2021 Year In Review: Major CA Health Reforms to Last Even Beyond the Pandemic

Despite the ongoing challenges through the pandemic, this was a major year of health reform in California. Health Access was proud to champion and collaborate on a number of historic investments in the state budget and reforms through legislation in 2021—victories that provided new coverage to hundreds of thousands, and new financial assistance to many more, while working to make health plans and the health system more accountable for quality and equity. These reforms will not only benefit Californians immediately, but create lasting change that will be felt even beyond the pandemic. 


The ongoing public health emergency due to the COVID-19 pandemic influenced our advocacy in a number of ways this year. Health Access was an active member of the Community Vaccine Advisory Committee, working to ensure an efficient, effective and equitable distribution of the new vaccines as they were rolled out through the first half of 2021. We advocated to make sure Californians could get testing, treatment, or therapeutics for COVID-19 without financial barriers, including helping to successfully pass state legislation on the subject.

The pandemic underlined the urgency for broader expansions of coverage and care, and investments and improvements in the health system overall, which we worked to achieve. Though we recognize we have much more to do to address all the issues that are being raised, from racial inequity to public health infrastructure and much more.


One of the major wins that will last past the pandemic is the #Health4All campaign victory to secure Medi-Cal coverage for all income-eligible older Californians over age 50 regardless of immigration status. This will result, in the spring of next year, an expansion of health care coverage to over 230,000 Californians who are among most vulnerable to COVID-19 and explicitly excluded from coverage during the pandemic. With children, young adults, and now soon older adults covered, we are set up to close the remaining undocumented immigrant exclusion in Medi-Cal for 26-49 year olds, with polling at historic highs in supporting universal coverage.

Health Access, our partners, and the #Care4AllCA campaign were also pleased to secure major improvements in Medi-Cal on eligibility and benefits, including eliminating the Medi-Cal asset test—a restriction preventing coverage for low-income seniors and people with disabilities with modest savings.


On our work not just to expand access, but also the affordability of coverage, we won ongoing budget support to ensure true zero premium plans for over 700,000 Covered California enrollees and set the stage to curtail burdensome cost-sharing in 2022.

This state assistance is on top of the federal premium help in Covered California we worked to win and implement this year through the American Rescue Plan, which established the government guarantee that no individual purchaser of coverage has to spend more than 8.5% of income for premiums—and less for lower-income individuals, on a sliding scale. This is a national change that was piloted and proven here in California. It is currently pending to be extended through 2025 in the Build Back Better proposal.

As a result of this work over the last few years, Covered California grew by hundreds of thousands of enrollees, which in turn helped spread the risk and cost of coverage, and resulted in the third year in a row of premiums increases averaging less than 1%.


This year’s state budget surplus meant other long-needed investments in Medi-Cal could be made, including more integration and care coordination, a major goal of the undertaking called Cal-AIM.

The efforts to pass the state’s new “Momnibus” law will provide doula coverage as a benefit in Medi-Cal, continuous coverage for pregnant and post-partum people, and other investments to improve maternal mortality and reduce racial disparities in childbirth.


Health Access worked with partners and policymakers to leverage and align the state’s contracting and regulatory power—through Medi-Cal, Covered California, and the Department of Managed Health Care—to increase plan quality and equity and reduce health disparities. Health advocates have been deep in the details to ensure the success of these various efforts, including:

  • A new reprocurement process to have all commercial Medi-Cal managed care plans re-apply and bid for these contracts worth billions, with new standards and commitments to improve access, quality, and equity.
  • Revamped quality standards and accountability for Covered California health plans through their model contracts, including a new effort to exclude plans that don’t meet basic standards.
  • New regulations at the Department of Managed Health Care to also hold private health plans accountable for quality and equity standards.

The work on industry accountability on cost, quality and equity also included the revamping of the Office of Statewide Health Planning and Development to be the new Department of Health Access and Information (HCAI). They will oversee key projects on everything from prescription drug price transparency to the ongoing development of a Health Payments Database. HCAI would also be the home of the proposed Office of Health Care Affordability which would set and enforce cost goals. The proposal passed the state Assembly and is pending for 2022.


The California legislature continued to work to beef up our patient protections, including efforts to improve notice of hospital charity care and payment policies (AB 532 Wood) and improve and update the Hospital Fair Pricing Act (AB 1020 Friedman) so the uninsured and underinsured are not overcharged.

A Health Access sponsored bill (SB 368 Limon) to require health plans to inform patients of their out-of-pocket spending and how close they are to meeting deductibles and out-of-pocket maximums. Another bill (AB 326 Luz Rivas) extended a program to encourage greater consumer representation at the Department of Managed Health Care. Other efforts would improve timely access to health and especially mental health (SB 221 Weiner), and allow individuals to put their dependent parents on their health plans (AB 570 Santiago).


With a new President and Congress, California advocates worked to take advantages of opportunities at the federal level, especially with leaders from California like Vice President Kamala Harris, and HHS Secretary Xavier Becerra, who had worked with California health advocates for years to help implement reforms on drug pricing and health care industry consolidation.

While some work, like spotlighting the potential impact of a Texas lawsuit against the ACA, was defense, much was about undoing damage of the Trump years and taking steps forward. We submitted comments and California’s proven and positive expertise on pending federal regulations, on everything from longer open enrollment periods to solutions for surprise medical bills. We also worked to protect California’s priorities, whether to ensure that our state’s stronger patient protections prevail, or to see if California can get permissions and waiver to take innovative steps forward.

On the effort to support President Biden’s Build Back Better budget plan, we issued analyses and sponsored and participated in numerous press conferences with Congressional Representatives to highlight key parts of the proposals, from the additional affordability assistance in the ACA marketplaces, to Medicaid and Medicare improvements, to prescription drug price reform. If passed, the Build Back Better plan would provide real relief for millions in California across the country.


Similarly, the victories in 2021 were big—not just responding to the pandemic, but putting in place new expansions and affordability assistance, investments and improvements that will go on even beyond the pandemic, helping millions of Californians. We know there’s much more to do, and thankfully the work this year did a lot to lay the foundation for future progress.