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 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majority in Congress including many Congressional Representatives from California have promised that the ACA should be repealed, without a comprehensive plan to replace it.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. How did you hear about this survey?

* 5. Age

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

* 7. E-mail Address

* 8. Address

* 9. Zip Code

* 10. County

* 11. Occupation

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

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

* 14. Has coverage saved your life (or someone in your family’s)?

* 15. Has coverage kept you (or your family) from financial ruin or even bankruptcy?

* 16. 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, or about a time when you could not get covered by health insurance. Do you have a pre-existing health condition (examples include everything from childhood asthma, to having had surgery, or a life-threatening illness) that you are concerned might get you denied coverage if the law changes moving forward? Have you ever been without health care?

* 17. 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:

* 18. Are you willing to speak further with Health Access staff or the Fight4OurHealth coalition about sharing your story?

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

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

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

* 22. Are you comfortable with sharing your story with an audience at a Community meeting or Town Hall?

* 23. Share your picture (optional)

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* 24. Share your social media profile (optional)