"Keep your eyes on California."

The eyes of the nation are upon California. Just take a look at the headlines from Covered California’s announcement on plans and premiums:

The subtext is not just competitive rates for consumers, or evidence that the Affordable Care Act is working. It’s that the entire success of the ACA is now dependent on California. With other states experiencing political opposition and hurdles, there are a handful that are leading the way. And of those, California is the biggest. In fact, it’s the only state among the 12 states with the highest uninsured rates that is has a Democratic Governor, much less a legislature as well.
As John McDonough writes: California, along with a number of other progressive states, decided to make their new Exchange along the “active purchaser” model, rather than just posting whatever insurers want to sell. Peter Lee, the Executive Director of the California Health Benefit Exchange, is an experienced and smart health policy leader with a long history of active purchasing. This development rebuts assertions that Massachusetts’ success with our Health Connector was an aberration because we started out with a much lower level of uninsurance than in most other states.  California has among the highest uninsurance rates in the nation, and an unreformed individual health insurance market. If it works in California, that argument is moot.”
All the other commentary echoes this point.
But no other makes the point with as much forcefulness as Brian Beutler at Talking Points Memo. For California advocates and activists, policymakers and political leaders, I would recommend reading it to feel the full weight and pressure of history. Here’s a long clip, with emphases added:

The spoiler version is that out in California, where the state government and advocacy groups are actually interested in doing Obamacare right, things are looking pretty good. They’re standing up their exchanges and it turns out premiums for basic bronze and more comprehensive silver health plans will actually come in lower than anticipated. 

This is almost unambiguously good news for Obamacare. 

You can tell it’s good news because it’s obviously good news, but also because the brigade of conservative writers who comb the news for every last Obamacare glitch in less cooperative states have been pretty quiet about it. 

But in addition to auguring well for the law and suggesting its detractors have been blowing implementation problems out of proportion, I think this news underscores the strategic importance, from the administration’s point of view, of getting the ACA right in California in particular.

For those following ACA news closely, I’d almost say forget everything you hear about the law outside of California. 

California is huge, geographically and population-wise. Yet it’s better positioned than almost any state in the US to implement Obamacare smoothly — Democratic leadership, big activist networks, etc. If they can make this work, then a). the law will have a huge head start toward meeting it’s national coverage goals and b). it will serve as a model for every other state in the country for how to make it work. 

More to the point, all the states trying to make the law fail will look very stupid and terribly craven if California pulls this off. 

Their predictable claims that Obamacare is all screwed up won’t be very persuasive if a giant, historically mismanaged state like California can make it work well. 

If it fails in California, though, that’s a disaster. 

Thus, my hunch is that both the administration and California officials are unusually invested in getting it right there, more so than in any other state in the union. The other side of that coin, of course, is that conservatives will be heavily invested in finding ways to undermine it… 

But if you’re looking for an Obamacare bellwether, keep your eyes on California.

Health Access California promotes quality, affordable health care for all Californians.
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