How has the Affordable Care Act helped you?

Under the Affordable Care Act (ACA), millions of Americans have new health coverage options and new help to afford coverage that they can rely on. California led the nation in expanding Medicaid, giving working families subsidies in Covered California in order to afford private insurance, preventing people from being denied coverage because of pre-existing conditions, letting young people stay on their parent's insurance until age 26, and much more. 

But these options are at risk. President-elect Trump, and the Republican majority in Congress including many Congressional Representatives from California have promised that the ACA should be repealed, without a comprehensive plan to replace it. Without these new options and financial assistance, millions of folks who have benefited from the ACA will face dire health and economic consequences.

We need your help to be explicit with the new Congress and Administration about the true impact of their decisions—to fight to preserve the benefits we rely on today. Please share your story about how the ACA has helped you and your family. Your voice matters, and it will be what helps preserve this progress.

* 1. First Name

* 2. Middle Initial

* 3. Last Name

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

* 5. E-mail Address

* 6. Address

* 7. Zip Code

* 8. County

* 9. Occupation

* 10. How has the ACA helped you? Please check which reform(s) benefitted you or a family member. Choose "other" if you have a different issue.

* 11. If you are a physician, nurse, clinic employee, home care worker or other health provider, please tell us how the ACA has benefited you or your patients:

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

* 13. Please describe your story (take as much space as needed)

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

* 15. What is the best time to reach you?

* 16. Would you be willing to speak with media, lawmakers, and others about your story?

* 17. How did you hear about this survey?

* 18. Share your picture

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

* 19. Share your social media profile