ABSTRACT
This chapter provides a summary of the decisions made regarding the ACA in California. Unlike other states that struggled to agree on the best course of action or downright abhorred the thought of a federally mandated health care reform law, California demonstrated bipartisan cooperation from the beginning and did not delay implementing plans for a state health care exchange and Medicaid expansion. From the beginning, Covered California board members vowed to become the model for successful health reform implementation and focused on innovation to reinforce their health care infrastructure so it would support California residents for the long term. Like all states, California faced difficulties. Shortly after he was elected in 2011, Governor Brown began fulfilling his promise to balance the state budget at the expense of Medicaid physician funding while also problem solving on how to cover the largest uninsured population of any state in the country. In the end, key policymakers stayed the course and their actions combined with support from both state politicians and citizens allowed California to successfully implement the ACA and provide health care coverage to millions of Californians.
