Twenty Takeaways from 2020

Protecting Our Progress and Confronting the Challenges of COVID-19

Like most Californians, we had high hopes for progress in 2020. The year began in earnest with the implementation of expanded access and affordability to coverage for hundreds of thousands of Californians, and ambitious plans to increase health industry oversight to control costs, improve quality and equity, and win key patient protections.

When the pandemic hit in March, Health Access doubled-down on our commitment to protect California consumers, adapting quickly to the many changes in our health system and in response to COVID-19. This meant pausing some of our larger-scale efforts in the short-term in order to fight for consumer protections and access to care during a pandemic-induced economic downturn and state budget deficit. Coupled with the call for greater racial justice made throughout the country, we have also been compelled to do more to confront the health disparities and inequities that COVID-19 has spotlighted.

Yet in a year marked by grief and distance, health advocates were still able to win some key victories for California’s health and health care, culminating in the major effort on ending surprise medical bills nationally. Here are twenty things to take away from 2020 benefiting California health care consumers:


  1. Implemented first-in-the-nation coverage expansions that started January 1st, including Medi-Cal to all income eligible young adults regardless of immigration status, and new state subsidies in Covered California for more middle-income Californians helping hundreds of thousands get new coverage and additional affordability assistance.
  2. Advocated for aggressive and equitable state and federal responses to the COVID-19 crisis and communicated directly with consumers about their new health care options.
    • Encouraged proactive state efforts like expanding Medi-Cal to provide testing and treatment for COVID-19 for the uninsured and underinsured, extending Covered California’s special enrollment period, creating the Medi-Nurse line for the uninsured, instituting new insurance guidance to encourage COVID-19 testing and treatment without co-payments, ensuring an efficient and equitable distribution of vaccines, and more.
    • Pushed for multiple rounds of federal financial relief, including Families First, the CARES Act, and the end-of-year COVID-19 packages, which included increased unemployment help and direct financial assistance, even as we sought additional state and local aid, assistance for families to get and stay covered, and other elements in the House-passed HEROES Act.
    • Educated Californians about these changes and benefits, through many communications, organizing, and public education efforts including a webpage clearinghouse of information, blog posts, webinars, town halls, and regular email updates to our lists.
  3. Prevented proposed state budget cuts to Medi-Cal that would have curtailed benefits and access to care for millions, and in particular denied or discouraged coverage and care for tens of thousands of California seniors in the middle of a pandemic. Health and senior advocates organized virtual visits and rallies to urge #CareNotCuts to reverse these proposals.
  4. Increased transparency of health care costs, quality, and equity, with the establishment of a new Health Payments Database for a comprehensive tracking of the California health system. Also enhanced rate reporting in the individual market, to detect trends in premiums, cost-sharing, benefit design, and more.  AB 2118 (Kalra)
  5. Passed a first-in-the-nation initiative to help lower drug prices by allowing the state to contract to manufacture generic drugs under its own label, using California’s purchasing power to fix market failures of inflated and rising generic drug prices. SB 852 (Pan)
  6. Helped win mental health parity, expanding the range of mental health and substance use disorder treatments that private health insurance plans must cover. Previously, plans were only required to cover treatments for a limited range of “severe conditions.” SB 855 (Weiner)
  7. Banned flavored tobacco products in response to an alarming rise in e-cigarette use among youth. With 3.6 million middle and high school students using e-cigarettes, SB 793 (Hill) will help prevent youth from getting hooked on flavored products that are often marketed to them.
  8. Greater equity for LGBTQ Californians, by collecting data on sexual orientation and gender identity (SOGI) for public health efforts like those related to COVID-19 and to establish a Transgender Health Fund. SB 932 (Weiner)
  9. Expanded rural care for those living in one of the 35 counties that are a part of the County Medical Services Program (CMSP) consortium, with extended efforts under new “Path To Health” and “Connect To Care” options for the uninsured.
  10. Stopped surprise medical bills with a long-sought federal fix passed by Congress in the end-of-year COVID-19 relief package, which will prevent patients from getting unexpectedly out-of-network bills from doctors, hospitals, emergency rooms, or air ambulances. The deal keeps in place California’s strong protections against surprise billing by physicians in AB 72, but also fills in the gaps for seven million Californians not covered under state law. Health Access was also seeking a state solution in CA with the stalled AB 1611 (Chiu), but also had been very active in the federal fight.


  1. Electing a new U.S. President & ending the Trump Administration’s four years of attacks on our health care. The election of President-elect Joe Biden opens new possibilities for health reforms, nationally and in California, especially with key Californians in top positions, from Vice President-elect Kamala Harris to Health and Human Services Secretary-designate Xavier Becerra.
  2. Pushing back against Trump Administration efforts to discourage enrollment through discriminatory “public charge” rules, defunding public hospitals with a Medicaid “fiscal accountability” rule (MFAR), and undermining section 1557 nondiscrimination rules. We also educated the public on the pending Supreme Court case to strike the Affordable Care Act.
  3. Recommitting ourselves to racial justice and health equity by responding both internally and externally to the inequities highlighted by the large-scale national protests and the COVID-19 health crisis. This included support for policy reforms to increase health equity in the justice system.
  4. Serving as a key consumer voice on the rollout of the COVID-19 vaccine, as part of California’s Community Vaccine Advisory Committee along with state administrative and advocacy efforts to ensure a safe, efficient, and equitable distribution of the vaccine.
  5. Highlighting the need for new investments and increased revenues, while launching the #CommitToEquity campaign with a multi-issue cross-section of allies and stakeholders. Together, we had legislative champions introduce new bills to tax the wealthy to meet critical needs, like education and health care, during this pandemic and beyond.
  6. Getting commitments to cover seniors in Medi-Cal regardless of immigration status. While advocating to fully remove the exclusion of undocumented immigrants in Medi-Cal, the #Health4All coalition focused on the urgency to cover elders, particularly vulnerable during the pandemic. This expansion, included in the Governor’s January budget, was withdrawn in light of the state budget crisis, but state leaders committed to prioritize it when the economy rebounds.
  7. Initiating new efforts to improve Medi-Cal, including a new Cal-AIM set of reforms to better coordinate care, and a new re-procurement process to set higher standards for Medi-Cal managed care plans. After the pandemic stalled efforts, California sought a one-year extension of our Medicaid waiver with the federal government, with the expectation to submit a longer renewal next year, along with a revamped Cal-AIM reform proposal.
  8. Establishing the framework for a possible new Office of Health Care Affordability, backed by the Governor and a broad coalition of consumer, labor and health industry groups, to have coordinated oversight of the health system and to set enforceable cost-growth targets.
  9. Continuing oversight on hospital consolidation to ensure consumer benefits, with Attorney General Xavier Becerra implementing a $575 million settlement with Sutter Health, and imposing conditions on specific hospital mergers, including Cedars-Sinai and Huntington Beach Hospital. This year we renewed the fight to increase the AG’s authority over takeovers by for-profit chains and private equity with SB 977 (Monning) which stalled in the state legislature but likely will be revisited.
  10. Began the work to plan out a path to universal health coverage through a unified financing system as part of the Healthy California for All Commission. After writing up a scan of the health system in 2020, the Commission is expected to restart in 2021 identifying specific policy decisions that need to be made, along with what federal permissions are available under a new White House.

Even with everything that happened in 2020, Health Access, California’s health care consumer advocacy coalition, was proud to work with our partners and allies to secure these significant victories, and to start meaningful efforts that will continue in 2021 and beyond.