California was the first state to pass enabling legislation and create its own insurance marketplace following the passage of the Affordable Care Act (ACA). Since then, the state has been a leader in the implementation of the ACA and has reduced the uninsured rate from 17.2 percent in 2012 to 8.1 percent in 2015 while seeing some of the lowest premium rate increases in the country. Though there have been various technical challenges in implementation — and the law itself is complex in ways that reinforce these difficulties — in many ways Covered California is achieving exactly what was expected for exchange-type marketplaces, as they were conceived for 30 years previous to the passage of health care reform. It is a model of “managed competition” that should be a model for health reformers going forward. The report uses California Health Interview Survey data on enrollment in the individual market.

• Micah Weinberg
• Patrick Kellerman