How Has the Affordable Care Act Helped You?

Our health care is still under threat from Congress, the Trump administration, and the courts. Whether it's through cuts to Medicaid in the federal budget, or actions such as pulling cost-sharing discounts for low-income families, it's more important than ever that we take action to protect our care.

We want to know what your experience is with health insurance. Do you have a pre-existing condition? How did the ACA help you and your family? We want to hear from you! It's because of stories like yours, that we were able to defeat the many attempts at ACA repeal or other cuts or caps to our health care. And with your continued advocacy, we hope to build on the progress of the ACA to improve our health care system.

Thank you for sharing your story!

First Name

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* 1. First Name

Middle Initial

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* 2. Middle Initial

Last Name

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* 3. Last Name

Age

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* 4. Age

Phone Number (XXX-XXX-XXXX)

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* 5. Phone Number (XXX-XXX-XXXX)

E-mail Address

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* 6. E-mail Address

Address

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* 7. Address

Zip Code

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* 8. Zip Code

County

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* 9. County

Occupation

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* 10. Occupation

Do you have children? (currently 0-18)

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* 11. Do you have children? (currently 0-18)

Gender (optional)

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* 12. Gender (optional)

Race or ethnicity (optional)

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* 13. Race or ethnicity (optional)

What type of health insurance coverage do you have?

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* 14. What type of health insurance coverage do you have?

Please describe your health care story (take as much room as necessary). For example, tell us: about a time when you weren’t able to afford health coverage. Do you have a pre-existing health condition (examples include everything from childhood asthma, to having had surgery, or a life-threatening illness)?  What will happen to you and your loved ones if your health coverage is taken away? Has having coverage saved your life or saved you from financial ruin?

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* 15. Please describe your health care story (take as much room as necessary). For example, tell us: about a time when you weren’t able to afford health coverage. Do you have a pre-existing health condition (examples include everything from childhood asthma, to having had surgery, or a life-threatening illness)?  What will happen to you and your loved ones if your health coverage is taken away? Has having coverage saved your life or saved you from financial ruin?

Are you willing to speak further with Health Access staff about sharing your story?

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* 16. Are you willing to speak further with Health Access staff about sharing your story?

What is the best time to reach you and preferred method of communication?

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* 17. What is the best time to reach you and preferred method of communication?

Would you be comfortable sharing your story with the media, such as a reporter or local TV station?

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* 18. Would you be comfortable sharing your story with the media, such as a reporter or local TV station?

Are you interested in sharing your story directly with lawmakers through a meeting or phone call?

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* 19. Are you interested in sharing your story directly with lawmakers through a meeting or phone call?

Would you like to receive regular communication from Health Access?

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* 20. Would you like to receive regular communication from Health Access?

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