​California’s efforts to increase access to health insurance coverage and health care services reflect political, professional, and consumer leadership and a shared sense of social responsibility and will. This commitment is mirrored in the reduction in the number of the uninsured living in [this] state, in spite of efforts by the Administration to weaken the necessary infrastructure, which includes funding for outreach and enrollment workers to enroll hard-to-reach, eligible populations. Medi-Cal and Covered California leadership (which included extending the amount of time in which eligible individuals could sign up for coverage) combined with a number of activist community-based organizations to enable the state to beat the odds, reaching and retaining millions of beneficiaries.

Medicaid Coverage expansions in 32 states and Washington, D.C., was not the only Affordable Care Act (ACA) win. Most notably, the commitment to preventive health care services as part of essential benefits helped to ensure that more than 55 million women gained access to contraceptive coverage without copayments and deductibles. Additional progress included enabling consumers with a preexisting condition to gain vital access to coverage, young adults up to age 26 gaining coverage through their parents’ plans, retaining foster care youth as they aged out of the system at age 18 up to age 26, and efforts to reduce health care costs through a variety of cost containment learning efforts through the Center for Medicaid and Medicare Innovation (CMMI). Yet the almost daily barrage of Congressional and Administrative efforts to further weaken the ACA, beyond the elimination of the individual mandate (in 2019) and premium subsidies, will likely not decrease in intensity.