No state is more prepared than California to move ahead with health care reform now that the Supreme Court has spoken.

The state, with the nation's largest number of uninsured people at 7 million, moved aggressively to implement the law from the moment it was signed by President Obama in March 2010.

Already, hundreds of thousands of low-income Californians have access to health care, thousands of people with pre-existing health conditions have coverage and parents can keep their adult children on their coverage until age 26.

The state has the potential to draw in billions of federal dollars to continue building the framework for the new law and to expand the number of people eligible for Medi-Cal, the state's Medicaid health program for the poor, by as many as 3 million people.

Thursday's Supreme Court decision is "a victory for consumers; it's a victory for California," said Anthony Wright, executive director of Health Access California, a consumer health advocacy group. "It's a huge relief for the half million who are already getting coverage under the law, it's a relief to millions who have new consumer protections they wanted to keep."

The ruling means continued health care for low-income Californians who are already covered through county-run programs and for young adults who have been allowed to stay on their parents' plans. Seniors stuck with high out-of-pocket costs for prescription drugs through Medicare will get relief, and thousands of people with pre-existing health conditions will not be denied insurance.

Virtual marketplace

A key element of the law is what's known as the health insurance exchange, a state or federal-run virtual marketplace where people in 2014 are expected to be able to buy insurance at competitive prices, many with the help of federal subsidies.

California was the first state to set up its exchange and is preparing to enroll people in fall 2013 for coverage in 2014.

The state has moved forward with other key elements of the law, such as expanding coverage to low-income residents who don't qualify for Medi-Cal under current rules. Already some 400,000 low-income Californians, mostly childless adults, are covered through temporary programs in 47 counties funded with the help of federal money. Most of these residents will be transferred in 2014 to Medi-Cal.

The state has also enrolled about 11,000 Californians in a new high-risk insurance pool created by the federal law for people whose medical histories make it difficult or impossible to get coverage.

Hope for the future

Uninsured residents like Edith Gonzalez, a 26-year-old Academy of Art University student in San Francisco, hope the federal law will help them.

Gonzalez had insurance when she needed emergency surgery last fall to remove her gall bladder. But, she said, her insurer denied her claim, saying the gall bladder issue was a pre-existing condition. Until she needed surgery, she said she didn't even know she had the problem.

Gonzales now has a $120,000 medical bill and can no longer afford health insurance. She hopes the law will enable her to buy coverage again, regardless of her health history. "The passing of this gives me an opportunity to really try to get insurance (companies) to see me as person, not just as a figure for some accountant," she said.

The element of the law already in place that lets grown children stay on their parents' policies until age 26 has particular resonance in this era of high unemployment.

Robin Hansen, of San Francisco, has two sons, age 19 and 21, with health conditions that would make it difficult for them to find coverage on their own. Now she's assured they won't be denied insurance when they're forced off her policy at age 26.

That will be in five years for her oldest, who has learning disabilities.

"I'm hoping he'll have a job where there will be some kind of insurance offered," Hansen said, "but if he does have to buy some kind of private or supplemental insurance, he won't be discriminated against."

For the health law's advocates, the one setback Thursday was the court's decision to strike down a provision to withhold federal funding to states that declined to expand their Medicaid programs to more people.

That ruling will probably not have an impact in California, however.

"California has already taken the initial steps to begin implementing the Medicaid expansion, so it's unlikely the state will pull back," said Jennifer Tolbert, director of state health reform for Kaiser Family Foundation, which conducts research and tracks health care policy.

Federal aid

Thursday's ruling means California, which has not committed general funds to the effort, stands to reap billions of dollars in federal funds for further expansion.

For the Medi-Cal expansion alone, between 2014 and 2019, the state expects to receive about $45 billion in federal matching funds, according to an analysis by the Kaiser Family Foundation.

To date, the Kaiser Family Foundation calculated that California has received about $270 million to expand its network of health centers and clinics to accommodate the growth in the number of patients covered under Medi-Cal.

Already, California has been granted $40 million in federal dollars to set up the exchange, and on Wednesday submitted an application for $196 million in additional planning and startup money for 2014.

Sally Pipes, president and chief executive officer of the right-leaning Pacific Research Institute in San Francisco, argued that the federal government is not able to help the states as much as they need.

"Whatever the funds that come to California, it's not going to be enough to make a huge expansion of our Medicaid program," she said, adding that private insurance would continue to increase in cost. "It's going to cause more business to leave the state and more people to leave the state."

Hospitals and doctors had mixed views of the Supreme Court's decision.

Sue Currin, chief executive officer of San Francisco General Hospital, said health providers are concerned about physician shortages. She said elements of the health law have already provided coverage for more low-income residents.

"We've been on that road since 2010, and we're just thrilled it's going to continue," she said, adding that she hopes it will reduce uninsured patients in the county hospital's emergency department. "It's just going to take some time to work."