The Sacramento-San Joaquin Delta, the landward reach of the San Francisco Estuary, provides habitat for threatened delta smelt, endangered winter-run Chinook salmon, and other species of concern. It is also the location of huge freshwater diversion facilities that entrain large numbers of fish. Reducing the entrainment of listed fishes into these facilities has required curtailment of pumping, reducing the reliability of water deliveries. We reviewed the first 5 years (2001–2005) of the Environmental Water Account (EWA), a program instituted to resolve conflicts between protecting listed fishes and providing a reliable water supply. The EWA provided fishery agencies with control over 0.2–0.4 km³ of water to be used for fish protection at no cost to users of exported water, and fish agencies guaranteed no disruption of water supply for fish protection. The EWA was successful in reducing uncertainty in water supply; however, its contribution to the recovery of listed fishes was unclear. We estimated the effectiveness of the EWA to be modest, increasing the survival of winter-run Chinook salmon by 0–6% (dependent on prescreen mortality), adult delta smelt by 0–1%, and juvenile delta smelt by 2–4%. Allocating EWA water for a single life stage of one species could provide larger gains in survival. An optimally allocated EWA of equal size to the median of the first 5 years could increase abundance of juvenile delta smelt up to 7% in the springs of dry years. If the EWA is to become a long-term program, estimates of efficacy should be refined. If the program is to be held accountable for quantitative increases in fish populations, it will be necessary to integrate scientific, possibly experimental, approaches.