In his State of the State speech Thursday morning, Gov. Brown spent about 60 seconds addressing health and human services -- and all those seconds were devoted to the rollout of the Affordable Care Act.
Early in his speech, Brown reiterated his theme of fiscal discipline and seemed to urge caution in implementing the Affordable Care Act, stating, "The ultimate costs of expanding our health care system under the Affordable Care Act are unknown. Ignoring such known unknowns would be folly."
Later in the speech came the bulk of his comments about the ACA. Here's the transcript:
"California was the first in the nation to pass laws to implement President Obama’s historic Affordable Care Act. Our health benefit exchange, called Covered California, will begin next year providing insurance to nearly one million Californians. Over the rest of this decade, California will steadily reduce the number of the uninsured. Today I’m calling for a special session to deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January.
"The broader expansion of Medi-Cal that the Act calls for is incredibly complex. It will take more time. Working out the right relationship with the counties will test our ingenuity and will not be achieved overnight. Given the costs involved, great prudence should guide every step of the way."
Let's take these two items one at a time, starting with the health benefit exchange. Brown is calling for a special legislative session so that new laws necessary to implement the exchange can take effect more quickly. That speed is necessary since the exchange must open for people to enroll on October 1. Health insurance purchased in the exchange will start on January 1, 2014.
Regarding Medi-Cal, the governor's comment of "working out the right relationship with the counties" is an allusion to money, a topic he addressed when he released his budget earlier this month.
Right now, California counties receive billions in state dollars to care for the uninsured. Under the Affordable Care Act, most of the uninsured will have access to coverage. That access will largely be paid for in federal dollars. Gov. Brown believes that since the counties will benefit from this new federal money, they should pick up the tab for other things the state has traditionally funded. Childcare subsidies is one idea that has been tossed out. Determining the "right relationship with the counties" could shape up to be one of the political battles to watch in the coming months.
The "unknown" of the ultimate cost is, in part, because no one can be sure exactly how many people will sign up for coverage. In addition, the mass marketing that is expected to happen this summer to encourage people to enroll is expected to bring in many people currently eligible for Medi-Cal but not currently enrolled. The state will be on the hook for half the costs of these people -- not the 100 percent federal dollars for the newly eligible.
Listen to Jerry Brown's comments on health care reform: