Health Care Reform in the Balance: California and the Future of the Affordable Care Act

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California got off on the right foot in implementing the Affordable Care Act (ACA). This means it has more leeway to make adjustments to the program than do many smaller states, which will need greater assistance from federal policy changes and higher government spending to stabilize their individual marketplaces. However, if Congress continues to dismantle or underfund the program in coming years, California will have to decide whether to recreate features of the ACA, such as the individual mandate, at the state level, modify the ACA, or move toward other ways to finance healthcare access for the state’s residents. This report traces how California successfully built an ACA marketplace and what its options are in this period of retrenchment.

This report traces how California successfully built an Affordable Care Act (ACA) marketplace and what its options are in this period of retrenchment. California got off on the right foot in implementing the ACA, but if Congress continues to dismantle or underfund the program in coming years, the state will have to decide whether to recreate features of the ACA, such as the individual mandate, at the state level, modify the ACA, or move toward other ways to finance healthcare access for its residents.