The Democratic Party has decided to make California the face of Obamacare implementation. Multiple left-leaning writers have hailed California as the example of the law working. On Friday President Obama is going to fly all the way to San Jose to deliver a speech touting the new law.
If the Affordable Care Act is going to “succeed” anywhere it will be in California. It has three special conditions that make it the best case scenario for the law to look good.
- Democratic Control – California is completely controlled by Democrats who are actually committed to making the law work. This is a rarity among the fifty states with many local elected Republicans planning to do anything and everything to torpedo the law. There are only 13 states with completely Democratic government. This means California is one of the few states that will expand its Medicaid program and establish both its own individual and small business exchange.
- Large Size – California also has the added advantage of being extremely large, with several insurance companies. Many Democratic controlled states are small with concentrated insurance markets. California’s large size gives it the best chance of having a large risk pool and the robust level of competition makes it much easier for the state to try an active purchaser exchange model. It is one of only six states where the exchange will actively negotiate with insurance companies for the best deal.
- Large Uninsured Population – California is fairly unique among the blue states for having a large uninsured population, well above the national average. The uninsured rate in California is 20 percent, compared to only 9 percent in both Minnesota and Vermont. I consider the Medicaid expansion by far the best part of the new law, but many blue states had previously expanded their Medicaid programs. In those states the best part of the ACA will not have a big impact. Because California is starting from such a low par it will be easier for the ACA to improve the status quo.
Thanks in large part to the Supreme Court ruling and Republican opposition at the state level the national implementation of Obamacare is going to be far more problematic than Democrats initially expected. It will cover significantly fewer people and have a lot more issues, which why I suspect supporters of the law have started focusing so much on California.
When Obamacare implementation runs into trouble elsewhere I suspect Democrats are going to point to California as the example of how the law could have worked if not for the Republicans.
Photo by Free Grunge Textures released under Creative Commons License