Two-and-a-half months before President Obama signed the landmark Affordable Care Act, California State Assemblyman John Pérez had already introduced legislation proposing to implement one of the bill’s central components. Health care advocates describe the move as a sign the state was ready to forge ahead with providing affordable health care to its residents.
While 26 states were busy challenging the ACA in state and federal courts, California has spent the last two years aggressively implementing—and taking advantage of—the legislation’s generous grants and subsidies.
The state has already secured hundreds of millions of federal dollars from the legislation, including over $39 million for establishing a statewide health care exchange – a virtual marketplace where people can buy affordable health insurance. And legislators expect to receive around $15 billion annually to expand coverage to many of the nearly 20 percent of California residents who currently lack coverage.
“You don’t want to govern based on the idea that policies are going to change,” Pérez’s press secretary, John Vigna, said in an interview last Thursday afternoon, adding that “partisan theatrics” aside, California legislators have been working on the assumption of the bill’s constitutionality.
By upholding the Affordable Care Act, “we in California have been given a green light in validation of the work we have been doing to lay the groundwork for full implementation,” said California State Assemblyman Bill Monning Thursday afternoon in a teleconference organized by the California Endowment and Health Access, two prominent California health policy advocacy groups that celebrated the Supreme Court decision.
California Worst State for People Who Are Sick
Quick to implement the act, California remains among the worst states in the nation for people who are sick. Compared to other states, Californians are less likely to be insured or receive employer-based coverage and are at a greater risk of being denied coverage for pre-existing conditions, according to a press release from the California Endowment.
This is particularly true for minorities, who are much less likely to have health insurance.
“California has already taken critical steps to secure and expand access to health care for communities of color in California,” said Ellen Wu, executive director of the California Pan-Ethnic Health Network, in a press release applauding the court’s decision.
About 60 percent of California’s uninsured are Latino, and of the nearly half million Californians who have gained coverage since the passage of the Affordable Care Act, over two-thirds come from communities of color.
California’s early and aggressive adoption of the legislation was not without risks.
Tough questions from the Supreme Court’s conservative justices caused many court observers and politicians to brace for a reversal. While the individual mandate was upheld, a majority of justices did find this central provision unconstitutional under the commerce clause, which was the administration’s legal rational for the measure.
Californians Already Benefiting From Law
The Supreme Court’s ruling provides relief to hundreds of thousands of Californians who are already benefiting from the State’s implementation of the federal law. This includes an estimated 400,000 low-income residents who became eligible for Medi-Cal under the law and whose coverage could have been revoked if federal funding did not continue under the Affordable Care Act.
“Today’s decision was a relief for the nearly half million Californians who are already getting coverage under the law,” said Anthony Wright, executive director of Health Access, who participated in the teleconference.
The Supreme Court’s decision to strike down a provision of the Affordable Care Act that compelled states to expand coverage under the Medicaid program, the only part of the law that fell in Thursday’s ruling, will not affect California because it has already voluntarily chosen to expand coverage beyond the level mandated by the legislation.
Wright minimized the importance of this part of the decision, citing the generous federal benefits offered to states in exchange for compliance. “I do think every state will take advantage of this deal,” he said.
Even as health care advocates are rejoicing in the court’s decision, they are disappointed in Governor Jerry Brown’s decision to eliminate California’s popular Healthy Families program, an insurance program for low-income children. The axing of that program was a compromise with state Democrats intended to help close a $15.7 billion budget deficit. This decision was finalized June 27 late in the evening.
But for many advocates, the Supreme Court victory overshadowed the state loss.
“It is not good to chip away the foundation we are trying to build on,” Wright said, but noted: “At the same time, what the Affordable Care Act does is to give us a light at the end of the tunnel.”
New resources that will be available when major provisions of the Affordable Care Act go into effect in 2014 will make the loss of Healthy Families more manageable, Wright said.