California reached a pivotal milestone along the road to health reform implementation with Governor Arnold Schwarzenegger's historic signing of two bills creating the California Health Benefit Exchange. This policy briefing examines the central challenges facing the state as it works to establish an operational exchange by 2014.

Participants provided a synthesis of the design and policy issues that informed California's approach to establishing an exchange. The event included perspectives from Jon Kingsdale and Rick Curtis, who advised California's Health Reform Task Force this year.

The speakers were:

• Scott Bain, principal consultant, California Senate Committee on Health
• Kim Belshé, secretary, California Health and Human Service Agency
• Rick Curtis, president, Institute for Health Policy Solutions
• Patrick Holland, managing director, Wakely Consulting Group and former chief financial officer, Massachusetts Health Connector
• Jennifer Kent, deputy secretary for legislation, Office of Governor Schwarzenegger
• Jon Kingsdale, independent consultant and former executive director, Massachusetts Health Connector
• Ed Neuschler, senior program officer, Institute for Health Policy Solutions
• Sumi Sousa, special assistant to California Assembly Speaker John Pérez

Highlights from the event were:

• Jon Kingsdale and Ed Neuschler set the context about what exchanges are, why they are needed, and what the federal law says about them.
• The legislative staff panel discussed the policy considerations that went into the legislative framework. Patrick Holland and Rick Curtis talked about considerations and trade-offs in exchange design with an emphasis on selective contracting, adverse selection, and the broader insurance market.
• One theme was that California's implementation team is very concerned about avoiding the mistakes of the Health Insurance Plan of California/PacAdvantage.
• Another theme was that a selective contracting capability for the exchange is seen as important, but that the related details remain to be worked out.

Slides from the presentations and a transcript of the event are available as Document Downloads, and a published report is available under Related CHCF Pages.