California Health and Human Services Secretary Diana Dooley and other state officials have indicated that if the U.S. Supreme Court rules that the federal health reform law is unconstitutional, California will face challenges enacting reforms, the Sacramento Bee reports (Siders, Sacramento Bee, 6/22).
Background on Supreme Court Case
The Supreme Court case centers on whether the federal government can require residents to purchase insurance and whether federal lawmakers have the power to pressure states to expand insurance coverage through Medicaid.
The court is expected to make a decision next week.
Potential Gains From Reform Law
California stands to be one of the biggest recipients of federal funding from the reform law because of its large number of uninsured residents. The state has 7 million uninsured residents, making up nearly 20% of its population.
Under the reform law, California could receive as much as $9 billion annually to expand Medi-Cal, the state's Medicaid program. According to calculations from the Urban Institute, the state could receive an additional $6 billion annually for low- and middle-income residents who buy subsidized insurance through the state health insurance exchange.
In addition, California physicians could receive an additional $700 million annually in increased reimbursements under the law for treating patients who obtain coverage under the Medi-Cal expansion (California Healthline, 6/20).
State Officials' Comments
On Wednesday, Dooley said, "We will press ahead to address the underlying problems, but if the full act is stricken -- and by that I mean, if we don't have the federal financial participation -- it will be very hard for us to make significant gains in the short run."
She added that until the state's chronic budget deficit issues ease, "it will be very hard for us to consider a significant initiative like making the Medicaid expansion that we would be able to do if the [reform law] is upheld."
Sen. Ed Hernandez (D-West Covina) said it would be "a travesty" for California if the reform law is overturned. He said, "Without the federal subsidies ... it'd be very difficult for California to move forward, not that we can't try."
Brown's administration has indicated that certain provisions of the health reform law, such as the state's health benefit exchange, will remain intact regardless of how the Supreme Court rules.
Some Republican lawmakers have criticized Democrats for enacting legislation related to the health reform law ahead of the Supreme Court's decision.
Sen. Tom Harman (R-Huntington Beach) said Democrats "don't have an answer" for what happens "if the court strikes this law down." He added, "Yet they want to expand [health reform] dramatically, to have the state pay for it, and California cannot afford to self-fund these types of programs" (Sacramento Bee, 6/21).