The Affordable Care Act (ACA), passed into law in early 2010, identified significant responsibilities for both the federal government and the states prior to full implementation in 2014.

The ACA includes many short-term changes intended to expand and improve health insurance, including new consumer protections for people with private coverage; tax credits for small, low-wage businesses; and a new program that allows those with preexisting conditions to purchase health insurance. At the same time, investments are being made to strengthen prevention and public health, and to support community clinics. In the longer term, broad expansion of enrollment in both private health insurance plans and public programs is anticipated.

This CHCF Sacramento briefing provided a basic overview of the ACA and its impact on California as the state implements health reform. This briefing is intended for those not closely following the ins and outs of the ACA or implementation activities in California.

Presenters discussed the creation and operation of the California Health Benefit Exchange, opportunities and challenges for Medi-Cal as it moves to accommodate an expanded patient population, provisions of the ACA intended to shore up the health care workforce to meet the increased demand for health services under health reform, opportunities to advance prevention and wellness, and ways to support seniors in the community under the framework of the Community Living Assistance Services and Supports program (CLASS Act), part of the ACA designed to expand options for people who become disabled and require long-term aid.

The speakers were:

• Gretchen Alkema, vice president of policy and communications, The SCAN Foundation
• Janet Coffman, assistant professor, Philip R. Lee Institute for Health Policy Studies, UCSF
• Marian Mulkey, director, CHCF Health Reform and Public Programs Initiative
• Karen Shore (facilitator), vice president for planning and health policy, Center for Health Improvement
• Janani Srikantharajah, program coordinator, Prevention Institute

Highlights of the presentation were:

• Karen Shore opened with a brief overview of the ACA and described major components of the law.
• Janani Srikantharajah discussed the differences between primary and community prevention; opportunities for prevention available in the ACA, including $15 billion for community prevention over 10 years; community transformation grants; and community-centered health homes.
• Marian Mulkey focused her remarks on present-day health care costs and coverage, public and private coverage expansion and related changes in benefits, and access to care in the ACA and provided an update on implementation activities in California in these areas.
• Gretchen Alkema talked about the projected growth in the older adult population and opportunities presented by the ACA to transform long-term supports and services through Community Living Assistance Services and Supports (CLASS), expanding supportive services via Medicaid, coordinating care and care transitions, workforce enhancements, and nursing home reforms.
• Janet Coffman closed with a discussion of the impact of the ACA on demand for health care services and additional health workforce challenges. She outlined the ACA provisions on funding for physician reimbursement and health provider education, described state activities to assess and plan health workforce strategies, and described the vulnerabilities in funding of workforce grant programs because funds have been authorized but not yet appropriated.

The presenters’ slides are available as Document Downloads. Videos of the presentation with slides embedded are available under External Links.

For more information, contact Danny Sandoval (916.329.4542).