In 2010, Congress enacted the Patient Protection and Affordable Care Act (ACA), which made sweeping changes to federal health care laws affecting how millions of Californians access health care. The law has imposed new requirements on states, health insurers, employers, employees and other individuals in an effort to expand coverage to millions of uninsured Americans, and to control the ever-increasing cost of health care. Some of its key provisions include:

  • An individual mandate requiring most U.S. citizens and legal residents to have health insurance coverage or pay a penalty.
  • An employer mandate requiring large employers to offer affordable coverage that includes a basic level of benefits to their full-time employees and their dependents or pay a penalty.
  • Creating health insurance marketplaces (exchanges) where individuals without access to employer-sponsored coverage and small employers can purchase coverage and apply for federal subsidies to make their premiums more affordable.
  • Requiring that health insurers cover individuals with pre-existing conditions, design plans that cover 10 essential health benefits, limit administrative costs and spend more on direct care, and change how they calculate premiums so that lower-income individuals and those with chronic health issues are not priced out of the market.
  • Expanding the Medicaid program (known as Medi-Cal in California) to cover adults who make less than 138% of the federal poverty level, and promising to cover most of the cost of that expansion for states.
  • A number of new taxes to help offset the costs associated with providing subsidies and expanding Medicaid, including an increase in Medicare payroll deductions, taxes on medical devices, health insurers, drug manufacturers, investment income, indoor tanning services and, starting in 2018, an excise tax on the most expensive health care plans, referred to as “Cadillac plans.” Health Care


Promote a sound and affordable health care system. Work to contain costs and avoid unnecessary and expensive regulatory controls, including mandates.

Major Victories

Stopped state proposals in recent years that would have increased health care premiums by establishing numerous health care coverage mandates.

Promoted voter rejection of ballot measures in 2014 that would have led to increased health care costs: Proposition 45 and its fundamentally flawed approach of giving the state Insurance Commissioner authority to approve health insurance rates (thereby potentially delaying health care decisions); and Proposition 46, which would have removed the longstanding cap on pain and suffering awards in medical malpractice lawsuits.

Blocked legislative proposals in 2014 that would have increased health care costs, including new health care mandates (AB 1771, SB 1053) and bills that would have undermined managed care plan savings (AB 2533) or nonprescription-based health care products and services (AB 1917).

Supported urgency measure in 2014 helping small employers control health care costs by allowing them to extend pre-Affordable Care Act policies through the end of December 2015 (SB 1446).

Advocated signing of legislation in 2014 eliminating confusion on waiting period limitations for health care coverage (SB 1034).


• Promote efforts to contain costs and improve access to health care by supporting a health care system that is affordable and improves the overall health of California citizens.

• Work to avoid unnecessary and expensive regulatory controls, including mandates, and continue to support a climate where market forces play the predominant role.

• Continue to support managed care legislation and regulatory action that promotes quality care and cost containment.

• Encourage personal responsibility for individual health care, including coverage, wellness and education, in order to enhance quality of life and achieve long-term health care cost savings.

• Oppose policies and initiatives that shift the cost of health care programs and coverage of the uninsured and underinsured to employers.

• Support opportunities to gain efficiencies and optimal outcomes by coordinating the fragmented health care delivery systems.

• Support policies that promote affordability and value in the Small Business Health Options Program (SHOP) exchange.

• Support efforts to streamline government regulations in order to increase efficiency and reduce overall administrative burdens.

• Support innovative solutions to improve access, quality and cost of health care delivery, including inter-operable e-prescribing with the appropriate assistance for development of infrastructure.

• Support policies that encourage continued Medi-Cal discoveries and innovations that improve quality of care.

• Support the development of a public database with independent governance and clearly defined requirements related to data collection and submission to provide information to purchasers about the quality and value of health care services, providers, and coverage in the state.

Issues Summary

Cost Pressures on Hospitals Increase Employer Premiums
Position: The California Chamber of Commerce supports efforts to improve access to high-quality health care while containing costs to ensure that employer-sponsored coverage remains affordable. Hospital care accounts for a substantial portion of all health care spending, and therefore, policies that lower the cost of in-patient hospital services can have a big impact on insurance premiums for employers. To that end, the CalChamber is supportive of policy changes that allow for more efficient delivery of health care by coordinating fragmented health care delivery systems, promoting use of the most effective treatments based on medical evidence, expanding the use of managed-care over fee-for-service, and streamlining regulations.
Cost Pressures on Hospitals Increase Employer Premiums

Health Care Bills

Business Issues Guide




Policy Contact

Mira-Guertin-2011-300x300Mira Morton
Policy Advocate
Education, Health Care