Board members noted that California has more uninsured residents — roughly 7 million — than the entire population of some states. One of the exchange's key challenges between now and the time open enrollment begins is to explain to Californians how they will be affected by the reforms and how this new part of state government will work.
California's ethnic diversity also will be a challenge in getting out the message. The exchange's marketing effort will provide outreach material in 13 languages.
"It's still a very heavy lift," said Dooley, who also is the secretary of the state Health and Human Services Agency.
She and Lee expressed relief that President Barack Obama had been re-elected, because Republicans had vowed to repeal the health care overhaul if they had won the White House. "At least some of the uncertainty that we faced is now behind us," she said.
Covered California's chief mission is to expand coverage by providing low-cost but affordable health care using federal tax subsidies and credits. The marketplace it is establishing will allow consumers to compare plans and prices online.
Under the federal law, consumers will be required to have insurance or pay a penalty, the so-called individual mandate. By 2016, that penalty will be $695 a year per family member, or $347 for dependents under age 18.
In addition to initiating the exchange, California has taken some key steps under the federal health care law. They include banning insurers from refusing coverage for children with pre-existing illnesses and allowing young people to remain on their parents' plans through age 26.
Also Wednesday, the board approved a plan for Covered California to be financially self-sufficient by January 2015, partly through assessments on insurers. It is seeking a federal grant of about $706 million to cover its expenses over the next two years.