The decision to delay a vote until Monday was made by Senate President Pro Tem Don Perata and announced by Health Committee Chairwoman Sheila Kuehl more than four hours into a marathon hearing that opened at 9 a.m. and continued without a break well into the evening.

The delay comes amid political uncertainty over the fate of the reform bill that would expand health insurance to an additional 4.7 million Californians. Two Democrats on the 11-member panel have said they do not intend to support the bill, and they could combine with the four Republican members to kill it.

Perata does have the option of appointing additional members to the committee before it votes.

Kuehl, an advocate of a single-payer system in which the government would be the sole insurer in the state, has said she cannot support what she believes is an inferior approach. In addition, Sen. Leland Yee, D-San Francisco, said this week he cannot support the bill because he believes it does not protect individuals from being required to pay more than they can afford for mandatory health insurance.

Democratic Assembly Speaker Fabian Nuñez, the bill's author, assailed Yee's position as hypocritical because he did not support a proposal last year that would have given the state authority to regulate health insurance rates.

Coverage for about 70%

"The Assembly put a bill before the Senate Health Committee to oversee those rates," Nuñez said. "Sen. Yee didn't vote for it. He walked away."

The $14 billion reform measure, negotiated principally by Republican Gov. Arnold Schwarzenegger and Nuñez, would extend coverage to about 70 percent of Californians who are now uninsured by expanding public health programs, mandating that nearly everyone buy insurance and requiring all employers to either provide health benefits to workers or pay a fee into a state purchasing pool.

Nuñez, who said he is confident the bill will advance out of the committee to face a deciding vote in the full Senate, called the plan "fundamental healthcare reform that makes access to healthcare a right and not a privilege."

Of key concern to the Senate is whether the program would be financially self-supporting or whether it would further burden a state budget already stretched beyond the breaking point.

Nonpartisan Legislative Analyst Elizabeth Hill, who conducted a study at Perata's request, reported the plan would operate in the black through its first five years if premium costs for those in the state purchasing pool could be kept to the $250-per-month level that proponents anticipate. If those costs turned out to be $300 per month instead, Hill projected the program would operate in the red from the start.

"We do think it will be difficult to meet all of the requirements in the bill at the $250 level," Hill said.

Nuñez and Health and Human Services Secretary Kim Belshé argued the $250 estimate is conservative.

It was arrived at, Belshé said, by adding a 30 percent cushion to rates the state now pays for individuals covered by Medi-Cal managed-care plans. "It's an appropriate point of comparison," she said. "The state has experience in managing and operating publicly funded programs."

'At least $100 out of whack'

Sen. Sam Aanestad, R-Grass Valley, said the better comparison is the average premium now paid for those who have group policies in the state, which is $379 per month.

"I feel your $250 is at least $100 out of whack," he told Belshé.

The costs and benefits of plans offered to those who receive coverage from the purchasing pool would be negotiated by the Managed Risk Medical Insurance Board, the state agency that now negotiates policies offered under the Healthy Families children's insurance program.

The board would negotiate with insurers on behalf of an estimated 2.5 million customers and have much more leverage than employers, even those that negotiate rates for several thousand employees, said Beth Capell, a lobbyist for the Service Employees International Union. "It would be a whole different game," she said.

All workers whose employers opt to pay into the pool rather than directly provide benefits would receive coverage through the pool.

Their premiums would largely determine the state's costs, because the state would at least partly subsidize coverage for everyone in the pool with incomes below 400 percent of the federal poverty level, or $68,680 for a family of three.

The plan would be funded chiefly by four sources: a fee of up to 6.5 percent of payroll on employers, a 4 percent tax on hospital revenues, individual payments of up to 5.5 percent of family income by those insured through the pool, and the infusion of $4.4 billion in new federal healthcare funds to the state.

If the Senate ultimately approves the framework of the reform, the financing provisions would be subject to voter approval via an initiative that would be placed on the November ballot.