California’s effective implementation of the Affordable Care Act (ACA) has led to the largest drop of the uninsured of all 50 states, with 93 percent of state residents now covered by health insurance. In spite of these coverage gains and improved affordability for many, individuals eligible for Covered California make up the state’s second largest group of uninsured after undocumented residents. Many Californians enrolled in individual market coverage also struggle to afford premiums and out-of-pocket costs.