Covered California, the state's ACA marketplace covering nearly 2 million residents, reports that 89% receive federal subsidies averaging $563 per month, reducing average out-of-pocket premiums from $698 to $135. The expanded subsidies from 2021 are set to expire at year-end unless Congress renews them, with estimates that approximately 400,000 Californians would drop coverage immediately if they lapse. The exchange's Quality Transformation Initiative, overseen by Chief Medical Officer Monica Soni, requires health plans to meet performance targets on blood pressure control, diabetes management, colorectal cancer screening, and childhood vaccinations, with non-compliant plans paying penalties that generated $15 million in the program's first year.