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History of Health Reform in California

Health Access History


Community coalition fights “patient dumping” by hospitals and ER physicians who deny emergency care to uninsured patients, putting in place state policies that led to the federal EMTALA law.

Gov. Deukmejian proposes 10% cut to base funding of Medi-Cal: Grassroots coalition capacity to fight back was limited.


Gov. Deukmejian signs legislation penalizing patient dumping, as well as to fund physicians who provide emergency care to the uninsured (the Maddy Fund).

Health Access California organized out of coalition that fought patient dumping.

Health Access Foundation also founded


Numerous measures like AB 328 (1989-90), AB 14 (1991-92) and AB16 (1993-94) on expanding access proposed by Assm. Burt Margolin, and supported by Health Access California, including employer “pay or play.” “BabyCal” and “KidCal” proposed.

Task Force out of AB 350 (Brown/Maddy) recommends an employer mandate at end of Deukmejian Administration.

A version of Insurance Commissioner Garamendi’s “managed competition” plan passes, but is vetoed by Gov. Wilson.

Lois Salisbury serves full-time as first chair of Health Access.

Maryann O’Sullivan serves as founding Executive Director.

Health Access develops health policy proposals, including single-payer.


Legislative proposals, including SB 308 (Petris), a single-payer proposal, and “KidCal” (Margolin), stall.

California expands coverage for pregnant women to twice the poverty level.

Small group underwriting reforms AB 1672 (Margolin) pass, including a purchasing pool, guaranteed issue and modified community rating.

Prop. 166, an employer mandate by supported by California Medical Association, and opposed broadly including by Health Access, fails with 32%.


President Bill Clinton sworn in. Clinton health plan debated in Congress.

Maria Ferrer becomes executive director.


Clinton health plan fails in Congress.

Prop. 186, a single-payer initiative supported by Health Access California and others, fails with 27%. Democrats also lose Congress. Anti-immigrant Prop. 187 passes.

As Blue Cross of California converts from non-profit to for-profit, state regulators and advocates insist on protecting charitable assets. Two conversion foundations are created: The California Endowment and California HealthCare Foundation.

Bruce Livingston becomes executive director.


Gov. Wilson proposes elimination of most state-funded services for undocumented immigrants, including prenatal care, kidney dialysis and all other health services.

Beth Capell, a founding board member, joins Health Access as contract lobbyist.


Prop. 214 and Prop. 216, HMO reforms, supported by consumer groups and opposed by insurers, fail with 42% and 39%.

Health Access joins others groups around the country to protect and expand Medicare and stop privatization.


State Child Health Insurance Program (SCHIP) passes. California creates Healthy Families (Villaraigosa), with support from children’s groups and Health Access after key amendments.

Gov. Pete Wilson proposes HMO reform task force, vetoes all HMO reform bills. Attempts to override Wilson’s vetoes fail.

HMO reform an election year issue in key races.

Health Access California and others announce HMO Patient Bill of Rights legislative package in Jan 1997, sponsors 30-50 bills/year.


Newly-elected Gov. Gray Davis signs 21-bill HMO reform package, including:

  • Disclosure of Criteria for Denial of Care/Utilization Review SB 59 (Perata)
  • Guaranteed Second Opinion AB 12 (Davis)
  • Independent Medical Review, AB 55 (Migden) & SB 189 (Schiff)
  • Right to Sue SB 21 (Figueroa)
  • Regulation of Medical Groups, SB 260 (Speier)
  • Mental Health Parity, AB 88 (Thomson)
  • Coverage of Diabetes Supplies, SB 64 (Solis) & Contraceptives AB 39 (Hertzberg) & SB 41 (Speier)
  • Creation of Department of Managed Health Care & Office of Patient Advocate, AB 78 (Gallegos)

Melinda Paras becomes executive director.

Video Medical Interpretation project started to increase language access in CA public hospitals and show viability overall.


New efforts to streamline Medi-Cal and Healthy Families.

First measure to prevent hospital overcharging of the uninsured is introduced.

Health Care Options Project SB 480 (Solis) re-starts health reform debate.

Health Access begins new efforts to expand coverage in California.

Early adoption of posting regular updates via the Health Access Blog, still continually published.


Efforts to expand HMO Patient Bill of Rights continues with passage of:

  • SB 842 (Speier): sets standards for drug coverage.
  • AB 2179 (Cohn): timely access to care.
  • SB 853 (Escutia): requires language access.

Facing $38 billion budget deficit, Gov. Davis proposes massive health care cuts.

After a year and a half serving as organizing director, Anthony Wright becomes executive director in mid-2002.

Health Access organizes against budget cuts.


Single-payer health coverage re-enters legislative debate with SB 921 (Kuehl).

Employer coverage expansion SB 2 (Burton) passes, signed by Gov. Davis. Supported by Cal. Labor Federation, CMA, Health Access and others.

Governor Davis recalled; Governor Schwarzenegger elected.

Prop. 72, referendum on SB 2, opposed by the Chamber of Commerce and CA Restaurant Association, gets 49.2%, repeals law.

Health Access helps lead broad-based efforts at health reforms on multiple tracks, including employer mandates but also single-payer, public program expansions, etc.

Health Access helps lead effort on Prop. 56 to lower threshold to pass budgets and taxes, which fails with 34% of the vote.


Schwarzenegger holds special election with several proposals, all of which fail, including Prop. 76 spending cap.

AB 356 (Chan) was signed into law to provide disclosures to consumers about both reasons for pre-existing condition denials and rate increases. Would later reveal infamous Anthem Blue Cross 39% rate increase filing in 2010.

AB 772 (Chan), universal children’s coverage, providing coverage for undocumented children vetoed by Gov. Schwarzenegger.

Health Access California with “OurRx” coalition, after years of working on legislation, sponsor Prop. 79, to win drug discounts. PhRMA opposes with $80 million, and sponsors competing Prop. 78. Both fail with 39% and 42%.


Major victories:

  • AB 774 (Chan), first-in-nation protections to prevent hospitals overcharging the uninsured, signed into law after a five year campaign.
  • AB 2911 (Núñez/Perata), to negotiate for better drug discounts, signed by Gov. Schwarzenegger (but never implemented due to budget crisis).
  • SF Supervisor Tom Ammiano pursues local reform; Mayor Gavin Newsom creates task force, both leading to unanimous passage of Healthy San Francisco.
  • SB 840 (Kuehl) universal single-payer bill (latest iteration from SB 921 in 2003), passed full legislature for first time. Gov. Schwarzenegger vetoes.

Prop. 86, a tobacco tax to fund emergency rooms and children’s coverage, fails with 48.2%

HealthIOU initiative starts to implement new laws, sponsored by Health Access California, providing consumer protections against uninsured paying more for drugs and hospital care. Launches www.HospitalBillHelp.org


Gov. Schwarzenegger proposes new health reform package and designates 2007 as “Year of Health Reform.” After several versions including AB 8 (Nunez), ABx1 1 (Núñez/Schwarzenegger), comprehensive health reform proposal, stalls in Senate Health Committee in Jan. 2008

President Barack Obama elected, with mandate on health reform.

Health Access and “It’s Our Healthcare” coalition work to advance both comprehensive and specific health reforms. Health Access gets dozens of pledges from Congressional representatives to pursue federal health reform.


With leadership from President Obama, and California Congressional leaders (including Speaker Nancy Pelosi, key committee chairs Waxman, Miller, and Stark, and many others), the Patient Protection and Affordable Care Act is enacted.

Major budget crisis re-emerges. Major budget cuts trigger elimination of dental and other benefits in Medi-Cal, and 10% provider rate cuts.

Health Access leads the California campaign for Health Care for America Now (HCAN) to pass the Affordable Care Act. All California Democrats vote for “Obamacare.”

Health Access and others fight budget cuts, playing a lead role with other low-income advocacy groups in the Health and Human Services Network.


California passes key bills to adopt many of the consumer protections in the Affordable Care Act, including:

  • AB 1602 (Perez) & SB 900 (Alquist) establish first-in-the-nation post-reform Health Benefits Exchange.
  • SB 1163 (Leno) institutes rate review in California.
  • AB 2244 (Feuer) ensures access and affordability for coverage for children with pre-existing conditions.
  • AB 2345 (De La Torre) requires coverage of preventive services and AB 2470 (De La Torre) prevents rescissions.
  • AB 342 (Price) allows young people to stay on parents’ coverage until age 26.
  • SB51 (Alquist) requires medical loss ratio and outlaws annual and lifetime limits.

Also: AB 1503 (Lieu) bill passes to protect uninsured from ER doctor overcharges.

California voters pass Prop. 25, to pass state budgets by a simple majority, rather than 66%–stopping the years late budgets and brinksmanship.

Governor Jerry Brown elected.

Health Access commits to a multi-year effort, starting with Governor Schwarzenegger and extending through Governor Brown, to implement and improve the ACA.


While dealing with massive budget deficit, newly elected Governor Brown continues California implementation of health reform, with bills on improving consumer assistance SB 922 (Monning), streamlining eligibility and enrollment AB 1296 (Bonilla), and instituting the medical loss ratio SB 51 (Alquist).


California passes SB 222 (Evans/Alquist) and AB 210 (Hernandez), a long-sought mandate to require maternity coverage in all plans, 18 months earlier than required under federal law’s essential benefit protections.


Governor Brown signs more bills implementing the Affordable Care Act, including ones setting standards for essential health benefits, AB 1453 (Monning) & SB 951 (Hernandez), the new rules for small group coverage AB 1083 (Monning), and new notice for coverage options during life changes AB 792 (Bonilla).

Over 50 counties start Low-Income Health Programs (LIHPs), enrolling over 550,000 Californians—most of the early Medicaid expansions nationally.

Proposed tobacco tax Prop. 29 fails by an incredibly close margin, 49.9% of the vote.

Prop. 30, an upper income tax increase, passes, which along with previous steep budget cuts and a recovering economy, promises to end a decade of budget deficits and crises.

President Obama re-elected, with Democrats gaining seats in the U.S. House & Senate, continuing implementation of the Affordable Care Act, which is upheld by the Supreme Court

Health Access agrees to host the CA LGBT HHS Network, staffed by Kate Burch, with renewed focus on making sure ACA implementation is inclusive of the LGBT community.

After a decade of work, Health Access spins off the last part of its video medical interpretation (VMI) project, now in place in public hospital systems throughout California.


In special legislative session, California officially implements and improves upon the ACA’s major planks, including instituting the individual insurance market reforms such as the ban on pre-existing conditions AB1x2 (Pan) & SB1x2 (Hernandez), and the Medi-Cal expansion, AB1x1 (Perez) & SB1x1 (Hernandez/Steinberg).

Adult dental benefits partially restored in the state budget.

Health Access co-leads “Save Our Safety Net” efforts with counties, CSAC, and SEIU to expand Medi-Cal while preserving funds for public hospitals and clinics.


California begins its implementation of the ACA, launching coverage through Covered California and the Medi-Cal expansion; new consumer protections and market rules also take effect. Millions of Californians gain coverage through Medi-Cal and Covered California.

Through SB 964 (Hernandez), California requires annual surveys of health plan network adequacy and timely access.

Prop. 45, to institute health insurance rate regulation in California fails with 41% of the vote.

Governor Jerry Brown is re-elected.

Beth Abbott, longtime Director of Administrative Advocacy for Health Access, appointed by Governor Brown to be Director of the Office of the Patient Advocate.


California takes additional steps to #Health4All, including undocumented immigrants:

  • Expansion of Medi-Cal coverage for all children, SB 4 (Lara)/AB75.
  • Seeking a waiver to open up Covered California, SB 10 (Lara)
  • Having multiple counties expand eligibility for safety-net services, from 9 to 47, including Sacramento, Contra Costa, Monterey, and CMSP.

The Legislature passes new protections against unfair health care costs, sponsored by Health Access, including:

  • Protections against surprise medical bills, AB 72 (Bonta, Wood, et. al.)
  • Caps on extreme prescription drug cost-sharing, AB 339, (Gordon)
  • Prohibition on “junk” employer-based coverage, AB 2088 (R. Hernandez)
  • Requirement on accurate & updated provider directories, so patients don’t end up out-of-network, SB 137 (Ed Hernandez)
  • Notice of unreasonable rate increases and opportunity to shop for other coverage, SB 908 (Ed Hernandez).

Improvements in Medi-Cal include a new “Medi-Cal 2020” waiver, a revamped MCO tax, and key investments, including the limiting of estate recovery.

In special session, the Legislature passes the strongest tobacco control package in a generation, raising the smoking age to 21 and regulating e-cigarettes.

California voters support new revenues by wide margins, including Prop. 55 (upper-income tax extension) and Prop. 56 (tobacco tax).

Donald Trump is elected President.

With the CA Immigrant Policy Center, Health Access co-chairs the #Health4All coalition of over 100 partner organizations to win coverage for all Californians regardless of immigration status.

Health Access expands its MergerWatch oversight over several hospital and health plan acquisitions in the state, winning key conditions.

Branching out to public health issues, Health Access actively works on the Save Lives campaign for greater tobacco regulation and taxation.


GOP control of the White House and Congress threatens the progress made and the coverage provided for millions under Medicaid, Medicare, and the Affordable Care Act. Yet after multiple attempts at ACA repeal and Medicaid cuts and caps, these core health programs largely survive the year because of massive resistance, including in California.

California continues to see a reduction in the uninsured to 7%, despite federal administrative attacks on the ACA, due to state counter-actions by Covered California and the Legislature, such as AB 156 (Wood) on a full three-month open enrollment, and SB 133 (Hernandez) to ensure patients continuity of care when insurers withdraw from a market.

Dental and vision coverage in Medi-Cal are fully restored in the state budget, along with provide rate supplements from tobacco tax funds.

California passed landmark legislation on prescription drug price transparency, SB 17 (Hernandez).

With national partners, Health Access and allies immediately mobilize #Fight4OurHealth campaign in California to protect health care, helping organize over 180 actions and events, from town halls and press conferences to rallies, over the year.

The California LGBT HHS Network, under Director Amanda Wallner, significantly expands it staffing with two projects, #Out4MentalHealth, and #WeBreathe on tobacco control.


California took additional action to stop sabotage of the ACA, with legislation to ban junk coverage, including substandard “short term” plans, AB 910 (Hernandez). Also limited association health plans, AB 1375 (Hernandez).

California placed greater oversight on the industry, including:

  • Stronger review of health plan mergers. AB 595 (Wood).
  • Ensuring the $250 cap on co-pays, AB 1021 (Weiner).
  • Ensuring 80% of premiums are spent on patient care, AB 2499 (Arambula).
  • Regulating pharmaceutical benefit managers (PBMs). AB 315 (Wood).

2018 elections change the health policy landscape, with Californians voting out 7 members of Congress that voted for ACA repeal—half of the state’s Republican caucus. The election of California’s Nancy Pelosi to Speaker ends the threat of Congressional attacks on the ACA and Medicaid.

Governor Gavin Newsom is elected.

#Care4AllCA campaign launches to get to universal coverage without needing federal approval, with new efforts on expanding coverage and affordability, containing costs and prices, & improving accountability to ensure access, quality, and equity.

Legal and Policy Director Tam Ma joins administration as Deputy HHS Secretary.

Former Health Access organizer Melissa Hurtado wins state Senate seat.


Under Governor Newsom, California took first-in-the-nation steps to expand coverage, access and affordability, including:

  • New state subsidies to provide additional affordability assistance in Covered California, both for lower-income and middle-class consumers beyond the ACA threshold of four times the federal poverty level.
  • Medi-Cal expansions for all income-eligible young adults, regardless of immigration status.
  • Other improvements in Medi-Cal to restore benefits, keep seniors and people with disabilities covered; improved quality standards and integration efforts, and increase screening for adverse childhood events led by a new Surgeon General.

California took steps to further control costs, include

  • Expanding and enhancing rate review of health premiums for large purchasers, including AB731 (Kalra);
  • Efforts to lower prescription drug pricing, including protections against “pay for delay” policies through AB824 (Wood), and the starting of Medi-Cal Rx and a state prescription drug purchasing pool.

A settlement with Sutter Health prohibiting future anti-competitive contracting and pricing practices.

Health Access actively engages on federal campaigns to #LowerDrugPricesNow and against surprise medical bills.

Executive Director Anthony Wright is appointed by Assembly Speaker Rendon to the Healthy California For All Commission, to plan out the path to universal coverage.


Responding to the COVID-19 pandemic, California takes proactive steps to provide testing, treatment, and eventually, therapeutics.

California passes first-in-the-nation initiative to contract to manufacture generic drugs. SB 852 (Pan).

Congress passes No Surprises Act, to ban most surprise medical bills, based in part on California’s state law.

Joe Biden is elected President, and Kamala Harris Vice President.

Health Access leads #CareNotCuts effort to prevent #CABudget proposals to undo health care and coverage gains.


The State Budget expands Medi-Cal to 280,000 Californians 50+, regardless of immigration status. The State Budget commits to fully remove the exclusion in Medi-Cal based on immigration status by January 2024, which would expand coverage to 700,000+ Californians 26-49.

The assets test in Medi-Cal is effectively eliminated. Premiums are eliminated in Medi-Cal for children and working people with disabilities. Share of cost is reduced for Medi-Cal seniors.

Medi-Cal goes through new reprocurement and recontracting to hold Medicaid managed care plans to higher quality and equity standards. Covered California, DMHC introduce new standards as well.

California creates an Office of Health Care Affordability, to set enforceable cost growth targets for the health industry.

California’s #Health4All campaign of 8-years inspires other states to expand their Medicaid programs to undocumented immigrants.

Amanda Wallner becomes first Deputy Director for Health Access. Dannie Cesena becomes the fourth director of the CA LGBTQ HHS Network.