California has done more over the last decade than almost any 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 Trump, is weighing whether to scrap the healthcare law. And Trump, who has pledged for four years to dismantle the law, hasn’t indicated how he’d replace its core protections should he win a second term.

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