Harold S. Luft, Ph.D., Director, Palo Alto Medical Foundation Research Institute; Senior Investigator in Health Policy Research; Caldwell B. Esselstyn Professor Emeritus of Health Policy and Health Economics, Philip R. Lee Institute for Health Policy Studies, UCSF

Much of the discussion about the Affordable Care Act (ACA) has focused on its efforts to expand the number of people with health insurance coverage. Beyond the challenges of coverage expansion, however, the ACA incorporates important features intended to slow the rate of growth in health-care expenditures. Ideally, these will increase the value to patients of the care they receive – regardless of payer. These changes, critical to the long-term sustainability of the health-care system, have begun to unfold across the nation; they will have a somewhat different trajectory in California.