California’s Head Start on Obamacare

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California is behind other states in everything from education funding to road maintenance, but it is at the head of the pack when it comes to implementing the Patient Protection Affordable Care Act, upheld last week by the U.S. Supreme Court.

That's because while most states have waited to learn of the act's constitutionality before undertaking any preparatory activity, California legislators moved quickly to create the state's medical insurance infrastructure.

The Health Benefit Exchange is the cornerstone of expanding health care to as many as five million of the state's seven million uninsured residents. Enacted by the legislature and signed by Governor Arnold Schwarzenegger in October 2010, the exchange will create a virtual marketplace for businesses and individuals to purchase health insurance.

At least five types of health plans will be made available, ranging from basic catastrophic coverage for young adults to high-end plans with comprehensive benefits. A five-member independent board will select the insurance companies for the collaborative exchange as well as the enrollment process.

Because of the state's early work, California has become something of a beta site for national implementation.

That role has served the state well. The federal government has contributed $40 million in program set-up costs, with another $196 million expected in the coming months.

The state's Health Benefit Exchange expects to begin the enrollment process in October of next year, with a full roll out on January 1, 2014.

Meanwhile, the program will generate a massive infusion of federal dollars to California. Current estimates project that the federal government will contribute $10 billion to the state over a ten year period to pay for or subsidize qualified applicants, depending upon their income levels.

Those who earn up to 133 percent of the poverty level--about $30,000 for a family of four--will qualify for basic health insurance at no cost. Those earning between 133 percent and 400 percent of the federal poverty level will receive subsidies that decline in size as their incomes rise. 

Not to be lost among the numbers and jargon is the simple fact that California is prepared to move quickly and efficiently, rather than struggle to catch up. It's an unusual position for the once-Golden State, given our reputation for late budgets and endless gridlock.

Whatever else we may be doing wrong, it appears that the legislature and former governor got this one right.

Larry Gerston teaches political science at San Jose State University and is the political analyst at NBC Bay Area.

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