The report focused on California’s experiences during the first full year after implementation of the Affordable Care Act’s coverage expansion. Focusing on those who have gained coverage either through Covered California or an expanded Medi-Cal program, the report examined the state’s health care system after roughly 4.4 million people have enrolled in coverage in the two programs. Using results from a comprehensive survey, the report found that those with insurance were more likely to use it, but the newly insured had more trouble than the previously insured navigating how to use their coverage. Additionally, almost half (47%) of those newly enrolled in Covered California reported having difficulty affording their monthly premiums, compared to 27% of those who were previously ensured prior to 2014. The report also found that community clinics and health centers are increasingly relied upon by the uninsured and newly insured.