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The fifty states will play a critical role in implementing the Affordable Care Act, and California is one of the states at the forefront of reform. The act can provide coverage to millions of currently uninsured Californians and offers important benefits in terms of more-affordable coverage, improved access to services, and better health outcomes. As the paper by Peter Long and Jonathan Gruber in this issue of Health Affairs notes, the ultimate effects of health reform in California will be influenced by the policy and program decisions that state lawmakers and administrators make during the next three years. Key issues include revamping cumbersome eligibility determination and enrollment processes that could prevent rapid enrollment in expanded public health insurance-but also affording that expansion in the face of large state budget deficits. California policy makers need to move thoughtfully and strategically to ensure that the potential of federal health reform becomes a reality for state residents. [ABSTRACT FROM AUTHOR]

From 2004 to 2007 the California HealthCare Foundation's Step by Step: Local Coverage Expansion initiative supported insurance coverage expansions for uninsured children and adults in thirty California counties. In this paper we describe the initiative and its achievements as well as challenges for grantees. Also, we discuss the implications of the initiative's outcomes for expanding coverage locally and more broadly. Implementing new insurance programs is possible in the most difficult settings. Although there are real challenges to sustaining these expansions and limits to what they can accomplish in the face of major unmet needs, they may lay useful groundwork for broader expansions later. [ABSTRACT FROM AUTHOR]

Using multiple databases, this paper examines recent trends in the affordability and comprehensiveness of small-group and individual health insurance markets in California. Both became less affordable over the study period. In 2006, a single person age 32-52 earning the median income who purchased individual insurance spent on average 16 percent of income on premiums and out-of-pocket medical expenses. For individual insurance, the share of medical expenses paid by insurance as opposed to patients declined from 2002 to 2006. In the small-group market, premiums rose more than 50 percent from 2003 to 2006, but the proportion of claims paid by insurers for a standardized population remained constant. [ABSTRACT FROM AUTHOR]

This paper summarizes the discussion that occurred at a November 2003 roundtable on philanthropy and health policy making. The roundtable was intended to stimulate a conversation about the strategic interplay of health policy and philanthropy in a challenging economy; to gain a richer understanding of the needs and expectations of funders and policymakers so that resources can be leveraged far more effectively; and to identify practical, collaborative approaches for advancing policy development and implementation. The gathering included more than fifty key leaders from state and national foundations; state policymakers; representatives from the California governor's office and key state health agencies and commissions; private-sector leaders; and academics. [ABSTRACT FROM AUTHOR]

This paper examines recent trends in benefits and premiums for individual health insurance products purchased by Californians. There is much variability in the coverage available in the individual insurance market, with correspondingly wide variability in premiums. Despite concerns about increased consumer cost sharing, the average share of health spending covered by these products has remained constant between 1997 and 2002. Whether this trend can continue in the face of higher health costs is unclear. [ABSTRACT FROM AUTHOR]

The article offers information on various publications concerning medical care in the U.S. November 2008 California HealthCare Foundation issue discusses the status of eprescribing in the state and describes how greater alignment of health care stakeholders can stimulate its adoption. A white paper entitled "Health Information Technology in Colorado," was released by the Colorado Health Foundation, which has made health information technology (IT) a strategic priority and has invested 8.5 million dollar in its Healthy Connections initiative.

Presents a personal viewpoint concerning Medicaid (Medi-Cal) managed care program from a California health analyst. Comment on the paper by Gold and colleagues; Unique challenges and opportunities for Medi-Cal with the state's size and diversity; Scope, depth and complexity of Medi-Cal.