California is striving to be a leader in implementing the federal health reform law, but state officials expect to face several challenges along the way, Politico reports.
Diana Dooley, secretary of the California Health and Human Services Agency, said the state wants to be the "lead car" for implementing the reform law. Dooley added, "We are absolutely committed to implementation; we want to move forward."

Leading the Way on Reform

In fall 2010, California became the first state to establish a health insurance exchange under the reform law. Three members already have been appointed to the California Health Benefit Exchange five-member board, and the remaining two appointments are expected to occur in the next month. Officials then will begin searching for the exchange's executive director and move forward on a business plan, community outreach and grant applications. California has reserved $1 million to hire staff for its health insurance exchange.

Expected Challenges

Despite its progress on a health insurance exchange, California is expected to face several challenges as it continues to implement the federal health reform law. Kim Belshé, former CHHS secretary, noted that the size of California's uninsured population will affect how it moves forward with federal requirements to expand Medi-Cal, the state's Medicaid program. California has about seven million uninsured residents and is expected to enroll nearly 15% of them in Medi-Cal, according to the advocacy group Families USA.

The reform law also calls for states to establish a single, easy-to-navigate entry point for health insurance exchanges and public benefit programs. The requirement could pose challenges for California, which currently operates an array of enrollment and eligibility systems for Medi-Cal and Healthy Families, the state's Children's Health Insurance Program.

In addition, California is expected to face financial obstacles as it works to implement the reform law at the same time that it faces a significant budget deficit. Earlier this month, Gov. Jerry Brown (D) proposed a budget plan that would cut $1.7 billion from Medi-Cal.

Forging Ahead

Despite the possible obstacles ahead, Dooley, Belshé and other state leaders say they expect California to continue making progress by maintaining an aggressive pace in implementing the reform law (Kliff, Politico, 1/18

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