Hiltzik: How California made Obamacare work
California’s nation-leading embrace of the Affordable Care Act began with a Republican governor.
Arnold Schwarzenegger had been trying since 2007 to create a universal health care program for the state. He had reached an agreement with then-Assembly Speaker Fabian Nuñez to impose an individual mandate — a requirement that almost all Californians carry health insurance — while providing subsidies for low-income residents. His plan, drawing from the program implemented in Massachusetts under then-Gov. Mitt Romney, would forbid insurers to turn away people with preexisting medical conditions.
In the end, the cost of the program, estimated at $15 billion in 2008, when recession was beginning to bite, sank its chances in Sacramento. But the work done on the proposal placed the state in a perfect position to fully exploit the Affordable Care Act when it came into existence two years later.
“Those of us who worked on the legislation understood that a lot of what was in the Affordable Care Act was a reflection of the work that California had done,” recalls Deborah Kelch, who was a legislative staffer during the California push and went on to become executive director of the Sacramento-based Insure the Uninsured Project.
“There was a lot of desire and effort in the Schwarzenegger administration and the Legislature to do something like the ACA,” Kelch says. “So when the ACA came, we were particularly well situated to take advantage of it and go forward.”
With the Affordable Care Act’s tenth anniversary upon us — President Barack Obama signed the measure on March 23, 2010 — it’s evident that California’s full-scale embrace of the law has yielded dividends for the state, its residents and even the federal government, measured in the billions of dollars and millions of covered enrollees.
Since the inauguration of the individual insurance exchanges in 2013, California’s uninsured rate has fallen by 10 percentage points, to 7.2%. That’s the largest drop in the nation. Among “eligible uninsured” people — that is, excluding those barred from participating because of their immigration status, such as adult undocumented residents — the rate is even lower, 3%.
“California made the right bets,” says Peter Lee, executive director of Covered California, the state’s insurance exchange.
What inspired Schwarzenegger in 2007, and the state’s leaders since then, was the realization that health care is in the community’s interest — that a hole in the public health safety net affecting any individual or family is a danger to all. Nothing has brought that fact to the nation’s consciousness like the current coronavirus crisis.
“If you think you can be an island unto yourself and not worry about the health of your neighbor, there’s no better lesson than what we’re seeing with this virus,” Lee says. “I want my neighbor, my co-workers, the kids going to school with my children to be vaccinated when they should be and treated with ready access to affordable care.”
While California’s approach to coverage may have given it a leg up in grappling with the spread of COVID-19, the disease caused by the novel coronavirus, it’s still hampered by attacks on the Afforable Care Act taking place outside its borders.
The most serious threat is a lawsuit brought by Texas and 17 other red states aiming to declare the entire law unconstitutional. The U.S. Supreme Court agreed earlier this month to review the case, which means the law’s fate will be up in the air at least until the end of the year. A ruling overturning the law will undo much of what California has accomplished.