WASHINGTON — California has done more over the last decade than almost any other state to expand health insurance, bolster services for its most vulnerable residents and improve the quality of its clinics and hospitals.
Sick patients are getting more help managing diabetes, heart disease and other chronic illnesses. Women are giving birth more safely, health records show. And the share of working-age Californians without health coverage tumbled from nearly 1 in 4 to just 1 in 10 before the current economic crisis — one of the steepest declines in the nation.
But the gains — largely made possible by the Affordable Care Act, or Obamacare — now hang in the balance of the presidential election.
The Supreme Court, poised to get another justice appointed by President Donald Trump, is weighing whether to scrap the health care law. And Trump, who has pledged for four years to dismantle it, hasn't indicated how he'd replace its core protections should he win a second term.
"The stakes have never been higher," said California Atty. Gen. Xavier Becerra, who is defending the law at the Supreme Court against an effort to nullify it by the Trump administration and a group of Republican-led states. Becerra and others in California are also fighting to stop administration efforts to relax rules dictating protections that health insurers must provide.
For his part, Trump insists he will safeguard sick Americans. "Will always protect pre-existing conditions!!!" he tweeted recently.
Despite years of promises, however, the president has never produced a plan to do that. And he has made little secret of his hostility to California, claiming in another recent Twitter post that the state is "going to hell."
Trump's antipathy has fueled widespread concerns among California health care leaders about what a second Trump term might bring, especially if the Supreme Court invalidates all or part of the health care law.
"California has made a lot of progress in recent years, but people don't fully appreciate how much of that depends on the financing and framework of the Affordable Care Act," said Anthony Wright, executive director of Health Access California, one of the state's leading advocacy groups for patients. "If the law is wiped away, much of California's progress collapses with it."
Former Vice President Joe Biden, the Democratic nominee, has defended the 2010 law, proposing a host of initiatives to build on its protections.