Health advocates are decrying the budget deal reached between Gov. Jerry Brown and legislative leaders last week, calling it a missed opportunity to improve health care access for struggling Californians.

The $200 billion deal reached Friday between Brown, Assembly Speaker Anthony Rendon and Senate President Pro Tem Toni Atkins includes $500 million to fight homelessness and $90 million to increase grants to people on welfare. However, it dropped key proposals by Democratic legislators to expand Medi-Cal eligibility to undocumented immigrants under age 26 and expand financial subsidies for people who purchase health insurance on the Covered California exchange.

Brown touted the deals’ approximately $16 billion in contributions to the state’s rainy day fund and reserves.

But advocates said they are furious that Brown and legislative leaders didn’t use more of the state’s budget surplus—estimated to be the largest in decades—to tackle health care disparities and further support the Affordable Care Act in the face of federal attempts to undermine its stability.

“To say it’s a missed opportunity is an understatement,” said Kimberly Chen, government affairs manager for the California Pan-Ethnic Health Network (CPEHN), a statewide health advocacy group. “When you have multi-million dollar surpluses and you can’t find the room to do really basic but impactful health investments, it’s just incredibly disappointing.”

Many health-related proposals shunned in the budget deal had been top priorities for the Care4All California Coalition, a broad affiliation of organizations and advocacy groups campaigning to make health care more affordable and inclusive. These included the expansion of Medi-Cal to cover undocumented young adults and increasing subsidies to purchase health insurance.

Additionally, the coalition had sought subsidies to ensure higher-income earners didn’t pay more than 8 percent of their income toward health insurance premiums, and supported raising the maximum income level seniors and people with disabilities must meet to qualify for full-scope Medi-Cal.

“We were shocked,” said Anthony Wright, executive director of Health Access California, which is leading the Care4All California campaign. “We were realistic that we weren’t going to get everything we asked for, but it was shocking that we got not 50 percent or 20 percent, but zero.”

Even relatively low-cost requests for health program improvements did not make it into the budget deal, said Chen. She pointed to a $1 million CPEHN-supported proposal to fund asthma-prevention outreach to Medi-Cal beneficiaries, and a $1.4-million request for the Department of Health Care Services to analyze health care data in more detail for certain demographic groups such as Pacific Islanders and Southeast Asian populations.

“We’re just kind of puzzled as to why the state won’t make modest investments (in programs) that have been proven to show returns on investment in the future,” Chen said.

Wright said the lack of funding for new health proposals will leave low-income Californians vulnerable to insurance premium increases and continue to make it hard for many people to afford and access care.

“There will continue to be over 2.8 million uninsured Californians,” he said. “There will continue to be many families that struggle to afford health care.”