Press Releases

Press inquiries may be directed to:

Rachel Linn Gish, Director of Communications
rlinngish@health-access.org: 916-497-0923 ex. 809

Statement Peter Lee Leaving Covered California

During today's Covered California board meeting, Peter Lee, the first Executive Director of Covered California, announced he will be departing the role in February of next year. Covered California, established in 2010, was the first state-based exchange to be created after the enactment of the Affordable Care Act. Lee took the helm in 2011 and working alongside advocates, health plans, and enrollers, built an exchange that now enrolls over 1.5 million Californians and serves as a model for the nation. 
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For immediate release: Thursday, September 16, 2021

For more information, contact:
Rachel Linn Gish, Director of Communications, Health Access California, 916-532-2128 (cell)

STATEMENT ON PETER LEE LEAVING COVERED CALIFORNIA

SACRAMENTO, CA – During today’s Covered California board meeting, Peter Lee, the first Executive Director of Covered California, announced he will be departing the role in February of next year. Covered California, established in 2010, was the first state-based exchange to be created after the enactment of the Affordable Care Act. Lee took the helm in 2011 and working alongside advocates, health plans, and enrollers, built an exchange that now enrolls over 1.5 million Californians and serves as a model for the nation.

Below is a statement from Anthony Wright the Executive Director of Health Access California, the statewide health care consumer advocacy coalition, which helped to craft the legislation creating Covered California and serves a key voice in its continued growth and consumer-centered design:

“Hundreds of thousands of Californians have health insurance, and better and more affordable coverage, because of Peter Lee’s efforts not just implementing but improving upon the Affordable Care Act. The ACA has seen its share of near deaths, but at each turn Peter proactively found work-arounds and other state-based responses to protect consumers’ coverage.

“In multiple ways, Peter Lee used the bargaining power of over 1.5 million Californians to take best-in-the-nation steps to reduce costs, improve quality, and advance equity for consumers. Peter’s work to standardize benefits across insurers is a national model to reduce consumer confusion, allowing Californians to make apples-to-apples comparisons, and foster real price competition. Elsewhere, decisions about the design of benefits are made in a private corporate boardroom, but Peter created a space where stakeholders, including patient advocates and health plans, could work together to make Covered California the most consumer friendly exchange in the country. Peter has not been afraid to say no to insurers who weren’t offering added value, or who tried to play games to get healthier consumers and avoid sicker ones.

“He quickly implemented state-level affordability assistance to ensure Californians got the best coverage at the lowest prices. This first-in-the-nation premium help served as the proof of concept for the relief in the American Rescue Plan, which is now helping millions of Americans finally afford health care coverage for themselves and their families. When Congress hopefully makes this additional affordability assistance permanent in the Build Back Better package, all Americans will have Peter to partially thank for that extra help accessing health coverage.

“It’s a testament to the infrastructure and team Peter built at Covered California that most Californians will not notice this leadership transition, but because of him, millions of Californians have better, more affordable, more understandable health care coverage, and the peace of mind and financial stability that comes with that.”

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    Another Low Rate Increase for 2022 Covered California Health Premiums New Federal & State Aid Means Even Lower Premiums for Most Covered California Consumers

    Following a year that has seen the greatest investment in the Affordable Care Act since the law took effect, Covered California, the state's health care insurance marketplace, today announced its third straight year of minimal premium rate increases. In fact, earlier this year, virtually all in Covered California saw reductions in their premiums through federal subsidies, which will continue in 2022. Through the American Rescue Plan (ARP), the Biden Administration took action to increase subsides for those who purchase health care on their own via the marketplace, capping premiums to 8.5% of income across the board - and much lower for middle and lower income consumers. These actions, along with state affordability assistance, have significantly reduced costs for the nearly 1.6 million enrollees in Covered California, leading to higher enrollment and a more stable market.
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    For immediate release: July 28, 2021

    For more information contact:
    Rachel Linn Gish, Director of Communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

    ANOTHER LOW RATE INCREASE FOR 2022 COVERED CALIFORNIA HEALTH PREMIUMS

    NEW FEDERAL & STATE AID MEANS EVEN LOWER PREMIUMS FOR MOST COVERED CALIFORNIA CONSUMERS

    • The Biden Administration’s American Rescue Plan, along with state investments, have significantly reduced costs for nearly all 1.6 million Covered California enrollees, leading to higher enrollment and a more stable marketplace.
    • As a result of more people in the individual insurance market sharing the risk and cost of care, unsubsidized CoveredCA enrollees will see a rate increase of less than 2%. Many could see decreases as shopping around could lower premiums on average by almost 8%.
    • The American Rescue Plan caps premiums at 8.5% of income, and recent state budget investments will ensure zero dollar premiums for many in CoveredCA, protecting against the sticker shock many have faced who have lost employer benefits during the pandemic. The average combined savings of state and federal subsides is over $700 per month for California families. 
    • Consumer advocates highlight the low CoveredCA rates and the importance of coverage, and urge Congress to make ARP subsidies permanent. 

    SACRAMENTO, CA – Following a year that has seen the greatest investment in the Affordable Care Act since the law took effect, Covered California, the state’s health care insurance marketplace, today announced its third straight year of minimal premium rate increases.

    In fact, earlier this year, virtually all in Covered California saw reductions in their premiums through federal subsidies, which will continue in 2022. Through the American Rescue Plan (ARP), the Biden Administration took action to increase subsides for those who purchase health care on their own via the marketplace, capping premiums to 8.5% of income across the board – and much lower for middle and lower income consumers. These actions, along with state affordability assistance, have significantly reduced costs for the nearly 1.6 million enrollees in Covered California, leading to higher enrollment and a more stable market.

    In part because of this increased enrollment, unsubsidized Covered California consumers will see a rate increase of just 1.8%, and many could see lower costs by shopping around and changing plans. This is the third straight year with record low rate increases, coinciding with the first state subsidy enhancement, which Health Access helped to spearhead, and now with the enhanced subsidies in the ARP. Combined state and federal affordability assistance means that California families will see average savings of over $700 per month in health insurance premiums.

    Covered California also announced that all 11 health insurance companies will return for 2021, and a new insurer will enter the market in Contra Costa County. Many insurers will also expand their coverage, giving all Californians at least two choices for coverage and most have 4 or more. Due to the ongoing pandemic, this year’s open enrollment will extend through the end of the year. Covered California is also prioritizing equity by requiring plans to collect race and ethnicity data to identify and address health disparities.

    “As the pandemic continues, it’s never been more urgent to get covered, and with these new federal and state subsidies, it’s never been as affordable. Californians should look into getting this comprehensive coverage, which will be capped at no more than 8.5% of their income, with affordability assistance that could be worth hundreds if not thousands of dollars. Even those who don’t get subsidies will see minimal rate increases, and could actually also get a lower price by comparison shopping on Covered California,” said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition. “Just as the Affordable Care Act was upheld by the Supreme Court earlier this year, these new subsidies and low rate increases are finally showing the full promise of the law coming to fruition.”

    “California’s premium subsidy program provided proof-of-concept for the subsides extended by the Biden Administration’s American Rescue Plan,” said Wright. “Californians should take advantage of this new coverage and economic security for many Californians and their families, and Congress should make this affordability assistance permanent.”

    Just yesterday, Governor Gavin Newsom signed the health budget bill, AB 133, that will further improve affordability in Covered California next year. It will mean that nearly 700,000 Covered California enrollees will see true zero premium coverage beginning January 1, 2022.

    For those who have seen their income reduced significantly or entirely, Medi-Cal offers low to no-cost comprehensive health coverage and enrollment is open year round. Starting in May 2022, anyone eligible based on income age 50 and over can enroll, regardless of immigration status.

    “With the pandemic prolonging, we urge all Californians to get covered. Even if you checked out Covered California before, look again and see the new options and affordability assistance now available. Health care coverage is the best protection for you and your family’s health and financial stability as the COVID-19 pandemic rages on,” said Wright. “Californians should sign up for coverage and this new affordability assistance—and then join the fight to have Congress continue it into the future.”

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      Governor Newsom Signs 2021-22 Health Budget Bill

      Today Governor Gavin Newsom signed one of the key pieces of the 2021-22 state budget, the health budget trailer bill (AB 133) which includes historic funding in Californian's health system, making it more universal, equitable, and affordable in the wake of the COVID-19 pandemic and beyond. Today's signing ensures a first-in-the-nation end to the exclusion of income-eligible undocumented adults age 50 and over in Medi-Cal. Other major initiatives improve and expand Medi-Cal, and make Covered California more affordable.
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      For Immediate Release: Tuesday, July 27, 2021

      CONTACT:
      Rachel Linn Gish, director of communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

      GOVERNOR NEWSOM SIGNS 2021-22 HEALTH BUDGET BILL

      Budget includes historic investments in California’s health care system, moving the state closer to universal health care coverage

      Starting in May 2022, Medi-Cal will include all income-eligible adults age 50 and over, regardless of immigration status, providing coverage to over 235,000 Californians

      FRESNO, CA – Today Governor Gavin Newsom signed one of the key pieces of the 2021-22 state budget, the health budget trailer bill (AB 133) which includes historic funding in Californian’s health system, making it more universal, equitable, and affordable in the wake of the COVID-19 pandemic and beyond. Today’s signing ensures a first-in-the-nation end to the exclusion of income-eligible undocumented adults age 50 and over in Medi-Cal. Other major initiatives improve and expand Medi-Cal, and make Covered California more affordable.

      “This budget takes big steps toward a more universal and equitable health system, building on the progress California has made implementing and improving on the Affordable Care Act over the last decade,” said Anthony Wright, Executive Director, Health Access California.  “The removal of unfair exclusions in Medi-Cal, and making Covered California more affordable, will make it easier for hundreds of thousands of Californians to get on and stay on coverage. The pandemic reminded all of us of the urgency of health care and coverage for not just ourselves, but our fellow community members; this budget makes big strides toward a better health care system that we all rely on.”

      Health Access joined #Health4All legislative champions Senator Maria Elena Durazo (D – Los Angeles), Assemblymember Joaquin Arambula (D – Fresno), and Senator Susan Talamantes Eggman (D – Stockton) alongside Governor Newsom in Fresno today as his budget signature made California the first state in the country to remove exclusions in their state Medicaid program for those 50 and above. While Illinois had agreed to start covering those 65+ last year, California will now have the most expansive coverage, including children, young adults up to age 26, and now older Californians 50 and above. The expansion to older undocumented adults is estimated to provide health coverage for approximately 235,000 more Californians beginning in May of 2022.

      “With the signing of AB 133 today, California will move closer than ever to universal health care coverage.  These first-in-the-nation investments to will expand health care to hundreds of thousands of Californians, and improve our health system for all who call California home,” said Jose Torres Casillas, Legislative Associate for Health Access California, who spoke at today’s bill signing. “This means that people like my tios, my tias, and abuelos can go and access a primary care doctor and treat the variety of chronic conditions they may have as they are getting older or any issues that have been exacerbated by the pandemic.”

      In another major step towards universal and equitable coverage, the final budget eliminates the Medi-Cal asset test that has for too long prevented some Californians from accessing Medi-Cal for having a small amount of savings. This will ensure access to care for tens of thousands of seniors and people with disabilities, and allow them to have savings needed to deal with housing and other needs and emergencies.

      The budget bill also lays the groundwork to improve affordability in Covered California, a much needed investment to make coverage more accessible to those purchasing care on their own in a high-cost state like California. The federal help in the American Rescue Plan has provided real relief to virtually all 1.5 million in Covered California and potentially hundreds of thousands more, yet cost barriers remain for many including high deductibles and other out-of-pocket cost sharing. The budget calls for a $335 million reserve fund for a potential future affordability program in Covered California. It also directs Covered California to develop options for further reducing cost-sharing, and includes funding to subsidize state-only coverage by one dollar, allowing tens of thousands of low-income Californians to get true zero-premium plans.

      “Millions of Californians have lost their health care coverage during the economic downturn caused by the pandemic, imperiling their financial and health recovery. This budget removes some cost barriers to care that will encourage more Californians to enroll in coverage,” said Diana Douglas, Policy and Legislative Advocate for Health Access California.

      Health care advocates praise a number of other important steps to improve Medi-Cal and reduce health care disparities also included in this final 2021-22 budget:

      • Improving Medi-Cal coverage for pregnancy and post-partum to reduce inequitable maternal mortality rates for black and indigenous women.
      • Creating culturally and linguistically appropriate Medi-Cal documents.
      • Continuing Cal-AIM reforms to improve and streamline the Medi-Cal program.

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        2021-22 CA Budget Takes Major Steps to a More Universal & Equitable Health Care System

        Today the State Legislature passed the final 2021-2022 health budget bill (AB 133) that includes historic investments in expanding and improving health coverage for millions of Californians. It now goes to Governor Newsom for his final signature in the coming days. Many of the proposals included in this budget bill were key priorities of the Care4All California coalition of over 70 consumer, community, labor, progressive, and health care organizations working to advance the goal of quality affordable health care for all Californians as soon as possible. 
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        For Immediate Release: Thursday, July 15, 2021

        CONTACT:
        Rachel Linn Gish, director of communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

         

        2021-22 CA BUDGET TAKES MAJOR STEPS TO A MORE UNIVERSAL & EQUITABLE HEALTH CARE SYSTEM

        Final Health Budget Bill Adopts Key Priorities of the Care4All California Coalition 

        SACRAMENTO, CA – Today the State Legislature passed the final 2021-2022 health budget bill (AB 133) that includes historic investments in expanding and improving health coverage for millions of Californians. It now goes to Governor Newsom for his final signature in the coming days. Many of the proposals included in this budget bill were key priorities of the Care4All California coalition of over 70 consumer, community, labor, progressive, and health care organizations working to advance the goal of quality affordable health care for all Californians as soon as possible.

        The coalition supported these investments which, working together, represent important steps to a more universal, equitable, and affordable health care system in California. These organizations pushed for key proposals to improve Medi-Cal and reduce health care disparities for low-income Californians and communities of color that made it into the final 2021-22 budget, including:

        • Expanding Medi-Cal, in a first-in-the-nation action, to cover 235,000 income-eligible undocumented immigrant adults age 50 and over.
        • Ending the assets limit for seniors and people with disabilities to access Medi-Cal, making CA the first state to fully end this antiquated rule that prevented 18,000 from enrolling in our state Medicaid program.
        • Improving Medi-Cal coverage for pregnancy and post-partum to reduce inequitable maternal mortality rates for black and indigenous women.
        • Creating culturally and linguistically appropriate Medi-Cal documents.
        • Continuing Cal-AIM reforms to improve and streamline the Medi-Cal program.

        Together these investments will provide over 250,000 more Californians with health coverage through Medi-Cal and improve the program for the more than a third of Californians – and half of California’s children – who are enrolled in Medi-Cal.

        In addition to these major Medi-Cal reforms, the coalition also worked to improve affordability for many Covered California enrollees that were included in the final budget:

        • Subsidizing state-only coverage by one dollar, allowing hundreds of thousands of low-income Californians to get true zero-premium plans.
        • Building a new Covered California affordability reserve, and directing Covered California to develop options for further reducing cost-sharing, such as for high deductibles and copays.

        One major piece supported by the campaign that is still under negotiation is the creation of an Office of Health Care Affordability – an effort to tackle the rising cost of care with a more coordinated, holistic approach. First proposed by the Governor in his January budget, the Legislature agreed to create this new Office in order to collect and analyze information and identify trends in health care prices. This data would be used to set enforceable cost targets and includes accountability measures for those not meeting the goals. Negotiations with different stakeholders in the health industry are continuing.

        More details in this factsheet from Health Access

        Since 2017, the Care4All California campaign has worked on what can be done at the state level to build and improve upon the federal Affordable Care Act, without the need of federal interventions or an act of Congress. ​​​These wins this year join previous gains the coalition has helped make in California such as instituting first-in-the-nation state subsidies to help more low- and middle-income Californians afford coverage in Covered California, expanding Medi-Cal to young adults regardless of immigration status, implementing more tools to fight the skyrocketing cost of prescription drugs, and making our health system more accountable to ensuring equity and higher quality care.

        Here is reaction on the budget bill’s passage from key leaders of the #Care4AllCA campaign including Health Access California, Western Center on Law & Poverty, California Immigrant Policy Center, California Pan-Ethnic Health Network, The Children’s Partnership, SEIU California, NextGen California, and the California Physicians Alliance:

        “This budget takes big steps toward a more universal and equitable health system, building on the progress California has made implementing and improving on the Affordable Care Act over the last decade. The removal of unfair exclusions in Medi-Cal, and making Covered California more affordable, will make it easier for hundreds of thousands of Californians to get on and stay on coverage. The pandemic reminded all of us of the urgency of health care and coverage for not just ourselves, but our fellow community members; this budget makes big strides toward a better health care system that we all rely on.” –  Anthony Wright, Executive Director, Health Access California.

        “The budget makes important progress towards ensuring that all Californians can access the health care they need. We are especially excited that soon Medi-Cal will cover those age 50 and older who but for their immigration status would already be eligible, and that Medi-Cal will phase out the asset test that forces elders and some people with disabilities to choose between savings and health care. We’re also happy to see Medi-Cal extended for postpartum people, as well as the inclusion of doula care, as important efforts to decrease health disparities faced by Black and indigenous parents. We look forward to continuing the work to achieve quality, affordable health care for all.” – Jen Flory, Policy Advocate, Western Center on Law & Poverty

        “Access to Medi-Cal is life-changing for undocumented older adults and their families across California. Communities and advocates have worked for years to ensure that all Californians can have access to health care, and we are thrilled that our state leadership has removed exclusions for adults over age 50 to access essential preventative care through Medi-Cal. Everyone who calls California home, regardless of their birthplace or income, should have access to the care they need to stay healthy and live full lives. We will continue to advocate until no Californian is excluded and we can finally have health for all.” – Cynthia Buiza, Executive Director, California Immigrant Policy Center.

        “We thank the Governor and the legislature for passing numerous Care4All California priorities that will expand equity in our health care systems for millions across our state. From expanding health care to undocumented seniors ages 50 and up, to funding community-based organizations to review Medi-Cal documents for cultural and linguistic competency, to funding the Health Equity and Racial Justice Fund as part of a $300M ongoing funding package starting next year; this budget takes multiple opportunities to expand health care regardless of race, gender, sexual orientation, class, ability, and immigration status. We look forward to continuing to reduce health care disparities and inequities through our systems, policies, and budgets.” – Kiran Savage-Sangwan, Executive Director, California Pan-Ethnic Health Network

        “The Children’s Partnership recognizes that racial justice and equity are paramount to the well-being of California’s children and families. We are excited about the success of a number of Care4All budget priorities that  begin to address the specific needs of children and families from marginalized communities through a whole child, whole family approach, including Medi-Cal 12-month postpartum coverage and increasing access to health coverage regardless of immigration status for people over 50. However, more must be done to support our state’s children, particularly our youngest who are at a critical stage of their life, when 90 percent of brain development occurs. This includes addressing gaps in coverage that lead to disruptions in care for physical and mental health needs by providing continuous coverage for young children ages 0 to 5. We also continue to uplift the need for additional and explicit investments that support early childhood mental health in community settings, such as child care and development programs, where services are most likely to reach low-income children of color. The Children’s Partnership is encouraged by the legislature’s interest and is eager to support the administration in implementing this policy before the unwinding of the Public Health Emergency. We look forward to continuing to advance a whole health and prevention agenda that meets children and families where they are.”- Kristen Golden-Testa, Health Policy Director, The Children’s Partnership

        “This year, SEIU members came together to fight for a budget that would lead us forward from the crisis of the pandemic into a more resilient and equitable society. We knew that fundamental reforms to our healthcare system would be the cornerstone of that process.  With this budget, California is taking tremendous strides forward in our goal of ensuring universal healthcare by including more of our undocumented family members, neighbors, and community members in our healthcare system. After years of speaking out about the injustice of the arbitrary home care hours cut, we are finally turning the page on that harmful and dangerous chapter. And we are beginning to reverse decades of neglect of our local public health infrastructure, which serves to combat health inequities and protect all of our communities. Our work is far from done: Brown and Black Californians demand continued and greater investment in our communities, in our health, in our children, in good jobs, and in an equitable recovery.” – April Verrett, President of SEIU Local 2015 and an Executive Board Member of SEIU California

        “The state’s budget is a reflection of its values and this year’s California state budget made significant investments to improve our healthcare system. From expanding Medi-Cal coverage to undocumented seniors to removing the inequitable asset test for the elderly to reimagining the infrastructure of our health care delivery system with CalAIM — there is much we can be proud of.  Although these investments are a step in the right direction – we still have a long way to go. Years of racial disparities have been brought to light those hit hardest by the pandemic, underscoring the importance of providing equitable, affordable, and quality healthcare coverage to everyone. The Care4All California Coalition stands ready to collaborate and ensure we collectively reach this goal. ” – Elena Santamaria, Policy Advisor, NextGen California

        “As a physician-led statewide nonprofit organization, CaPA elevates the voices of healthcare professionals and is helping create an equitable healthcare system in which our future healthcare leaders will practice. CaPA is a proud member of the #Care4AllCA coalition and is ready to continue working alongside so many California organizations and legislators who also believe that healthcare is a human right!” – Beatriz Sosa-Prado, M.S., Executive Director, California Physicians Alliance (CaPA)

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          Governor Newsom and State Legislature Strike Budget Deal with Major Steps Towards a More Universal Health Care System

          Tonight, state legislative leaders today announced the outlines of a 2021-2022 budget agreement with Governor Newsom that includes funding for a more universal, equitable, and affordable, health care system. The final deal includes historic investments in our health system, including a first-in-the-nation end to the exclusion of income-eligible undocumented adults age 50 and over in Medi-Cal. 
          READ MORE

          For Immediate Release: Friday, June 25, 2021

          CONTACT:
          Rachel Linn Gish, director of communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

          GOVERNOR NEWSOM AND STATE LEGISLATURE STRIKE BUDGET DEAL WITH MAJOR STEPS TOWARDS A MORE UNIVERSAL HEALTH CARE SYSTEM

          •  State Legislative leaders announced a budget deal with Governor Newsom tonight that includes funding for key health care proposals.
          • The agreed-upon budget includes funding for a first-in-the-nation end to the exclusion in Medi-Cal for undocumented Californians ages 50 and older–a major step to #Health4All.
          • Another health expansion and benefit for seniors is the elimination of the asset test, which excluded seniors and people with disabilities who had even minor savings.
          • While budget trailer bills will follow, they are expected to include key steps to improving health care affordability in Covered California and by establishing a new statewide Office of Health Care Affordability, and other improvements to bolstering benefits and coverage to reduce health disparities.

          SACRAMENTO, CA – Tonight, state legislative leaders today announced the outlines of a 2021-2022 budget agreement with Governor Newsom that includes funding for a more universal, equitable, and affordable, health care system. The final deal includes historic investments in our health system, including a first-in-the-nation end to the exclusion of income-eligible undocumented adults age 50 and over in Medi-Cal.

          “By opening up Medi-Cal coverage to all income-eligible Californians age 50 and over regardless of immigration status, California is not just making our health system more universal and equitable, but stronger and more resilient for all of us. Especially after a pandemic, our health care system works better when anyone who calls California home can access comprehensive and preventative health care,” said Anthony Wright, Executive Director of Health Access California, which co-chairs the #Health4All campaign with the California Immigrant Policy Center. “So many of these immigrants have contributed over their lives to California by working, paying taxes, raising families, and being pillars to our community and economy, and they should be fully included in our health system as well. This expansion will directly benefit thousands of Californians, from vulnerable seniors to essential older workers, but also the health system we all rely on.”

          California becomes the first state in the country to remove these exclusions in their state Medicaid program for those 50 and above. Illinois had agreed to start covering those 65+ last year, California will now have the most expansive coverage, including children, young adults up to age 26, and now older Californians 50 and above. The expansion to older undocumented adults is estimated to provide health coverage for approximately 235,000 more Californians.

          In another major step towards universal and equitable coverage, the budget deal eliminates the Medi-Cal asset test that has for too long prevented some Californians from accessing Medi-Cal for having a small amount of savings. This will ensure access to care for seniors and people with disabilities, and allow them to have savings needed to deal with housing and other needs and emergencies.

          “The antiquated asset test in Medi-Cal is burdensome and inequitable for older Californians and those with disabilities. Removing this test is a necessary step to improving health care access for tens of thousands of Californians,” said Jose Torres Casillas, Legislative Associate for Health Access California. “Together, these budget actions remove unfair exclusions for older Californians to get the care and coverage they need, which was even more urgent during this pandemic.”

          Health care advocates praise a number of important steps to improve Medi-Cal and reduce health care disparities previously agreed upon for the 2021-22 budget:

          • Improved Medi-Cal coverage for pregnancy and post-partum to reduce inequitable maternal mortality rates for black women
          • Continuous Medi-Cal coverage for children age 0-5
          • Creating culturally appropriate Medi-Cal documents
          • Continuing Cal-AIM reforms

          While this deal is a major win for expanding health care coverage, additional budget trailer bills will follow. They are expected to include key steps to improving health care affordability in Covered California and by establishing a new statewide Office of Health Care Affordability, and other improvements to bolstering benefits and coverage to reduce health disparities.

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            Supreme Court Upholds the Affordable Care Act Keeping in Place Coverage for Millions of Californians

            In a huge victory for Americans and Californians, the U.S. Supreme Court today issued a 7-2 ruling in California v. Texas that keeps the Affordable Care Act (ACA) intact for the over 30 million Americans and 5 million Californians who rely on it's protections and financial assistance. The Court found that the plaintiffs who sought to overturn the law lacked the standing to challenge it in the first place. 
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            For immediate release: Thursday, June 17, 2021

            For more information contact:
            Rachel Linn Gish, Director of Communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

            SUPREME COURT UPHOLDS THE AFFORDABLE CARE ACT KEEPING IN PLACE COVERAGE FOR MILLIONS OF CALIFORNIANS

            • After a decade of attacks, the U.S. Supreme Court has yet again found that the Affordable Care Act, which includes protections for pre-existing conditions and federal help to afford care for 5 million Californians, remains constitutional and intact.
            • The court ruled that the the opponents to the law lacked standing to even bring the case. 
            • Having seen the biggest gains under the ACA, California had the most to lose. Advocates celebrate the decision, and vow to continue to the work to improve and expand the ACA toward the goal of a universal, affordable, equitable health system.

            SACRAMENTO, CA – In a huge victory for Americans and Californians, the U.S. Supreme Court today issued a 7-2 ruling in California v. Texas that keeps the Affordable Care Act (ACA) intact for the over 30 million Americans and 5 million Californians who rely on it’s protections and financial assistance. The Court found that the plaintiffs who sought to overturn the law lacked the standing to challenge it in the first place.

            “After a decade of partisan attacks, the ACA remains the law of the land, helping millions of Californians access and afford care,” said Anthony Wright, executive director of Health Access California, the statewide health care advocacy coalition which has been fighting for the ACA since 2008. “The idea that we could have taken health care away during a pandemic was simply unthinkable, and we are relieved that this ridiculous case was finally rejected along with past partisan attacks. Millions of Californians can now rest a little easier knowing that their health care is no longer in limbo.”

            In California v. Texas, several state attorneys general, led by the state of Texas and then president Trump’s Administration, argued to strike down the Affordable Care Act, and with it, patient protections, including for people with pre-existing conditions, the financial assistance for many low- and middle-income Americans to afford coverage, the Medicaid expansions, and much more. California’s then Attorney General Xavier Becerra was granted standing to lead the appeal and California’s Department of Justice continued to lead the ACA’s defense even as Becerra was confirmed to serve as the U.S. Health and Human Services Secretary.

            “California had the biggest drop of the uninsured rate of all 50 states under the ACA. California has gone further than any other state in implementing and improving the ACA, and thus had the most to lose,” said Wright. “This ruling spells relief for so many Californians, including the 1.5 million who get financial help to afford health plans in Covered California, 4 million who have Medi-Cal coverage under the ACA, and the millions more who get benefits, patient protections, and peace of mind for never being denied coverage for a pre-existing condition.”

            “With the ACA intact, we urge Californians to sign up for coverage as soon as possible, especially now since the passage of the American Rescue Plan has made premiums for Californians lower than ever. We hope this decision provides momentum for Congress to make this additional affordability assistance permanent and take other actions to expand coverage,” said Wright. “While we hold accountable those who sought to take away health coverage and consumer protections from millions, we should focus on the unfinished work at the federal and state level to expand coverage and improve affordability. Hopefully this decision helps support state policymakers making state budget decisions in the next few days on how much we further expand Medi-Cal, provide greater affordability in Covered California, and have an Office of Health Care Affordability to help contain costs for all.”

            For more on California’s efforts to block the federal sabotage of the ACA, see this Health Access fact sheet

            For more on what was at risk in California if the ACA was fully repealed, visit our website.

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              California Legislature Passes Their 2021 – 2022 Budget with Major Steps Towards A More Universal Health Care System – Deal on Final Budget Must Still Be Reached with Governor Newsom

              Today the California State Assembly and State Senate voted to pass a 2021-2022 state budget that includes funding for a more universal, equitable, and affordable, health care system. While the Legislature is in agreement on this version of the budget, negotiations continue with Governor Newsom on a final deal. 
              READ MORE

              For Immediate Release: Monday, June 14, 2021

              CONTACT:
              Rachel Linn Gish, director of communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

              CALIFORNIA LEGISLATURE PASSES THEIR 2021-2022 BUDGET WITH MAJOR STEPS TOWARDS A MORE UNIVERSAL HEALTH CARE SYSTEM

              DEAL ON FINAL BUDGET MUST STILL BE REACHED WITH GOVERNOR NEWSOM

              • Both the California State Assembly and State Senate today passed their joint 2021-22 state budget which includes funding for key health care proposals, but does not reflect a final deal with the Governor.
              • The legislative deal reached on June 1, and passed today, includes funding for a first-in-the-nation end to the exclusion in Medi-Cal for undocumented adults age 50 and older. Governor Newsom’s May Revision included a proposal for Medi-Cal for the undocumented age 60 and over. 
              • The State Senate and Assembly both voted to improve health care affordability in Covered California and by establishing a new statewide Office of Health Care Affordability, and improve Medi-Cal by ending the Medi-Cal assets test for older Californians, and bolstering benefits and coverage to reduce health disparities.
              • All eyes now on the Governor reach a deal with the Legislature to ensure the enactment of these proposals. 

              SACRAMENTO, CA – Today the California State Assembly and State Senate voted to pass a 2021-2022 state budget that includes funding for a more universal, equitable, and affordable, health care system. While the Legislature is in agreement on this version of the budget, negotiations continue with Governor Newsom on a final deal.

              On June 1, the state legislature announced a joint budget proposal that aligned on a number of key health care proposals, which is what was passed today. It includes historic investments in our health system, including a plan for the first-in-the-nation end to the exclusion of income-eligible undocumented adults age 50 and over in Medi-Cal. The Governor’s May Revision included a proposal to end this exclusion for those 60 and over.

              “By ensuring Medi-Cal for all Californians age 50 and over, regardless of immigration status, California can be on the cutting edge of health care equity,” said Jose Torres Casillas, legislative associate for Health Access California, which co-chairs the #Health4All campaign with the California Immigrant Policy Center. “Our older immigrant communities are among the most vulnerable group currently excluded from public coverage programs, particularly at risk for COVID-19, and are most likely to have exacerbated conditions if they survived the virus. We urge Governor Newsom to join with the California Legislature to make this vital investment in the health of our communities, to help us get out of this pandemic and create a better and more equitable health care system for the future.”

              In an effort to tackle the rising cost of care with a more coordinated, holistic approach, the Legislature’s budget allocates funding to establish an Office of Health Care Affordability. First proposed by the Governor in his January budget, the Legislature agreed to create this new Office in order to collect and analyze information and identify trends in health care prices. This data would be used to set enforceable cost targets and includes accountability measures for those not meeting the goals.

              The legislature’s budget also improves affordability in Covered California, a much needed investment to make coverage more affordable in a high-cost state like California. The federal help in the American Rescue Plan has provided real relief to virtually all 1.5 million in Covered California and potentially hundreds of thousands more, yet many cost barriers remain including high deductibles and other out-of-pocket cost sharing. While advocates were hoping that all of the $700 million previously allocated for affordability assistance could be redirected to further subsidize the cost of care in Covered California, about $335 million is proposed to go into a reserve for a potential future affordability program. The legislative budget passed today also directs Covered California to develop options for further reducing cost-sharing, and includes funding to subsidize state-only coverage by one dollar, allowing tens of thousands of low-income Californians to get true zero-premium plans.

              “Millions of Californians have lost their health care coverage during the economic downturn caused by the pandemic, imperiling their financial and health recovery. This budget removes some cost barriers to care that will encourage more Californians to enroll in coverage and hope that this will be reflected in a final deal with the Governor,” said Diana Douglas, Policy and Legislative Advocate for Health Access California.”

              In another major step towards universal and equitable coverage, the budget passed today by the Legislature eliminates the Medi-Cal asset test that has for too long prevented some Californians from accessing Medi-Cal for having a small amount of savings. This will ensure access to care for seniors and people with disabilities, and allow them to have savings needed to deal with housing and other needs and emergencies.

              “The antiquated asset test in Medi-Cal is burdensome and inequitable for older Californians and those with disabilities. The Legislature is right to take this step to improve health care access for tens of thousands of Californians and we look to Governor Newsom to remove this barrier to care,” said Torres Casillas.

              Health care advocates praise the legislature for voting to pass a budget that includes a number of important steps to improve Medi-cal and reduce health care disparities, and hope that Governor will agree to to include in a final budget:

              • Improved Medi-Cal coverage for pregnancy and post-partum to reduce inequitable maternal mortality rates for black women
              • Continuous Medi-Cal coverage for children age 0-5
              • Creating culturally appropriate Medi-Cal documents
              • Continuing Cal-AIM reforms

              Additional investments in the legislative budget passed today will target inequities in our health care system, including:

              • Establishing a Health Equity and Racial Justice Fund to support community-based initiatives supporting communities of color
              • Creating a Transgender Wellness Equity Fund
              • Investments in public health infrastructure

              Learn more in this Health Access Factsheet: Key Health Care & Coverage Issues in the 2021 -2022 California State Budget 

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                Major Effort to Contain Inflated Health Care Costs Passes CA State Assembly

                Today, the California Assembly passed AB 1130 by Assemblymember Jim Wood, to implement a new statewide Office of Health Care Affordability, a bold effort to address the rising cost of health care, on a preliminary 44-12 vote. 
                READ MORE

                For Immediate Release: Thursday, June 3, 2021

                CONTACT:
                Rachel Linn Gish, Director of Communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

                CA STATE ASSEMBLY PASSES MAJOR LEGISLATION TO CONTAIN INFLATED HEALTH CARE COSTS

                AB 1130 (Wood) establishes an “Office of Health Care Affordability” which would set cost goals across California’s entire health care industry

                Also pending as part of the CA State Budget

                SACRAMENTO, CA — Today, the California Assembly passed AB 1130 by Assemblymember Jim Wood, to implement a new statewide Office of Health Care Affordability, a bold effort to address the rising cost of health care, on a preliminary 44-12 vote.

                “We’ve known for a long time that it’s the price of health care that’s the problem, not that people use more care. The inflated cost of care is taking a bigger and bigger bite out of workers’ wages and family finances, actually forcing many people to skip or ration their care,” said Yasmin Peled, policy advocate for Health Access California. “We cannot make health care more affordable for Californians unless we tackle the underlying cost of care, which would be the mission of this new Office of Health Care Affordability.”

                The price of health care in the United States is higher, for almost all services, than in other developed nations, but does not correlate to better care. In California, health insurance premiums for employer coverage increased by 249% between 2002 and 2017, six times the rate of general inflation. If costs were to continue to grow just at the rate of general economic growth, Californians could save billions of dollars every year.

                Americans get less care than those in many other wealthy countries, including fewer doctor visits and health outcomes in terms of illnesses, health status, and life expectancy are no better in the U.S., and on some measures, are even worse than other wealthy nations. According to a recent California Health Care Foundation poll, more than half of California families delayed or skipped care due to cost and nearly half of those who postponed care said it made their conditions worse.

                The new Office of Health Care Affordability would monitor cost trends and data for a range of health care spending such as health insurance premiums, hospital care, physician care, and prescription drugs, recognizing the role that they all play together, rather than singling out any one part of the industry. It would use that data to look at the real-world costs experienced across our health care system, and use that data to set targets for these health sectors. The Office would provide strategies and flexibility to health stakeholders to meet these targets, but costs could not exceed targets without penalty or explanation. The Office would also set goals for quality and equity.

                “Californians are facing an affordability crisis on many fronts, but crushing increases in health care costs are at the top of the list, particularly during a pandemic,” said Peled, “This Office would put in place a comprehensive strategy to contain health care costs, setting targets for affordability with accountability, and drive innovation in payment and delivery of care while still prioritizing quality and equity.”

                The establishment of an Office of Health Care Affordability has the support of a broad range of organizations, including consumer, labor, business, and health industry stakeholders. It is also included in Governor Newsom’s 2021-22 budget proposal, and in the joint legislative budget proposal.

                Resources

                  CA Governor Newsom’s Health Budget: Key Takeaways: #Health4All & More, Missed Opportunities

                  Governor Gavin Newsom today unveiled the 2021- 22 May Revision of the state budget, which includes some important investments to improve and expand our health care system, but also missed major opportunities for expansion and improvement. "The pandemic underlined the urgency of fixing the inequities in health care, and this proposed budget makes some important investments to expand and improve our health system, while missing other major opportunities to meet urgent ongoing needs, especially given the size of the surplus," said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition.
                  READ MORE

                  For Immediate Release: Friday, May 14, 2021

                  CONTACT:
                  Anthony Wright, Executive Director, Health Access California, awright@health-access.org, 916-870-4782 (cell)

                  Yvonne Vasquez, Communication Associate, Health Access California, yvasquez@health-access.org, 916-407-7078 (cell)

                  GOVERNOR NEWSOM’S INCLUDES EXPANSION OF MEDI-CAL TO OLDER CALIFORNIANS REGARDLESS OF IMMIGRATION STATUS;

                  BUT MAJOR MISSED OPPORTUNITIES TO MAKE CARE MORE AFFORDABLE & AVAILABLE POST-PANDEMIC

                  • The 2021-22 CA budget May Revision announced today by Governor Gavin Newsom makes major investments to expand and improve health care, especially in Medi-Cal.
                  • The budget proposal makes a historic step towards #Health4All by removing the exclusion of income-eligible undocumented seniors in Medi-Cal age 60 and over–a group particularly at risk dealing with the pandemic and its aftereffects.
                  • At same time, the Governor’s budget proposal would take back over $700 million in state subsidies in Covered California that could have furthered lower premiums and deductibles for hundreds of thousands of Californians.
                  • Other missed opportunities include not eliminating the Medi-Cal asset test that excludes some other seniors and people with disabilities, and not further expanding Medi-Cal to get closer to #Health4All, especially for essential workers that bore the brunt of the COVID-19 crisis. With the current significant surplus, health and community advocates seek bolder steps to ensure Californians to have access to care and coverage post-pandemic.

                  SACRAMENTO, CA – Governor Gavin Newsom today unveiled the 2021- 22 May Revision of the state budget, which includes some important investments to improve and expand our health care system, but also missed major opportunities for expansion and improvement.

                  “The pandemic underlined the urgency of fixing the inequities in health care, and this proposed budget makes some important investments to expand and improve our health system, while missing other major opportunities to meet urgent ongoing needs, especially given the size of the surplus,” said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition. “The Governor is right to propose to strengthen our health system for everyone by removing the unfair exclusions to Medi-Cal for the undocumented immigrants, especially some of the seniors who have been disproportionately harmed by COVID-19. We appreciate the improvements in Medi-Cal benefits and services, from coverage of post-partum care, doulas, and community health workers, to the reforms to provide more enhanced and accountable care.”

                  “This budget recognizes that our health system is better when everyone has access to coverage, including primary and preventative care, and we will continue to advocate with the Legislature to improve access and affordability in both Medi-Cal and Covered California. In Medi-Cal, we will want to further remove counterproductive exclusions, whether from an outdated asset test, or to do more to undo the unjust exclusion based on immigration status, especially for essential workers exposed during this pandemic,” said Wright. “We are disappointed that in this time of surplus, the Governor proposes to reclaim the general fund investment of hundreds of millions of dollars that should go to increasing affordability assistance to further lower premiums and deductibles, especially important on our high cost-of-living state. We hope the Legislature takes the opportunity to take these additional steps to a universal health care system, which we realize is more urgent than ever post-pandemic.”

                  Prior to the Governor’s May revision, the California Assembly and Senate Budget chairs identified and prioritized many of these proposals, including additional #Health4All expansions of Medi-Cal regardless of immigration status, the removal of the asset test in Medi-Cal, additional affordability assistance in Covered California, and more.

                  #HEALTH4ALL AND MEDI-CAL: The budget includes Medi-Cal coverage for all income eligible seniors, age 60 and over, regardless of status. While the #Health4All coalition—made up of leading health and immigrant rights organizations across California— praised this step, the recently announced historic budget surplus, along with the continuing pandemic, make it even more urgent and possible to cover all adults, regardless of age or immigration status. Both the Assembly and the Senate highlighted Medi-Cal expansions to more income-eligible undocumented Californians beyond seniors as a top priority in this year’s budget. An expansion for undocumented seniors was included in the Governor’s initial 2020 state budget, but was withdrawn due to a forecasted budget downturn that failed to materialize. In just a year, our state has gone from a budget deficit of tens of billions, to a budget surplus of tens of billions, opening the possibility for getting to Health4All adults in the near future.

                  “Most of these undocumented seniors have given a lifetime of contribution to California in working, raising families, and paying taxes, yet have been excluded from Medi-Cal coverage despite being the most vulnerable to COVID-19. We certainly feel the urgency to cover the seniors that survived, that may likely have exacerbated medical conditions, along with a broader group of essential workers who were exposed and in need of coverage and care. We will work with our legislative champions to support this request and take further steps to #Health4All. The price tag to simply remove this exclusion entirely is a small percentage of the new surplus.” said Jose Torres Casillas, policy advocate with Health Access California. “We also feel the need of expanding Medi-Cal coverage to more seniors and people with disabilities by eliminating the asset test, which discourages savings and limits the ability for thousands to get the coverage they need. In this pandemic, we learned that our health is dependent on the health and caring of others, including our friends, family members, and those in the community.”

                  COVERED CALIFORNIA: “The proposed budget takes back over $700 million of dollars in existing state affordability help in Covered California, missing a major opportunity to further reduce premiums or deductibles in Covered California. This reduction in state investment risks raising premiums should federal assistance not be made permanent. California was proud to pilot additional affordability assistance in our health insurance marketplace, but as much as the new federal dollars are welcome, many families need more help in a famously high cost-of-living state. Given our higher costs, Californians need additional assistance beyond any affordability standard set nationwide.” said Diana Douglas, policy advocate with Health Access California. This pandemic showed the problems of leaving people uninsured, or with coverage that leaves people with deductibles of thousands of dollars, discouraging care. We urge the Legislature to look to keep this California commitment to additional affordability assistance. California should once again be a leader by further investing in subsides to help millions of Californians who need more help paying for care in our high-cost-of-living state, and cover more Californians during this pandemic and beyond.”

                  ADDITIONAL AFFORDABILITY AND ACCOUNTABILITY: The proposed state budget continues key initiatives on health care costs, quality, and equity. This includes the effort to create a new Office of Health Care Affordability, to confront health care consolidation and set cost-growth targets for all sectors of the industry. “As Californians face an affordability crisis on many fronts, the Office of Health Care Affordability is a bold effort to put in place a comprehensive strategy to contain health care costs, setting enforceable targets for affordability with accountability, and drive innovation in payment and delivery of care while still prioritizing quality and equity,” said Yasmin Peled, policy advocate with Health Access California. Other industry accountability efforts would require health plans to meet goals regarding quality and reducing disparities, through regulation by the Department of Managed Health Care and contracting by Medi-Cal and Covered California.

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                    Major Health Care Affordability Proposals to Be Heard Today in Senate Budget Subcommittee

                    Today, the California Senate Budget Subcommittee on Health and Human Services will meet to hear a number of key health care budget proposals, including two major efforts to make our health care system more affordable for consumers. The Office of Health Care Affordability as well as additional affordability assistance in Covered California will both be considered during the hearing which begins at 2:30pm today, May 4th, 2021. These efforts are among the most impactful of a number of health care budget proposals put forward by health care advocates this year. 
                    READ MORE

                    For Immediate Release: Tuesday, May 4, 2021

                    CONTACT:
                    Rachel Linn Gish, Director of Communications, Health Access California, rlinngish@health-access.org, 916-532-2128 (cell)

                    MAJOR HEALTH CARE AFFORDABILITY PROPOSALS TO BE HEARD TODAY IN SENATE BUDGET SUBCOMMITTE 

                    California can take bold steps to create a more affordable health care system this year

                    • Today at 2:30pm PST the California Senate Budget Subcommittee on Health and Human Services will meet to discuss major proposals to make health care and coverage more affordable.
                    • One item to be heard is the Office of Health Care Affordability, with the goal to contain skyrocketing health care costs in California.
                    • Another item to be heard is an effort to redirect additional affordability assistance in Covered California to further lower costs for consumers beyond the new federal help in the American Rescue Plan. 

                    SACRAMENTO, CA — Today, the California Senate Budget Subcommittee on Health and Human Services will meet to hear a number of key health care budget proposals, including two major efforts to make our health care system more affordable for consumers. The Office of Health Care Affordability as well as additional affordability assistance in Covered California will both be considered during the hearing which begins at 2:30pm today, May 4th, 2021. These efforts are among the most impactful of a number of health care budget proposals put forward by health care advocates this year.

                    “The pandemic has only made the need for affordable health care and coverage more urgent. Now is the time to take action that will lower cost barriers for millions of Californians who still struggle to afford health care,” said Anthony Wright, executive director of Health Access California, the statewide health consumer advocacy coalition, a key backer of these proposals. “These budget proposals seek to take on inflated health care prices that impact everyone, and provide additional affordability assistance to those who need it.”

                    Among the first agenda items the committee will consider is the effort to implement a new statewide Office of Health Care Affordability to contain rising health care costs. The price of health care in the United States is higher, for almost all services, than in other developed nations, but does not correlate to better care. In California, health insurance premiums for employer coverage increased by 249% between 2002 and 2017, six times the rate of general inflation. Americans get less care than those in many other wealthy countries, including fewer doctor visits and health outcomes in terms of illnesses, health status, and life expectancy are no better in the U.S., and on some measures, are even worse than other wealthy nations. Aligning health cost growth with economic growth could save Californians billions per year. The Office was included in Governor Newsom’s January budget proposal, and is also pending as legislation (AB 1130 by Assemblymember Wood). The new Office would monitor cost trends for a range of health care spending including on health insurance premiums, hospital care, physician care, and prescription drugs.

                    “As Californians face an affordability crisis on many fronts, the proposed Office is a bold, far-reaching effort to address inflated health care costs that are taking a bigger and bigger bite out of workers’ wages and family finances, forcing many people to skip or ration their care,” said Yasmin Peled, policy advocate for Health Access California, who will testify in support of creating an Office of Health Care Affordability in committee this afternoon. “This Office would put in place a comprehensive strategy to contain health care costs, setting targets for affordability with accountability, and drive innovation in payment and delivery of care while still prioritizing quality and equity.”

                    Another item to be considered by the committee today will be a new and exciting proposal to lower the cost of care for many of the 1.5 million Californians in Covered California, and potentially hundreds of thousands more. Earlier this year, President Biden’s historic American Rescue Plan included the largest expansion of Affordable Care Act subsides for those purchasing care in the state marketplaces since the law was passed. No American of any income will spend more than 8.5% of their income for coverage, effectively eliminating “affordability cliffs” in ACA marketplaces. California had already taken similar steps two years ago with strong results, showing proof-of-concept for the national expansion. But many Californians who purchase care on their own still struggle to pay other out-of-pocket costs, such as cost-sharing and deductibles. California can redirect funds into additional affordability assistance this year.

                    “As state investments get supplanted with federal assistance, California can once again be a leader in making coverage more affordable,” said Diana Douglas, policy advocate for Health Access California, who will testify in support of expanded Covered California assistance in committee this afternoon. “By repurposing the state subsidies, California can help millions of consumers who need more help paying for care in our high-cost-of-living state, and cover more Californians during this pandemic and beyond.”

                    Other proposals not being heard today but in budget consideration including removing exclusions for seniors in Medi-Cal based on assets, and on immigration status. Both proposals would also expand access to care and coverage. All these proposals are detailed in a new Health Access Factsheet: Key Health Care & Coverage Issues in the 2021-2022 California State Budget.

                    Resources

                    Overall Budget

                    Office of Health Care Affordability

                    Covered California Affordability

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