California Lawmaker Revives Push for Single-Payer Health Care

California Assemblymember Ash Kalra is reigniting efforts for a single-payer health care system in response to recent federal funding cuts that threaten the state’s health care framework. With Congress approving significant cuts to federal Medicaid funding and proposing further changes to the Affordable Care Act, Kalra believes the momentum is right for a renewed discussion on universal health care through his proposed initiative, CalCare.

Kalra’s proposal, known as Guaranteed Health Care for All, aims to establish a state-run system that would provide health care at no cost to residents, regardless of income or immigration status. This is not the first time Kalra has introduced such legislation; he has attempted to bring a form of single-payer health care to the California Legislature on four previous occasions over the last five years. Despite these efforts, achieving legislative success has proven challenging.

“It’s clear that the current system is unsustainable,” Kalra stated. “With the scrutiny on Medicaid and ACA cuts, the public is more aware than ever that we need a comprehensive solution.”

Kalra’s initiative requires approval from the state Legislature and the governor before any funding discussions can commence. The proposal faces potential opposition, particularly from the powerful health insurance lobby, which has historically fought against such reforms.

Significant Cuts to Federal Funding

The backdrop to Kalra’s renewed efforts is stark. In 2025, nearly $1 trillion in federal Medicaid funding was cut as part of the One Big Beautiful Bill, severely impacting California’s Medi-Cal program, which serves over 15 million residents—more than a third of the state’s population. This reduction is projected to result in a loss of approximately $30 billion annually over the next decade, with no immediate remedy from state funding sources.

Additionally, the Republican-led Congress declined to extend federal tax credits that have helped millions afford health insurance through the ACA marketplace. As a consequence, enrollment in Covered California has dropped by 32% compared to the previous year, according to the agency.

The Department of Health and Human Services, under the Trump administration, has proposed new regulations that could exacerbate financial burdens for families relying on ACA plans. These rules could permit insurance companies to offer policies that require families to pay up to $31,000 in out-of-pocket expenses before receiving any coverage.

“The ongoing affordability crisis stems from unchecked health care costs,” said Kristof Stremikis, director of market analysis at the California Health Care Foundation. “The proposed changes shift the financial burden onto those who can least afford it.”

The Challenge Ahead

Kalra, serving in the Assembly since 2016 and the first Indian American in the California Legislature, remains undeterred by the challenges ahead. While he acknowledges the lack of support from Republican lawmakers—who he claims are aligned with corporate interests—he also recognizes that garnering sufficient backing from Democrats may be just as difficult.

Despite the obstacles, a recent poll commissioned by the California Nurses Association revealed that nearly 66% of Californians believe the state needs major reforms in its health care system, with 86% of Democrats supporting the single-payer proposal. The California Nurses Association is sponsoring Kalra’s bill, highlighting the significant public interest in reforming the health care landscape.

Financing a potential single-payer system poses another layer of complexity, with estimates suggesting costs could reach hundreds of billions annually. Securing federal waivers to utilize existing funds for this initiative is contingent upon state legislation passing to establish a state-run health care system. While several states, including New York and Oregon, have proposed similar legislation, none have successfully implemented a plan.

“The current system is deteriorating,” Kalra emphasized. “We need to engage the public in this conversation and push for change. Every year we delay, lives are affected, families face bankruptcy, and more Californians struggle with health care costs.”

As Kalra presses forward, he understands that the journey toward a single-payer health care system will be long and fraught with challenges, but he remains committed to fostering public discourse on the issue. The stakes are high, and the need for reform has never been more urgent.