What’s at Stake for Obama’s Health Care Law in California This Election?

Photo by Gabriela Quiros, KQED Science

On KQED Public Radio’s The California Report Magazine on Friday, Scott Shafer talked with Marian Mulkey, the director of the Health Reform and Public Programs Initiative at the California HealthCare Foundation, a health-policy think tank (and a funder of the show).

Edited transcript:

SCOTT SHAFER: First of all, the Affordable Care Act has gradually been getting phased in nationwide. Give us a sense of what’s been happening up to now, right here in California.

MARIAN MULKEY, CALIFORNIA HEALTHCARE FOUNDATION: California has implemented many of the early provisions of the Affordable Care Act, making some new extensions of coverage available, for example, to young adults, assuring that pre-existing conditions are covered for children, and implementing many of the early programs — one for people with pre-existing conditions is in place and covering people already.

California has taken steps in terms of planning and establishing a state-based exchange, which is the marketplace by which people will be able to view their choices, identify what’s available for them and access federal subsidy support for buying coverage.

SHAFER: And it’s fair to say California has been further out in front on that than pretty much any other state?

MULKEY: Yes, California was early in determining it wanted to have a state-based exchange and moved quickly, immediately after the passage of the law in 2010 to start one up and to make some initial decisions.

SHAFER: Some people thought that after the Supreme Court weighed in and basically affirmed the Affordable Care Act, that would kind of be the end of the story. But we do have this big election coming up — the President, Congress. What could change depending on the outcome of that election?

MULKEY: Well, everybody’s eyes are on the presidency right now, and certainly there is a difference. If Obama is re-elected, then we remain on the path that we understand pretty well now, in terms of implementing the Affordable Care Act. If Romney is elected, then I think it’s fair to say, at a minimum, there’s a little bit of a pause, that people are looking toward Washington, and it will likely take months before it’s really clear what the new administration intends to do and what Congress will allow or encourage them to do.

“If Romney is elected, then I think it’s fair to say, at a minimum, there’s a little bit of a pause…”

SHAFER: And last month, Governor Brown vetoed a couple of bills that basically would have required insurers to cover all Californians, regardless of pre-existing conditions, even if the Affordable Care Act is gutted by the new president or the Congress. Why do you think he did that?

MULKEY: There was certainly pushback from the insurance industry about separating that individual mandate that’s in the federal law from the guaranteed issue, or the requirement to sell to everyone regardless of their health, which was in the state law. But I think it’s fair to say that there were many details in those bills — they compromised across all the stakeholders on some of them, and apparently didn’t get all the way to a compromise that the governor could uphold when it came to his desk. I think it’s likely that those issues will be revisited very soon in 2013.

SHAFER: Looking ahead to January, we understand that the governor intends to call a special session of the Legislature, focusing on health. How might this election determine what they might focus on?

MULKEY: If President Obama is re-elected, and we appear to continue down this path toward implementing the Affordable Care Act, then California has many pieces of unfinished business around the specific way we do that.

The individual market rules that you described earlier, certainly the way that we expand and pay for a MediCal expansion — those would be high on the to-do list for the Legislature. On the other hand, if Mitt Romney is in the White House or if Governor Brown’s tax proposition doesn’t pass, then I think attention will go in many different directions. It won’t be so focused narrowly on the implementation of the Affordable Care Ac; there may be higher priorities with respect to balancing the state budget.