As the U.S. Supreme Court hears arguments by the Affordable Care Act's opponents, including some 26 states, other states are already putting parts of the law into practice as they look toward full implementation in 2014.
A new report by California's statewide Health Access coalition shows how the law, signed two years ago by President Obama, is already helping millions of Californians. It details steps underway to make sure the state is ready for the law's full impact. The report, prepared by Health Access policy analyst Linda Leu, is available here.
"Nationally, California has been one of the leaders in implementation," the report says, "but there is much more for the state to do to maximize the benefits and improve the health system."
Among actions already being taken:
Health care exchange: In its 2010 session, the state legislature started passing laws to create a new state-based exchange to help consumers compare health insurance plans. It has also passed key consumer protections including new regulations for insurers. The state is also using over $340 million in new federal funds to implement the law.
Pre-existing conditions: One of the Affordable Care Act's most important provisions is to do away with insurers' ability to deny care for preexisting conditions, which can be as widespread as pregnancy or acne.
Insurers already can't deny coverage to children for preexisting conditions, and the premiums they can charge are limited. In 2014 insurers won't be able to deny anyone coverage for a preexisting condition.
In the meantime, the report says, a federally funded, temporary Pre-Existing Condition Insurance Program offers affordable coverage to adults with preexisting conditions.
Caps on coverage: Under the ACA, health plans can no longer impose a lifetime dollar limit on patients' benefits, and in 2014, yearly caps will also be gone. Coverage can't be taken away because someone is diagnosed with cancer, or because they made a mistake in applying for insurance.
Low-income residents: In any given year, Health Access says, over 8 million, or over one-fifth of the state's residents, are uninsured, "and as a result, Californians live sicker, die younger, and are one emergency away from financial ruin."
In response, the state is already expanding coverage to low-income uninsured people under county-based programs, and in 2014, getting coverage under Medi-Cal (the state's Medicaid program) will be much easier.
(It is important to note, however, that undocumented people are not covered under the Affordable Care Act.)
The already insured: Preventive services, such as flu shots, colon cancer screenings and mammograms, are now free. Insurance companies must publicly report what they spend on health care and on administrative costs, and must spend 80 to 85 percent of premiums on health care or give consumers back the difference.
Women: Though nationally the ACA will require insurance companies to cover maternity care in 2014, California has already passed legislation requiring maternity coverage starting this year.
Nationally, young people can now be covered by their parents' health plans until they turn 26.
Seniors: The "donut hole" gap in prescription drug coverage is gradually being closed. Seniors too young for Medicare who have pre-existing conditions and lack health coverage will have new individual coverage specially for them, with subsidies to help cut the huge costs they face for private insurance.
Communities of color: The ACA includes important reforms to data collection that will help in development of culturally and linguistically appropriate programs that will help shrink the disparities in health care now experienced by communities of color.
While much health care reform legislation has already been signed into law, the report emphasizes that California has much more work to do, to be ready for 2014. Bills still pending include measures to improve consumer protections and insurance company oversight, and to reform enrollment systems to make it easier to get and keep coverage.
Photo: Health care supporters rally outside Supreme Court. March 26. Health Care for America Now (HCAN).