When it comes to implementing the health care reform law, California has just one place it wants to be: way out in front. “We want to be the lead car,” California Health and Human Services Secretary Diana Dooley told POLITICO in January, shortly after the state became the first in the nation to pass legislation allowing it to set up a health exchange. But four months later, it’s hard not to question whether California’s lead is slipping. Gov. Jerry Brown is more focused on filling a $25 billion hole in California’s budget than setting up health reform’s new programs. The state’s health exchange board held its first meeting in April and still has a vacant seat. And sweeping cuts to Medicaid threaten to undermine the public insurance program meant to serve as the foundation of the federal reform law.