By Olivia Niland

USC Annenberg’s California Endowment Health Journalism Fellowship hosted its semi-annual health journalism training institute Feb. 24-27. The theme of the four-day institute was health and place, and aimed to train and inform California health journalists through a series of panels and workshops.

One portion of the conference focused on “Health Reform in California: The Road Ahead,” featuring Gerald F. Kominski, Director of the UCLA Center for Health Policy Research, and Dr. Robert K. Ross, President and CEO of The California Endowment. The discussion, held Wednesday at the USC Davidson Conference Center, was moderated by Anna Gorman, senior correspondent for Kaiser Health News and focused mainly on the implementation the Affordable Care Act (ACA) through the state’s health insurance marketplace, Covered California.

“This is easily the biggest thing to happen to the health system in fifty years,” said Ross of ACA. “Probably the biggest thing that will happen for at least another twenty or thirty. I can’t imagine anything this big being tried by anyone who has watched what has happened to President Obama. No politician in their right mind would try to do anything in health care on this scale again.”

Kominski agreed about the scale of the ACA rollout, and both panelists likened universal healthcare to other the social movements of the past century.

“The ACA is a continuation of the Civil Rights Movement and the social justice that began sixty years ago,” said Kominski. “It is quite clear that the ACA through subsidies will be addressing, in a very direct way, poverty in the United States.”

Ross, as noted by Gorman, grew up in a poor area of New York and worked as a pediatrician during the crack cocaine epidemic in Philadelphia in the 1980s, witnessing first-hand the role that factors such as race, income and geography play in one’s quality of life and access to health care.

Coincidentally, Ross paid a visit to the White House the day after the discussion to meet with President Obama regarding “My Brother’s Keeper,” a program that aims to create opportunities for boys and young men of color, and stressed that Obamacare will work to decrease the disparity of coverage for low income and minority patients seen in the previous healthcare system.

“We’re really interested in how the AFA gives us the platform to make the health care system more prevention-oriented and more equity-minded in its orientation,” said Ross. “I feel like we’re in the Super Bowl now. This is our shot at fixing [the healthcare system], and if Obamacare fails, which I don’t think it will...single payer insurance is where we go next. There’s no market way to fix this other than Obamacare.”

Though it has received a fair share of criticism, Covered California, both Kominski and Ross agreed, has already proven successful.

“If you’re grading on the curve, California’s doing really well,” said Ross. “In an absolute basis, we’re doing okay. This is the biggest thing that’s happened in healthcare in half a century; it’s going to take us more than four or five months to get it right. I think it’s going to take us a couple of cycles of enrollment periods to get in rhythm with this new law."

Among the 25 states that have already chosen to implement the Affordable Care Act, California’s rollout of the program has already proven successful, though it will certainly not be without its problems, Kominski acknowledged.

“Because of lower premiums in California than we originally expected, and the better success that we’re having in terms of enrolling uninsured people, we could be down to two and a half million uninsured Californians in three years,” said Kominski. “But that’s still a lot of people. California’s going to a unique set of challenges.”

Some of these challenges, noted Kominski and Ross, arise simply from the fact that California is the most populous state in the nation and also one of the largest geographically, in addition to the fact that it is home to many undocumented immigrants and people who may not qualify for Covered California for various other reasons.

California’s many ethnic communities, and those around the country, generally, have also shown lower ACA enrollment rates due to the fact that many people rely far more heavily on the testimonies of friends and families than politicians.

“In America, we’re a living room, dining room culture,” said Ross. “Talking to someone and meeting someone who has benefited from [ACA] in your family or down the street is going to be better than any ad campaign, and in particular for ethnic communities. They’re not just message communities, they’re messenger communities; trust is a big deal. That was the best marketing campaign you could come up with.”

Despite these challenges, the state has already made its own mark on the ACA rollout by offering far fewer levels of insurance than other states in favor of standardizing copayments and deductibles, which seems to signal that California is taking a flexible approach to the issue, according to Kominski.

“The fact that there is allowance with state variation means that California can do some things that nobody else is doing and meet the challenges in a way that’s unique to California,” said Kominski. “It’s a pleasure to live in a state where this is an opportunity to get things right, and this is a transformative model as opposed to ‘we’ll do as little as possible to comply with the law.’”

The discussion, attended by about three dozen health journalists and experts, was followed by a Q-and-A session and a reception in the conference center. During the question and answer portion, several journalists made inquiries about what the panelists perceived to be the lifespan of the ACA.

“There are new opportunities every day of issues to fight on and fight about with regards to the ACA,” said Kominski. “If history has taught us nothing else...it’s that those of us who support this law and support a more equal health care system, and the next generation and the next generation are going to have to continue to fight to maintain what we’ve achieved in the last few years...all of this could unravel in a couple of years, depending on what way the country goes politically.”

Though both Kominski and Ross acknowledged the possibility of the ACA disappearing when President Obama leaves office, both essentially said that focus must remain on increasing participation in the program at the present moment.

“The politics we can’t control,” said Ross. “It’s not that I don’t worry about it, but I’m not worrying about it at the expense of getting enrollment up in California.”

The success of enrollment in California, and across the country, said Kominski, is now in the hands of the lawmakers, health care providers, and citizens who have advocated to bring universal health care to the point it has reached today.

“We have got to continue to fight for there to be progress,” said Kominski. “It has taken us 50 years to get to this point. It takes a lot of courage….but it is an ongoing battle.”