As California positions itself at the vanguard of the national healthcare overhaul, state officials are unable to say for sure how much their implementation of the federal Affordable Care Act will cost taxpayers.
The program, intended to insure millions of Americans who are now without health coverage, takes states into uncharted territory. California, which plans to expand coverage to hundreds of thousands of people when the law takes effect in 2014, faces myriad unknowns. The Brown administration will try to estimate the cost of vastly more health coverage in the budget plan it unveils next month, but experts warn that its numbers could be way off.
Officials don't know exactly how many Californians will sign up for Medi-Cal, the public health insurance program for the poor. Computing the cost of care for each of them is also guesswork. And California is waiting for key rulings from federal regulators that could have a major effect on the final price tag, perhaps in the hundreds of millions of dollars.
"No one has ever tried to do anything like this before," said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank. "Any numbers attached to this are just a guess."