EDITORIAL: Health care reform won't be easy in this complex state

We have fewer than five months until the October enrollment launch when uninsured Californians will be able to apply for coverage through the state.

Depending on their income, uninsured individuals can either buy insurance in the state's exchange, called "Covered California," or get coverage from expanded Medi-Cal, the joint state-federal insurance plan for lower-income people.

Yet big issues remain unresolved. The state needs to decide them quickly so providers, insurers, community groups, state agencies and counties can prepare for the October enrollment period.

In his January budget proposal, Gov. Jerry Brown was undecided between a state-based approach or a county-based approach, and he is not tipping his hand until Tuesday, when he presents his May budget revision -- very late in the game.

A county-by-county piecemeal approach makes no sense. The Legislative Analyst's Office recommends that the Legislature adopt a state-based Medi-Cal expansion to match existing statewide Medi-Cal benefit packages, provider networks and provider rates. Get this done.

The state estimates that half of the uninsured will sign up for insurance in the exchange or through Medi-Cal. But some 3 million to 4 million will remain uninsured - 3 million citizens, plus 1 million noncitizens who are not eligible for coverage.

Brown should heed the concerns of counties, but he should not issue the counties a blank check.

Dollars should be distributed by actual numbers of the remaining uninsured cared for by the county safety net.

The LAO says that given the multitude of issues the Legislature faces with health coverage alone, the state should "avoid introducing additional issues -- such as complicated shifts of authority over unrelated programs."

California has plenty to do to get the Medi-Cal expansion and the state health exchange going in time for the October open enrollment period. The governor and Legislature should focus like a laser on that -- and get it done by June 15.