The Supreme Court's historic ruling brought sighs of relief to California health officials. In the past months of uncertainty, they’d been bracing for a possible repeal of the Obama administration’s Affordable Care Act, while at the same time facing looming deadlines for implementing several major provisions of the health reform law.
"This ruling makes it possible for us to complete the work that we’ve started and be ready in January 2014 to begin providing health security to nearly 6 million Californians who are uninsured," said Diana Dooley, secretary of the California Health and Human Services (CHHS) agency, which operates Medi-Cal and a number of other health programs. "We’ve had many starts and stops, and we are now in the full-go mode."
California was first in the nation to begin the complex and expensive process of creating a health care exchange program required and funded by the federal health reform law. The idea is to provide a state-run marketplace that offers a smorgasbord of private health insurance plans to small businesses and to Californians who don’t have employee-sponsored insurance. Low-income residents will get subsidies to help them buy insurance.
"We look forward to making the purchase of insurance through California’s exchange as easy as buying a book on Amazon and shoes on Zappos," said Peter Lee, executive director of the exchange. Lee says by October 2013, Californians will be able to compare and choose plans based on costs and benefits. "And we’re going to be moving full speed ahead to build this marketplace, to make it easier for all Californians to get access to affordable insurance," he said.
But Mike Brewer, president of Kansas City-based Lockton Benefit Group – the world’s largest global insurance broker — says that may be a tough challenge.
"You can’t reduce the cost of health insurance if you don’t reduce the cost of health care," Brewer said. "There’s nothing in those exchanges that is necessarily going to do that. So what’s going to happen is health care costs will continue to go up, and it’s going to increase the subsidy requirements, and it’s going to increase the tax burden on people who are already paying for it anyway."
Meanwhile, other Californians are already signing up for care under two so-called "bridge programs" created in the state to provide health care to Californians with pre-existing conditions and to low-income individuals. The programs will last until those portions of the federal law take effect in 2014.