No state in America is better positioned to take full advantage of President Obama's health care reforms than California.

While Republican-led states continue to resist implementation -- and to pass up federal money -- California already has received more than $200 million to set up a health exchange marketplace, now officially called California Covered. If all goes as planned, it will eventually insure more than 20 million residents, including 7 million who are now uninsured.

The state is well positioned to receive more than $100 billion from the federal government over the next decade, money California desperately needs to care for its poorest residents. President Obama's re-election and the assurances that health care reform will move forward are the best news for Californians' health in decades.

If California stands to gain more than any other state from this, it also faces a challenge exponentially greater than most other states in getting its program up and running.

The exchange, by law, must start enrolling Californians by Oct. 1, 2013, in time for coverage to begin Jan. 1, 2014. That means a myriad of regulations and coverage options must be debated and implemented, a new health care computer system put in place and thousands of health care workers hired and trained for the millions of Californians who will be exploring their new insurance options. No state government agency has ever pulled off anything this big this fast.


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The federal government and California both have a lot riding on the success of the endeavor. Obama would love to have a model for how states can benefit from federal reforms, and this would be a big one. Gov. Jerry Brown's legacy will, in part, be judged on whether his heavy investment in the exchange delivers. California simply cannot fail to meet this challenge.

Brown is calling a special session of the Legislature in December to focus on how to deal with the implementation task. Any law that's passed in a special session can take effect in 90 days. The initial focus should be on how to expand Medi-Cal, the state's Medicaid program, to capture as many federal dollars as possible, and on establishing the benefits that will be offered by the exchange program.

The governor and legislators must walk a health care insurance tightrope. Offer a benefits package that covers everything including the kitchen sink (which is looking a little piqued, don't you think?), and the costs will sink the program. Offer an unattractive benefits package, and it won't attract the millions of Californians needed to finance a robust program. A clear, simple set of defined benefits and eligibility rules is what California Covered needs to get off to a fast start.

President Obama's re-election gives California an opportunity to solve many of its health care challenges. With the head start it has gotten, the state should become a model for the nation to follow.