Affordable Care Act - Real health care stories

Share Your Health Care Story

Health Access California and the #Fight4OurHealth coalition want to hear from you!

Our health care is under threat from Congress and the Trump administration. 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.

Particularly as open enrollment season begins, we want to know what your experience is with health insurance. Whether or not this is your first time getting it, or if you have a story from before the Affordable Care Act was passed, 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!

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* 1. First Name

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* 2. Middle Initial

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* 3. Last Name

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* 4. How did you hear about this survey?

Health Access e-mail alert

Health Access website

Social Media (Facebook, Twitter)

Fight4ourhealth alert

Other (please specify)

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* 5. Age

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

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* 7. E-mail Address

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* 8. Address

Street

City

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* 9. Zip Code

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* 10. County

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* 11. Occupation

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

Yes

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* 13. Gender (optional)

Male

Female

Decline to answer

Other (please specify)

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* 14. Race or ethnicity (optional)

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

Insurance I bought on my own through Covered California or an agent or broker

Medi-Cal

Medicare

Insurance through an employer (through my job or the job of my family member)

Uninsured

Not Sure

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

Yes

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

Yes

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* 18. 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?

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* 19. 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:

I have patients that got health insurance or Medi-Cal after the ACA

I saw patients that had coverage for the first time

I got health insurance or Medi-Cal for myself or a family member because of the ACA

Other (please specify)

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

Yes

Maybe

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

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

Yes

Maybe

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

Yes

Maybe

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

Yes

Maybe

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* 25. Share a photo

Photos are powerful. Congress needs to hear the stories of constituents and see our faces.

DOCX, DOC, JPG, GIF, JPEG, PDF, PNG file types only.

Choose File

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* 1. First Name

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* 2. Middle Initial

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* 3. Last Name

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* 4. How did you hear about this survey?

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* 5. Age

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

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* 7. E-mail Address

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* 8. Address

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* 9. Zip Code

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* 10. County

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* 11. Occupation

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

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* 13. Gender (optional)

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* 14. Race or ethnicity (optional)

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

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

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

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* 19. 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:

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

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

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

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

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

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* 25. Share a photo

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* 26. Share your social media profile (optional)