What Will the ACA Look Like in California? Getting to the Nitty Gritty Now

More than 200 people filled a Sacramento hotel meeting room yesterday to celebrate the 25th anniversary of Health Access, the consumer health advocacy group. But it wasn't all party -- the event featured a four-hour symposium with speakers including Diana Dooley, secretary of the state Health and Human Services agency; key legislators who chair health committees; and long time health advocates.

And everyone was focused on one thing: implementation of the Affordable Care Act.

After joking that "I quake in my boots" over the amount of work that needs to be done between now and January 1, 2014, Secretary Dooley sounded a distinctly cautionary note of what to expect as the rollout of Obamacare progresses in California. "It's going to take years to make this work," she told the crowd. "There are going to be fits and starts, speed bumps that we'll have to get over."

She talked about her concerns around affordability and capacity. Then she reminded the crowd of the wait for more information from the feds. For example, the Affordable Care Act promises to fund 100 percent of those newly eligible for Medicaid. But in an acknowledgement to the "fiscal cliff" discussions in Washington, she said it's unclear if some of that money may be pulled back.

"We're not going to extend benchmark coverage beyond what is sustainable," Dooley said, "because we cannot take it back. ... I don't want to be on the hook for promising things we can't deliver." She added that she wants to build on a stable foundation and maintain California's position as the "lead car" among states implementing the ACA, but added, "I want to be honest with our partners about where the challenges are."

With that, she had to leave, and three legislators took the podium with a decidedly different view of how the ACA should progress. Assemblymember Holly Mitchell argued that she felt it was a time to be "bold ... You heard from the representative of the administration who has a much narrower view than I see," she said. "We have another branch of government ... clearly we have work to do to create policy and create legislation that can get a signature out of the governor."

Ed Hernandez, chair of the Senate Health Committee, pointed specifically to bills he plans to introduce during the special legislative session expected to begin in early January. The Medicaid expansion bill is among them, he explained, saying the state should "draw down every federal dollar we can." Assemblymember Richard Pan, who chairs the Assembly Health Committee, echoed a desire to get "as close as we can to universal coverage."

Just before taking the podium for the last panel of the day, Ellen Wu, Executive Director of the California Pan-Ethnic Health Network, expressed a level of frustration with Dooley's remarks, especially Dooley's concerns about the cost of Medicaid expansion -- and an apparent suggestion that California might not implement the expansion as fully as advocates would like. "We helped with Prop 30," she said, referring to health advocates' work on behalf of the passage of the governor's education proposition. Communities of color "are 60 percent of California ... and now we're going to turn down federal dollars? It doesn't make sense." She said people of color feel they're "getting the short end of the stick, always getting left behind."

In that last panel of the day, Health Access Executive Director Anthony Wright pointed to the "10 short months we have until October, 2013" when the new exchange will begin selling insurance. "The final obstacle is the clock. That should not curtail our ambition."