STEVE INSKEEP, Host:
At the same time, a few states, including California, are moving ahead quickly with implementation. From member station KQED in San Francisco, Sarah Varney has more.
SARAH VARNEY: California has blazed many trails - from wheatgrass shots to personal computing. But with the health overhaul, it's shaping up less as a trailblazer and more as a renegade. Its congressional delegation and new crop of state leaders, including new California insurance chief Dave Jones, are not only embracing the law, but championing it.
M: As to my first priority - the implementation of health care reform - I believe it is important to move forward here in California, even if a new Republican majority in the House of Representatives wants to turn the clock back and deny Americans health care reform.
VARNEY: And like a good 'ole barn-raising, the California insurance exchange - a centerpiece of the plan - is rising out of the earth, practically overnight, with help from both parties. Earlier this week, outgoing Republican Governor Arnold Schwarzenegger made two appointments to the board that will oversee the exchange. One was his chief of staff, Democrat Susan Kennedy. The other was former secretary of Health and Human Services Kim Belshe, a Republican.
M: California wasn't starting from scratch with implementation.
VARNEY: Belshe led Schwarzenegger's effort to remake the state's insurance market in 2007, a plan similar to what is now federal law. The proposal failed, but Belshe says it created momentum.
M: California's guiding motto for health reform implementation has been 2014 is tomorrow. And it's true that many federal reforms are not slated to take effect until 2014, but the magnitude and the import of the state responsibilities require action now.
VARNEY: Still, strong support for the health law isn't surprising, says Democratic political consultant, Chris Lehane. California Democrats have a big lead in voter registration, in part due to a loyal - and growing - Latino population.
M: Part of it is the demographics. I think part of it is just the culture that exists out in California - people are forward looking, they embrace change.
VARNEY: California's enthusiasm is buoyed, no doubt, by the fact that the state won't pay for the expanded coverage out of its own depleted vault - at least not right away. And it has a lot to gain. The state has legions of uninsured residents, many of whom work in low-paying, service-sector and agricultural jobs. And some 3.4 million people are projected to gain coverage by mid-decade.
M: There is a huge benefit for folks in California from this legislation.
VARNEY: Robert Restuccia is head of Community Catalyst - a Boston-based consumer advocacy group that supports the federal law.
M: You have an insurance market that really discriminates against anyone who is sick. You have one of the highest number of uninsured. You have a delivery system that's underfinanced.
VARNEY: For NPR News, I'm Sarah Varney in San Francisco.
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