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Software support staff wearing blue shirts are on hand to make sure things run as smoothly as possible at the Covered California call center in Concord, Calif., on Tuesday, Oct. 1, 2013. (Dan Honda/Bay Area News Group)

Health care reform is certain to become a dominant political issue in California this fall, as special interests are gearing up to engage voters in a spirited debate about access to doctors and hospitals, health insurance costs, and taxes to fund government programs.

Oh, and there's likely to be some political discussion of Obamacare as well.

As California embarks on another ballot-initiative season, measures dealing with health care issues are proliferating.

Already qualified for the ballot is a health insurance rate-regulation measure that would for the first time give the state insurance commissioner the ability to reject proposed premium increases if they are found to be excessive.

That proposal, backed by Insurance Commissioner Dave Jones, is certain to not only provoke the insurance industry but also to engender opposition from supporters of the Affordable Care Act, who fear the measure could undercut the ability of the state's health insurance purchasing exchange to negotiate rates for policies offered through CoveredCA.com.

Also likely on the horizon is a battle royal between attorneys and doctors over California's $250,000 cap on noneconomic damages in medical malpractice lawsuits, a cap that has not been adjusted since it was established 39 years ago. When the cap was set in 1975, a new car could be purchased for less than $7,000 and the gas to run it cost about 60 cents a gallon.

Adding spice -- and, presumably, political appeal -- to that measure is a provision that would require hospitals to administer random drug testing to doctors.

Although backed by the Consumer Attorneys of California, it is sponsored by someone who has far more sympathetic appeal than an association of trial lawyers.

The chief proponent, Robert Pack, is a Bay Area businessman who lost his two young children in a car accident caused by a prescription-drug-addicted driver. He is driven by a sense of injustice both over what he perceives as lax controls over doctors who negligently prescribe opiate-based painkillers and the fact that California's civil justice system essentially set the punitive cost of those responsible for taking his two children's lives at $250,000, minus attorneys' fees.

The newest initiatives added to the health care mix are two hospital cost-containment proposals sponsored by the SEIU-United Healthcare Workers West union. One would prohibit hospitals from charging more than 25 percent above the estimated cost of goods and services provided to patients. The other would prohibit nonprofit hospitals from compensating executives at rate higher than that paid the president of the United States, now at $450,000.

The SEIU-UHW announced last week it has set aside $2 million to qualify those initiatives for the ballot.

"Health care workers in California are dead serious about improving the health of everyone in the state by lowering hospital costs and holding down executive compensation," said union President Dave Regan in a statement issued last week.

For good measure, there is also another cigarette-tax initiative that has been cleared for signature-circulation. This one would raise taxes by $2 per pack and dedicate most of the revenue to existing programs run by the California Department of Health Care Services that treat patients with tobacco-related diseases -- which is to say just about every public health program.

The last proposed cigarette tax initiative, in June 2012, sought to dedicate revenues for cancer research and suffered from the fatal flaw of not expressly stating that the money would go exclusively to California-based institutions. Despite that, and a $47 million opposition campaign funded by the tobacco industry, the measure lost by less than 0.5 percentage points.

Given the success of Obamacare enrollment in the state -- Covered California announced Tuesday that more than a half-million people purchased policies through the exchange from Oct. 1 to Dec. 31 and another 584,000 applicants were determined eligible for Medi-Cal -- campaign debate about Obamacare in California this fall may seem so, well, so 2012.

Health care politics in California appear to moving on in 2014, with a populist-oriented agenda that seeks to focus on some of the perceived cost-drivers of ever-increasing health costs -- excessive insurance industry profits, exorbitant hospital charges and occasionally incompetent doctors.

In many ways, these are rawer and sexier issues than the complex and relatively modest insurance reforms imposed by the Affordable Care Act. All of these proposed initiatives take aim at well-heeled special interests: hospitals, doctors and the tobacco industry.

It could be that, despite all the angst and anger directed at Obamacare, when it comes to the raw politics of health care reform Californians ain't seen nothing yet.