California could see more than 5 million residents obtain health insurance coverage by 2019, substantially reducing the number of the state's uninsured, state officials and health care advocates said following the Supreme Court's health care ruling Thursday.
The ruling preserved billions of dollars in federal subsidies for such an expansion, and the Brown administration said it is in "full 'go' mode."
"California has been a leader in health care reform for a very long time," California Health and Human Services Secretary Diana Dooley said after the court upheld the central provisions of President Barack Obama's signature law. "We've had many starts and stops, and we are now in the full 'go' mode here."
Though the administration vowed in recent months to press forward with provisions of the health care law even if the court were to strike part or all of it down, it was unclear how effective such an effort could have been without federal aid.
Under the Affordable Care Act, the state is expected to receive $45 billion to $55 billion from the federal government from 2014 to 2019 to expand Medi-Cal, with the state contributing an additional $3 billion to $6.5 billion.
The state's version of Medicaid, which currently provides coverage for nearly 8 million low-income residents, could add an additional 1.2 million to 1.6 million Californians to the program by 2019, according to the state.
Through the California Health Benefit Exchange, a public health insurance marketplace prescribed by the federal overhaul, officials estimate that about 2 million Californians – many of them currently uninsured – will obtain subsidized insurance beginning in 2014.
More than 2 million state residents are expected to purchase coverage without subsidies.
"This ruling removes a distraction from the job that thousands of Californians have come together to address," said Peter Lee, executive director of the California Health Benefit Exchange.
California, the first state in the nation to establish such an exchange, plans to begin marketing it heavily to residents next year, before starting pre-enrollment in October 2013.
"We look forward to making the purchase of insurance through California's exchange as easy as buying a book on Amazon or shoes on Zappos," Lee said.
Parts of the federal health care overhaul would have remained intact in California regardless of the court's ruling.
The state has already enacted legislation prohibiting most insurers from denying coverage to children because of pre-existing conditions and allowing people up to age 26 to remain on their parents' policies. According to the California Endowment, a health care foundation, one in six Californians age 19 to 25 have taken coverage on their parents' policies since 2010.
State officials said the exchange would remain in place, too, if the law were struck down. But insurers feared that without a mandate – and relatively healthy people in their insurance pools – they might be unable to contain costs.
Reaction to the ruling throughout the state was swift and, as elsewhere, highly partisan.
"For California, a state already in more than financial distress, this represents a potential huge new financial burden," California Republican Party Chairman Tom Del Beccaro said in a prepared statement. "Californians cannot afford the government we have – there simply is no way for us to afford this new and massive expansion of government."
At the state Capitol, Senate President Pro Tem Darrell Steinberg, D-Sacramento, said the act's implementation would only improve the economy.
"What this will mean to people and to our economy in the most positive way cannot be overstated," he said. "I'm really happy, I really am. It's a great shot in the arm for this country and shows that anything is possible."
Legislative Democrats and health care advocates suggested in the run-up to the court's ruling that California might enact a health care expansion of its own if the law were struck down, though prospects were uncertain: Lawmakers in 2008 rejected a health care expansion program proposed by Gov. Arnold Schwarzenegger, and voters four years before that repealed an attempt by Gov. Gray Davis to expand coverage.
Paul Song, a radiation oncologist in Los Angeles and a board member of the liberal Courage Campaign, said his organization still might back an effort to enact more sweeping changes.
"We still have a health care crisis regardless of how the Supreme Court ruled today," he said.
With the uncertainty of the November election and the desire of Republicans to repeal the law, Song said, "I think that no one should really breathe too comfortably yet."