California Health Care Affordability & Choice Act
A public option you can choose. Universal coverage every child deserves. Insurance companies you can finally compare against.
Health insurance premiums in California have risen 7% a year for the past decade — three times faster than wages. Medi-Cal runs at 5% overhead. Private insurers run at 15–20%. That's your money going to marketing budgets and executive bonuses instead of doctors and medicine. This act puts Medi-Cal on the same shelf as private plans so you can compare and choose. And it covers every single California child — birth through 17 — regardless of income or immigration status. No gaps. No excuses.
Your Health Insurance Should Work for You — Not the Other Way Around
This act doesn't replace private insurance — it competes with it. Medi-Cal Choice sits right next to Blue Shield and Kaiser on Covered California so you can compare premiums, benefits, and out-of-pocket costs side by side. If the private plan is better for you, take it. If Medi-Cal Choice costs less for the same coverage, that's your right to choose. Meanwhile, every child in California gets comprehensive healthcare — dental, vision, behavioral health, prescriptions — from birth. No enrollment gaps. No falling through the cracks. No child turned away.
Medi-Cal Choice — A Public Option You Can Choose
Same benefits. Lower overhead. Your choice — not a mandate.
Medi-Cal Choice puts a public insurance option on the Covered California marketplace right next to private plans. It offers the same essential health benefits required by the Affordable Care Act — plus California-mandated benefits like reproductive care, acupuncture, and chiropractic services — at four actuarial tiers (Bronze, Silver, Gold, Platinum) so you can compare apples to apples. Primary care visits have no copay. Telehealth is included at no extra cost. Same-day and next-day appointment targets are built in. The difference? Medi-Cal runs at 5% administrative overhead instead of the 15–20% private insurers charge, which means more of your premium dollar goes to actual healthcare. Provider participation is voluntary — no doctor is forced to participate — and all Medi-Cal providers are automatically eligible.
Healthy California Kids — Universal Coverage, Birth Through 17
Every child. Every family. Every zip code. No exceptions.
Approximately 200,000 California children are uninsured and another 500,000 are underinsured — with coverage so thin it barely functions. Kids fall through the cracks during family transitions, job changes, and bureaucratic lapses. This act ends that with Healthy California Kids: universal, comprehensive healthcare for every child in California from birth through age 17, regardless of family income or immigration status. Newborns are automatically enrolled at the hospital. Schools serve as enrollment sites. Coverage includes medical, dental, vision, behavioral health, and prescription drugs. Children's behavioral health gets a special guarantee: if the wait for an initial appointment exceeds 10 business days, the plan must authorize an out-of-network provider. And unlike the adult public option, children's coverage does not sunset — it's permanent.
Premium Subsidies That Actually Make It Affordable
Premiums capped at what you can actually pay — not what insurance companies want to charge
A public option only works if people can afford it. This act creates a sliding-scale premium subsidy on top of federal ACA tax credits that caps what families actually pay. Households at 138–200% of the federal poverty level pay $0 to $50 per month for Silver-tier coverage. Households at 200–400% FPL never pay more than 8.5% of income. And households at 400–600% FPL — the "subsidy cliff" families that Sacramento ignores — are capped at 12% of income. Premiums are community-rated, modified only by age (3:1 max ratio), tobacco use (1.5:1), and region. They cannot vary by health status, gender, or pre-existing conditions. The entire Medi-Cal Choice program is designed to be financially self-sustaining through enrollee premiums, with a state reinsurance backstop covering 80% of high-cost claims between $100K and $500K per member.
Fiscally Self-Sustaining — Not a Taxpayer Bailout
45% federal funding, 16% enrollee premiums, 3-month claims reserve, and a sunset review
This act is built to pay for itself. Total annual cost is approximately $10.45 billion — but 45% ($4.7B) comes from federal matching funds through Medicaid, CHIP, and ACA premium tax credits. Another 16% ($1.7B) comes from enrollee premiums. The net new state investment is approximately $2 billion, funded by a dedicated Health Insurance Premium Tax, Greenhouse Gas Reduction Fund allocations, and federal waiver pass-through revenue. The program maintains a 3-month claims reserve. If enrollment exceeds projections by more than 20%, DHCS can implement a waiting list for adults (but never for children — universal eligibility is guaranteed). The adult Medi-Cal Choice program sunsets January 1, 2034, unless the Legislature renews it after a comprehensive Year 5 evaluation by the Legislative Analyst's Office.
Market Competition & Anti-Crowd-Out Protections
This competes with private insurance — it doesn't kill it
This act is designed to add a choice, not replace the market. Anti-crowd-out provisions prevent employers from dumping employees onto the public option: employers with existing coverage can't drop it for three years, and after that, they must compensate employees with the equivalent of their premium contribution. Employers with 50+ workers who drop coverage pay a $3,000 per-employee assessment. Medi-Cal Choice participates in the ACA risk adjustment program so it bears the same actuarial risk as private plans — no gaming the system. Private insurers continue to sell on Covered California. Providers choose whether to participate. No one is forced into anything. If the public option is better, people will choose it. If private plans compete harder on price and service, everyone wins.
💰 What Families Actually Save
Real numbers, real households, real relief
Every Bill Meets These Standards
Federal waiver strategy, actuarial certification, dedicated funding, enrollment safeguards, sunset provisions, and comprehensive LAO evaluation. Not talking points — tested legislation.