Dozens of countries around the world provide guaranteed healthcare for all of their people. In the U.S., we do not. Thus, we have tens of millions of uninsured and under-insured residents, the highest prescription drug prices in the world, and tens of thousands of people who go bankrupt as a result of medical bills or die from untreated health conditions every year.
Over the past 20 years, there have been numerous efforts to improve healthcare access, affordability, and quality in California. Hundreds of organizations have come together to address these challenges, but have been repeatedly thwarted by a small group of wealthy corporations and corporate advocacy groups intent on ensuring that quality healthcare in California remains a privilege, not a guaranteed human right.
Below are some of the key bills and ballot measures that have shaped policy in this area. Click on them to learn more about what they did, or could have done, and who supported and opposed them.
2005
Proposed establishing a state drug discount program to reduce prices by up to 50% on prescription drugs for residents with an income at or below 400% of the federal poverty level.
Spending in Support
$81.3M
Spending in Opposition
$141.3M
Results
Defeated 61%/39%
Supporters
Spent $81.3 million, with the biggest supporters being:
California Teachers Association - Issues PAC
$35.9M
California State Council of Service Employees Issues Committee
$10.7M
CA Teachers Association/Association for Better Citizenship
$4.6M
CA Correctional Peace Officers Association Issues Political Action Committee
$3.3M
SEIU Local 1000 CA State Employees Association Issues PAC
$2.6M
Opponents
Led by the Pharmaceutical Research and Manufacturers of America, opponents spent $141.3 million, with the biggest spenders being:
$17.1M
$17.1M
$17.1M
$17.1M
$8.1M
$7.9M
$7.9M
$7.9M
$7.9M
$7.9M
$7.9M
Note that this spending also supported a competing ballot measure, Proposition 78, that would have made the drug discount program voluntary for pharmaceutical companies.
2005-06
Proposed the creation of the California Health Insurance System (CHIS), a single-payer healthcare system, to provide health insurance coverage to all California residents.
Results
Passed Assembly 45-33
Passed Senate 24-13
Vetoed by Governor Schwarzenegger
Supporters
A diverse group of 476 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, businesses, and others (as of 8/29/06)
Opponents
9 insurance companies, corporate advocacy groups, and other organizations (as of 8/29/06), including:
California Association of Health Plans and Health Net also opposed the bill at earlier stages of the legislative process
2007-08
Proposed the creation of the California Health Insurance System (CHIS), a single-payer healthcare system, to provide health insurance coverage to all California residents.
Results
Passed Assembly 44-32
Passed Senate 22-14
Vetoed by Governor Schwarzenegger
Supporters
Co-sponsored by California Federation of Teachers, California Nurses Association, California School Employees Association, California Teachers Association, and Health Care for All, this bill was supported by a group of 179 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, and other organizations (as of 8/31/08)
Opponents
22 insurance companies, corporate advocacy groups, and other organizations (as of 8/31/08), including:
Association of California Life & Health Insurance Companies also opposed the bill at earlier stages of the legislative process
2009-10
This bill would have established the California Healthcare System, an entity that would attempt to provide affordable and comprehensive health care coverage for all.
Results
Passed Senate 22-14
Died in Assembly
Supporters
Co-sponsored by the California Nurses Association and the California School Employees Association, this bill was supported by 199 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, businesses, and other organizations (as of 6/28/10)
Opponents
16 insurance companies, corporate advocacy groups, and other organizations (as of 6/28/10), including:
2011-12
This bill would have established the California Healthcare System, an entity that would attempt to provide affordable and comprehensive health care coverage for all.
Results
Died in Senate
Supporters
Co-sponsored by the California Nurses Association/National Nurses United and the California School Employees Association AFL-CIO, this bill was supported by 213 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, and other organizations (as of 1/26/12)
Opponents
14 insurance companies, corporate advocacy groups, and other organizations (as of 1/26/12), including:
2014
This measure would have required that changes to health insurance rates be approved by the California Insurance Commissioner before taking effect and required public notice and disclosure of such changes.
Spending in Support
$6.7M
Spending in Opposition
$81.9M
Results
Defeated 59%/41%
Supporters
Spent $6.7 million, with the biggest spender being the California Nurses Association, at $3.3 million
Opponents
Spent $81.9 million, with the biggest spenders being:
$26.8M
$26.4M
$17.7M
$9.4M
$393K
2015-16
This bill required health insurers to disclose rate changes and conduct public meetings for large group rate changes.
Results
Passed Assembly 51-27
Passed Senate 26-14
Signed by Governor Brown
Supporters
A collection of 27 large labor unions and other organizations (as of 9/10/15)
Opponents
23 corporate advocacy groups, insurance companies, and other organizations, including (as of 9/10/15):
2016
This measure would have regulated drug prices by requiring state agencies to pay no more than the U.S. Department of Veterans Affairs (VA) pays for prescription drugs.
Spending in Support
$26.8M
Spending in Opposition
$151.7M
Results
Defeated 53%/47%
Supporters
Spent $26.8 million, with the biggest spender being the AIDS Healthcare Foundation, at $26.0 million
Opponents
Spent $151.7 million, with the biggest spenders being:
$13.2M
$13.0M
$13.0M
$10.7M
$9.6M
$8.5M
$6.6M
$6.3M
$6.3M
$6.2M
Biogen
$6.2M
Gilead Sciences
$5.5M
Novo Nordisk
$4.9M
$4.2M
2017-18
This bill proposed the creation of the Healthy California program, which would have been required to provide comprehensive universal single-payer health care coverage system for all California residents.
Results
Passed Senate 23-14
Died in Assembly
Supporters
Sponsored by the California Nurses Association/National Nurses United and supported by 308 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, businesses, and other organizations (as of 6/1/17)
Opponents
46 insurance companies and corporate advocacy groups (as of 6/1/17), including:
2018
This measure would have required dialysis clinics to issue refunds to patients or patients’ payers for revenue above 115 percent of the costs of direct patient care and healthcare improvements.
Spending in Support
$50.3M
Spending in Opposition
$144.1M
Results
Defeated 60%/40%
Supporters
Spent $50.3 million, with the largest sources being unitemized contributions ($25.7 million) and Service Employees International Union – United Healthcare Workers West ($23.1 million)
Opponents
6 dialysis companies spent $144.1 million, led by:
2020
This measure would have required chronic dialysis clinics to: have an on-site physician while patients are being treated; report data on dialysis-related infections; obtain consent from the state health department before closing a clinic; and not discriminate against patients based on the source of payment for care.
Spending in Support
$11.1M
Spending in Opposition
$129.9M
Results
Defeated 63%/37%
Supporters
Spent $11.1 million, with the largest sources being Service Employees International Union – United Healthcare Workers West ($7.7 million) and unitemized contributions ($3.3 million)
Opponents
5 dialysis companies spent $129.9 million, led by:
2021-22
This bill would have established the California Guaranteed Health Care for All (or CalCare) as California’s single-payer health care coverage program.
Results
Died in Assembly
Supporters
Supported by 68 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, and other organizations (as of 1/20/22)
Opponents
19 insurance companies (as of 1/20/22), corporate advocacy groups, and other organizations, including:
2022
This measure would have required dialysis clinics to have at least one physician, nurse practitioner, or physician assistant while patients are being treated; report data on dialysis-related infections; and not discriminate against patients based on the source of payment for care.
Spending in Support
$9.3M
Spending in Opposition
$82.3M
Results
Defeated 68%/32%
Supporters
Spent $9.3 million, with $9.2 million coming from unitemized contributions
Opponents
5 dialysis companies spent $82.3 million, led by:
2023-24
This bill would have established the policy framework for the California Guaranteed Health Care for All Program (or CalCare), a health care service plan to provide comprehensive, universal, single-payer health care coverage and a health care cost control system for all residents of the state.
Results
Died in Assembly
Supporters
Supported by 90 health organizations, municipalities, labor organizations, faith-based groups, elected officials, consumer groups, and other organizations (as of 4/19/24)
Opponents
164 corporate advocacy groups, insurance companies, law enforcement groups, and other organizations (as of 4/19/24), including:
Where are we now?
If not for this small group of pharmaceutical companies, insurance companies, corporate advocacy groups, and for-profit dialysis companies, California could have a healthcare system that provides high-quality healthcare to all California residents, regardless of income.
Instead, while there have been some steps in the right direction (such as SB-546), currently in California:
- 2.6 million California residents are uninsured, and millions more are unable to afford care due to increasing copays, deductibles, and out-of-pocket costs (California Nurses Association)
- Insurance-related administrative costs amount to about $85 billion each year for California hospitals, doctors, and other providers, not including the costs for patients and employers to navigate the complex web of private insurers and public program (Healthy California for All Commission)
- California spends between $32 billion and $213 billion more per year on our current system than it would under a single-payer model with no cost sharing for patients and long-term care for all (Healthy California for All Commission)
- Every week, 80,000 dialysis patients across California are forced to receive substandard and costly care at understaffed, for-profit facilities (SEIU)
