Implementing National Health Reform in California:  Changes to Public and Private Insurance

Authors: William S. Bernstein | Patricia Boozang | Paul M. Campbell | Melinda J. Dutton | Alice J. Lam 

The California HealthCare Foundation (CHCF), in a report authored by Manatt Health Solutions, provides an initial assessment of the task that lies ahead for the state of California and its partners in implementing the coverage-related provisions of federal health reform legislation, known collectively as the Affordable Care Act (ACA) of 2010.  With an implementation timeline that spans nearly a decade, the new law will fundamentally alter the availability and structure of health insurance, bringing coverage for the first time to millions of Americans and creating new coverage options for millions more. 

Although the policy and legislation were crafted at the national level, their successful execution depends, in large part, on actions taken within the states, with much of the responsibility falling to state government.  The implementation of health reform will be a massive undertaking, requiring leadership, interagency and public-private collaboration, and a disciplined and aggressive planning process.  The report, "Implementing National Health Reform in California: Changes to Public and Private Insurance", identifies specific provisions that California either must or may implement, with a particular eye to the component tasks, decisions, and actions.  The findings in the report have been informed by interviews with 16 leaders in health care policy and analysis, both private actors and public officials. 

The report focuses on the state's responsibilities in both the public and private coverage spheres, which will grow considerably.  These include:

• Expanding Medicaid and reconfiguring its eligibility standards;
• Creating a health insurance exchange; and
• Implementing a wide range of reforms to commercial markets, as mandated by the new law. 

The goal for this early assessment is to help inform policymakers of actions needed to realize this potential.  In an effort to assist policymakers and stakeholders in navigating the legislation, each section of the report presents a summary outlining the provision discussed, its effective date, the responsible entities, and the decisions, tasks, and considerations facing California as it moves forward with implementation.  While each ACA provision differs in complexity, the report finds that the steps necessary to implement them fall into common categories:

• Monitoring, interpreting, and seeking to influence federal guidance; 
• Facilitating interagency collaboration and planning;
• Identifying and securing financing for administrative and programmatic needs;
• Making and effecting state legislative and regulatory changes;
• Securing state plan amendments, waiver amendments, and other necessary federal approvals;
• Redesigning information technology (IT) systems; and
• Redesigning administrative systems. 

Accompanying the report, as a tool for state policymakers and other stakeholders, is a CHCF/Manatt implementation timeline that charts the decade-long implementation schedule for the provisions of the ACA that relate to both public and private health insurance.  Despite the challenges, the new law has the potential to bring health insurance to many more Californians, improving their access to care. 

Please click here for the full report and implementation timeline available on the CHCF web site.  

With leading expertise in health care coverage and access, health information technology (health IT), health care financing and reimbursement, and health care restructuring, this report is part of Manatt Health Solutions’ growing body of work on federal health reform.  Please contact any of the following for further information:  William Bernstein, J.D.; Patricia Boozang, M.P.H.; Paul Campbell, M.S.; Melinda Dutton, J.D.; or Alice Lam, M.P.A.

back to top

For additional information on this issue, contact:

William S. Bernstein Mr. Bernstein is a member of Manatt, Phelps & Phillips, LLP’s Executive Committee, Chairman of the Healthcare Division, and Administrative Partner of the New York office.  Mr. Bernstein’s law practice concentrates on advising clients in the healthcare industry, including provider organizations, payor organizations, emerging companies and financial institutions.

Melinda J. Dutton Melinda Dutton serves as a Partner within the healthcare division of Manatt, Phelps & Phillips, LLP, and also plays a leadership role within Manatt Health Solutions (MHS), an interdisciplinary policy and business advisory practice within the firm.  Ms. Dutton’s practice concentrates on advising clients in the healthcare industry with respect to regulatory, public policy and business matters.