Our Health Care at Risk


Under the Affordable Care Act (ACA), millions of Americans have new health coverage options and new help to afford coverage that they can rely on. California led the nation in expanding Medicaid, giving working families subsidies in Covered California in order to afford private insurance, preventing people from being denied coverage because of pre-existing conditions, letting young people stay on their parent's insurance until age 26, and much more. But these options are at risk. President Trump, and the Republican majority in Congress including many Congressional Representatives from California have promised that the ACA should be repealed, without a comprehensive plan to replace it. Without these new options and financial assistance, millions of folks who have benefited from the ACA will face dire health and economic consequences. Visit www.Fight4OurHealth.com to see more personal stories, and visit www.FightAndResist.org to learn about upcoming phonebanking opportunities.

Share Your Story

We must be explicit with the new Congress and Administration about the true impact of their decisions—to fight to preserve the benefits we rely on today. Please share your story about how the ACA has helped you and your family. Your voice matters, and it will be what helps preserve this progress.

Your voice can make a difference. Tell us why the Affordable Care Act matters to you.

Learn more


SIGN-ON LETTERS: Coalition Organizations Committed to Ensuring that All Californians have Access to Quality, Affordable Health Care

Save Lives logo   Prop 55 logo

California's Health Is On The Ballot This November

Health Access California endorses propositions 55 & 56 to raise revenue for Medi-Cal, a pilar of our health system on which we all rely. 

Fact Sheets

Proposition 56 Saves Lives & Money, Raises Over $1 Billion to Improve Medi-Cal and Our Health System

Proposition 55 Can Restore and Improve Medi-Cal and Our Health System

YES on 55 & 56 for California's Health

Medi-Cal and the Propositions

Capitol Weekly: Medi-Cal pervades Nov. 8 ballot

Capital & Main: California Comeback: Will Health & Human Services Escape Future Cuts?

Learn More About Proposition 56

Kaiser Health News: Tobacco Tax Ballot Measure Would Fund Health Care For California’s Poor — But How?

Blog: Health Advocates Protest Big Tobacco’s Lies

Editorial Endorsements:

California Budget & Policy Center: Proposition 56: Should California Voters Increase the State Excise Tax on Cigarettes and Other Tobacco Products?

Yes on Prop 56 website

Learn More About Proposition 55

Press Release: Health Access California Endorses Proposition 55

California Budget & Policy Center Analysis: Proposition 55: Should California Maintain Higher Taxes on the Wealthiest to Fund Education, Health Care, and Other Services?

Yes on Prop 55 website


Merger Watch

Is bigger really better?

Consolidation in the health industry often means fewer choices and competition, with no benefit for patients or the public. Health insurance companies should not be allowed to get bigger unless they get better. Health Access is closely monitoring mergers and seeking strong consumer protections and other conditions to ensure that these mergers are in the interest of California consumers and the health system on which we all rely.

In seeking regulatory approval for these mergers, the burden is on the merging companies to show that consumers will actually benefit in the form of lower premiums, lower out-of-pocket costs, higher quality care, and reduced health disparities.

With several pending insurance mega-mergers pending, insurers must be required to comply with strong, enforceable conditions to ensure consumers receive the benefits promised by company executives and should be required to address any existing problems relating to cost, quality, and customer service. 


Anthem, one of the largest insurers in the state and nation, proposes to acquire Cigna for $48.3 billion. This merger would consolidate the national health insurance market from five major companies to just three. California regulators are reviewing this merger.

Centene-Health Net

Centene proposal to acquire Health Net for $6.8 billion was approved by both the DCI and DMHC in March of 2016. This merger will allow Centene to have a significant presence in California, gain entry into our commercial market and Covered California and drastically increase its participation in the Medi-Cal program by nearly sevenfold.


Aetna is proposing to acquire Humana, a large player in the Medicare Advantage market. Aetna has a troubling track record in California’s commercial market, including imposing unreasonable rate increases on small business purchasers. This merger raises concerns about its effects on California’s commercial market, where most of Aetna’s California business is based. The merger will also impact the Medicare marketplace, resulting in less competition and fewer options for California consumers.

Blue Shield-Care1st

The merger between Blue Shield of California and Care1st was completed in November 2015. Blue Shield, a large California-based insurer, purchased Care1st, a Medi-Cal managed care health plan in Southern California. Blue Shield’s acquisition of Care1st enabled Blue Shield to participate in California’s Medi-Cal program for the first time. In addition to our concerns about consumer protections, the Blue Shield-Care1st merger raises questions about Blue Shield’s nonprofit status and assets, including the $4.2 billion it holds in excess reserves and if those assets are subject to charitable trust obligations.

Nonprofit Hospital Mergers – Saint Agnes Medical Center

Trinity Health, which owns Saint Agnes Hospital in Fresno, CA, merged with another entity in 2013. One of the conditions of the Attorney General's approval of the merger required Saint Agnes to provide minimum level of charity care for six years. The minimum amount was set at $6,792,442 in 2013. Saint Agnes is now asking the Attorney General to reduce the minimum charity care amount because there are fewer uninsured people due to the Affordable Care Act implementation. Health Access opposes this request because charity care continues to be a needed and valued part of the safety net. 

Nonprofit Hospital Mergers – St. Joseph-Providence Hospitals 

St. Joseph and Providence are two major Catholic hospital chains with facilities throughout California. Health Access has requested the Attorney General to ensure that all existing hospital services remain open for at least ten years, require existing reproductive health services to be maintained, and more robust charity care to meet ongoing access and affordability needs of communities served by these hospitals. We also raise concerns about how this merger might lead to higher prices and less competition. 

Nonprofit Hospital Mergers – Daughters of Charity Health System 

In December 2015, the Attorney General granted conditional approval of a change of control and governance of the nonprofit Daughters of Charity Health System (DOCHS), allowing BlueMountain Capital Management to operate DOCHS’ six hospitals and gain a right to purchase the chain. Health Access advocated for strong conditions to ensure the hospitals and current services remain open for ten years and charity care is maintained.

The Attorney General previously granted conditional approval of the sale of DOCHS to Prime Healthcare, a for-profit company. Health Access opposed this merger unless it included strong conditions to ensure DOCHS’ hospitals and services would remain open to the community. Prime Healthcare subsequently backed out of the deal.

For more information about Health Access’ work on mergers, please contact:
Tam Ma, Policy Counsel, tma@health-access.org

Health Care Options Project

HCOP - Nine Options for Health Care Reform in California (2002)

HCOP Executive Summary (2002)

In October 1999, the Governor signed SB480 (Solis). This law calls upon the Secretary of the California Health and Human Services Agency (CHHS) to examine options for providing health care coverage to Californians -- approximately 6.3 million of whom lack coverage. The state legislation calls for a process that involves both public and private sector stakeholder groups in examining the various reform options.

To implement SB 480, CHHS applied for and received a one-year State Planning Grant of $1.2 million from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services on February 28, 2001, establishing the Health Care Options Project, designed to meet the requirements of SB 480. The grant provided an opportunity to develop and update ideas and options on how to expand coverage in California.

The goal of HCOP was to guide the state in a systematic exploration of different approaches to achieving expanded coverage by engaging in an in-depth examination of a range of reform options. An ambitious undertaking of HCOP was to provide policy makers and the public with detailed information about the costs and coverage impacts of different approaches to extending access to coverage. By using sophisticated economic modeling, the HCOP was able to estimate for each of the proposals how many people would become covered, the characteristics of the people that would be covered, the changes in their out-of-pocket costs, and the financial impacts on public and private payers, including employers. The options were then reviewed using a public process.

Health Access undergoes research and advocates quality, affordable, universal health care for all. These nine proposals as well as the HRSA, Lewin Summary, and the AZA Consulting Summary of the proposals are now applicable to many pieces of legislation introduced in the last several years and serve as important resources for policy analysts and lawmakers. Health Access also has its own report card on the nine proposals available: HCOP Report Card.

The Nine Proposals

The Cal-Health Option
This proposal would create the California Health Care Program (Cal-Health), which will coordinate the Healthy Families program through MRMIB, and the Medi-Cal program through DHS by providing a uniform and simplified application process. This option provides for outreach efforts to increase enrollment in the Healthy Families and Medi-Cal programs for those persons currently eligible but not enrolled. It also seeks to expand health insurance coverage under the Healthy Families program for parents of eligible children in families with incomes up to 250% of the federal poverty level (FPL). There will be a standard uniform benefits packages (SUBP) that can be offered by commercial carriers to persons with incomes above 250 percent of FPL and to small firms. Additionally, it seeks to extend coverage under Medi-Cal (under 133% of FPL) and Healthy Families (133%-250% of FPL) for non-custodial adults who are not eligible for any other health insurance programs.

Cal Care: A Single Payer Health Care System for California, developed by Judy Spelman and others; Health Care for All. This reform proposal also would replace current health financing arrangements with a single, publicly financed health insurance program that would cover all Californians. Savings from reduced administrative costs and other cost-savings features would help finance the extension of coverage to previously uninsured people. This proposal differs from the previous proposal in some areas of benefits and administration.

The CHOICE Option
CHOICE Option, submitted by Helen Halpin Schauffler and Sara B. McMenamin, University of California at Berkley. Under this reform option, a public program (CHOICE) would be created to offer coverage to working Californians and their dependents. Employers would pay a payroll tax to help fund health coverage for their workers, but would receive a refund for workers who chose to be covered through coverage offered by the firm. Workers (and their dependents) could enroll in CHOICE by paying premium that varies with their wages. Workers and their dependents who are enrolled in Medi-Cal or Healthy Families also could enroll in CHOICE. In addition, the proposal includes an outreach initiative aimed at individuals eligible but not enrolled in existing public programs.

The California PacAdvantage Program
The California PacAdvantage Premium Program, developed by Katie Horton, Peter Harbage, and Jennifer Ryan. This reform proposal would make subsidized coverage available to small employers and their employees with incomes below 350% of poverty through the state's existing non-profit small purchasing pool.

The California Health Services Plan
The California Health Service Plan, developed by Ellen Shaffer. This reform proposal also would replace current health financing and delivery arrangements with a single, publicly financed health care program that would provide health services to all Californians. Savings from reduced administrative costs and other cost-savings features would help finance the extension of coverage to previously uninsured people. Under this proposal, health care services would be provided through the public sector by hospitals and other facilities operated by the state and through health care professionals employed by the state.

Healthy California
Healthy California, developed by Rick Brown, UCLA, and Rick Kronick, University of California San Diego. This reform proposal would make coverage available to all citizens and legal residents through a new public program called Healthy California. In stage one a federal wavier would be sought to cover low-income adults and to integrate existing public programs into the new Healthy California. The income thresholds for current public programs also would be relaxed to permit the state to achieve federal matching payments for all families that enroll in the program. In the second stage, a pay-or-play premium requirement for employers would be instituted to help finance the system.

Single-Payer Option
The Single Payer Option, developed by James G. Kahn and others, University of California at San Francisco. This reform proposal would replace current health financing arrangements with a single, publicly financed health insurance program that would cover all Californians. Savings from reduced administrative costs and other cost-savings features would help finance the extension of coverage to previously uninsured people.

Managed Care Expansion Plan, Working Partnerships, USA
The Managed Care Expansion Plan, submitted by Working Partnerships, USA. Under this reform option, subsidies for coverage would be gradually phased-in over 15 years to California residents under 400% of poverty. Coverage would be provided through the managed care plan models currently serving Medi-Cal enrollees.

Managed Care Expansion Plan, ITUP (4.2 MB)
The Managed Care Expansion Plan, submitted by the Insure the Uninsured Project. This reform option would use a combination of strategies to reduce the number of uninsured, including an 1115 waiver to cover low-income adults, providing coverage to Medi-Cal and Healthy Families enrollees through employer plans when it is cost-effective, a refundable tax credit targeted to employers with low-income employees, and a refundable tax credit or voucher for individuals not offered employer-provided coverage.

Analysis and Summaries

HRSA Report
Report by The Health Resources and Services Administration, U.S. Department of Health and Human Services on the state of the uninsured, the overall health care environment, the Healthcare Options Project, and recommendations for a federally runned healthcare program.

Lewin Report
Report created by The Lewin Group Inc. and prepared for The California Health and Human Services (CHHS) Agency to summarize the nine proposals and provide information on employer premium subsidies, employer contribution requirements, single payer programs, and an analyses of the effects of the proposals.

AZA Consulting Report
Made by Claudia Williams, AZA Consulting. The paper does not focus on these common and shared improvements, but instead addresses how differences among proposals might produce varying results. It analyzes the proposed reforms, pointing to their differences, and suggests how these alternative designs might affect or contribute to the outcomes of interest.

SB 2/Prop 72

Health Insurance Act of 2003

Also known as SB 2, the Health Insurance Act of 2003, Proposition 72 sought to to ensure that employees get basic health coverage on the job and to expand such coverage to a million more workers, was defeated by a vote of 49.2% to 50.8%, a razor-thin margin of 180,426 votes out of over 12.6 million cast. It was the closest margin of the sixteen initiatives on California's November 2004 ballot.

Proposition 72 Archive

Proposition 72 Election Wrap-up

What Is Proposition 72?
Prop 72 In The News
San Francisco Chronicle October 2004
Los Angeles Times October 2004
Prop 72 Opposition

Other Resources

California HealthCare Foundation - Vote Health 2004
Latino Issues Forum

Information on SB2, the Health Insurance Act of 2003

SB2 (Burton/Speier)
What Is SB2
SB2 Talking Points
Health Coverage Impacts of SB2
Economic Impacts of SB2
Responses to Questions About SB2

Our Mission

Founded in 1987, Health Access is the statewide health care consumer advocacy coalition advocating for quality, affordable health care for all Californians. Our agenda includes:

  • Expanding Coverage: Implementing and improving upon health reform.
  • Fighting for a Fair Budget for the Future: Protecting public investments to preserve access to care.
  • Protecting Consumers: Ensuring consumer representation and protection.

Contact Us

1127 11th Street, Suite 925   map
Sacramento, CA 95814
Phone: 916-497-0923
Fax: 916-497-0921
Email: info@health-access.org
Click here for LA and Oakland offices

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