Health care is a major policy issue in this presidential election year. The success of the Affordable Care Act (ACA) in expanding health insurance coverage-as well as the political and legal challenges it has faced-has sparked serious state and national conversations about the role of government and public programs in ensuring that everyone has access to affordable health insurance. In California, the new governor and the Democratic majority in the legislature have signaled their support for further coverage expansions financed primarily with state funds.
Nearly 3 million Californians continue to lack comprehensive insurance coverage. The governor has asked a commission to develop options for providing health coverage to all Californians through a single-payer system-with the state serving as the sole insurer. There are major unknowns about how such a system would be financed and whether it would be politically achievable at state and federal levels. According to the November 2019 PPIC Statewide Survey, more than six in ten Californians believe that ensuring that all Americans have health coverage is the federal government’s responsibility. But there is a partisan divide: 82 percent of Democrats hold this view, compared to 19 percent of Republicans. The outcome of the 2020 election could reduce uncertainty, but state policymakers will need to decide how to advance the health and well-being of Californians.