Implementation of the Patient Protection and Affordable Care Act (ACA) began in earnest two years ago at the start of 2014 when, for the first time, large employers and individuals were required by law to purchase health care coverage or pay a penalty.

States also were required to simplify their eligibility rules for Medicaid to make it easier for low-income individuals to qualify, and lawmakers in 16 states further opted to expand their Medicaid programs to cover all individuals making less than 138% of the federal poverty level. Since then, six more states have opted to expand their programs, and several others are still considering doing so. At the same time, the federal health care exchange and a number of state-run exchanges, including Covered California, opened to allow individuals and families that do not qualify for Medicaid or have employer-sponsored coverage to purchase coverage on their own.

While many big changes took effect at the start of 2014, several components of the law were designed to take effect later, including a change to the definition of “small employer,” which just took effect at the start of 2016.

The gradual roll-out of the ACA has made it difficult to evaluate its impact on different parts of the health care market, as has the fact that health care spending naturally tends to slow during economic downturns and to accelerate during periods of recovery. For all of these reasons, it is difficult, if not impossible, to know what the long-term impact of the ACA will be. In the meantime, many of the health care policy changes being debated today continue to center around issues of access and affordability, and a few, in particular, have implications for employer-sponsored

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 2015 Job Killer that would have increased health care costs by granting ability for state regulators to unilaterally alter large-group rate changes (SB 546.)

Controlling Health Care Costs in 2015:

  • Stopped coverage mandates that would have increased employer premiums (SB 190, SB 289).
  • Supported legislation signed mid-year to extend funding for program to provide the Legislature with valuable independent analyses of medical, financial and public health impacts of proposed health insurance mandates (SB 125).
  • Blocked new targeted taxes on employer health insurance (SBX2 14, ABX2 19, ABX2 4)

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).


CalChamber supports efforts to contain health care costs and improve access to high-quality health care by avoiding unnecessary, expensive regulatory controls and the imposition of new coverage mandates, and by allowing market forces to continue playing a predominant role in driving innovation and
transforming health care delivery. In addition, CalChamber:

  • Opposes proposals to mandate specific levels of cost sharing or otherwise shift health care costs from some enrollees to others.
  • Supports policies that promote personal responsibility for individual health care coverage and wellness, and that encourage and better enable enrollees to make value-based decisions about their care.
  • Supports policies that encourage continued medical discoveries and innovations that improve the quality of care.
  • Supports continuing to allow health insurers and pharmacy benefit managers to design prescription drug formularies that encourage prudent utilization of prescription drugs and help them negotiate lower drug prices.
  • Opposes legislation that would limit the ability of employers to require prior authorization and encourage the efficient and safe utilization of health care services, procedures, and prescription drugs by their employees.

Issue Summary

A New Tax on Health Care?

Position: The CalChamber favors maintaining adequate General Fund support for safety-net programs, including Medi-Cal, and believes programmatic funding shortfalls should be addressed in the annual Budget Act in light of the state’s overarching policy priorities. The CalChamber opposes the imposition of new taxes on employer-sponsored commercial health care coverage to subsidize other health care programs, as it penalizes responsible employers, makes employee coverage less affordable and, over time, erodes the quality of the benefits employers can afford to offer to attract workers and maintain their competitiveness in a global economy.

A New Tax on Health Care?

Health Care Bills



Staff Contact

Jeanne CainJeanne Cain
Executive Vice President, Policy