Health Care for Every Californian: Understanding AB 1900 and the CalCare Proposal

By Julie Schurman, Director of Public Policy, The Arc of California

On February 12, 2026, Assemblymember Ash Kalra (D-San Jose) has introduced AB 1900 CalCare in the California State Assembly. AB 1900 would create a single payer, universal health care system for every person who lives in California.

The Arc of California is proud to support AB 1900 (Kalra). For individuals with developmental disabilities and their families, access to health care is not optional — it is essential. Yet too many Californians still face high premiums, deductibles, surprise bills, and medical debt.

What Would CalCare Do?

CalCare would guarantee health coverage to all California residents, regardless of citizenship status.

Under CalCare, everyone in California would have access to:

• • • Free Health care
    • Free Dental care
    • Free Vision care
    • Free Prescription medication
    • Free Long-term services and supports

And the system would eliminate:

• • • Premiums
    • Deductibles
    • Co pays
    • Surprise medical bills
    • Medical debt from any doctor, hospital, or provider

Health care would be treated as a public good, not something tied to your job or your income.

Why Is This Proposal Being Considered?

The United States has the most expensive health care system in the world. Yet our outcomes do not reflect that spending.

Compared to other developed nations, the United States has:

• • • Lower life expectancy
    • Higher infant mortality rates
    • Higher rates of avoidable deaths from treatable or preventable causes

At the same time, the United States spends roughly twice as much per capita on health care as the average of other developed countries. In many cases, we spend three times as much as countries that achieve better health outcomes through universal systems.

How Would We Pay for CalCare?

Eliminate the Middleman: California already spends enormous amounts of money on health care. The issue is not whether money exists in the system. The issue is how that money is spent.

Currently, we pay a very expensive middleman, that provides no value to healthcare users. That middleman is our health insurance companies.

It is not unusual for health insurance CEO’s to have a yearly compensation above $20 million. This is at the same time as health insurance companies deny hundreds of thousands of claims per month. Much of the revenue generated by health insurance companies go to shareholders and executives, rather than benefitting the healthcare user in any way.

CalCare would eliminate private health insurance companies in California.

Importantly, this would not change:

• • • The doctors you see
    • The hospitals you use
    • Regional center providers
    • Community based service providers

Providers would remain in place. What changes is how they are paid.

Under CalCare, California would move to a single payer model. Providers would be paid directly by the state, similar to how Medicare operates today.

Medicare currently pays providers directly for people over age 65. CalCare would extend that model to everyone in California, not just seniors.

Cost Savings

Rather than increasing overall spending, CalCare is projected to reduce it.

The Healthy California for All Commission found that California could save between $32 billion and $213 billion over ten years under a single payer system.

Drug Price Savings

The United States pays more for prescription drugs than any other country in the world. One reason is that drug companies negotiate separately with many different insurance plans.

A single payer system changes that dynamic.

With CalCare, California would negotiate as one large purchaser on behalf of nearly 40 million residents. That creates significant bargaining power.

Other countries with single payer systems routinely secure lower drug prices because pharmaceutical companies must negotiate with one unified buyer. CalCare would give California similar leverage to negotiate fairer prices for prescription medications.

Additional Savings

CalCare would also reduce costs by:

1. 1. 1. Cutting administrative waste
         Our current insurance based system requires extensive billing staff, prior authorizations, appeals, and complex paperwork. A single payer system streamlines those processes.
      2. Addressing preventable illness earlier
         When people delay care due to cost, conditions worsen and become more expensive to treat. Universal coverage promotes early intervention and preventive care, which lowers long term costs.

State and Federal Funding

Today, state, federal, and local governments already fund roughly half of all health care spending in California through programs such as Medi Cal, Medicare, Affordable Care Act subsidies and other public systems.

Under CalCare, those public funding streams would continue. The difference is that the dollars would be consolidated into one unified system.

California would seek a federal waiver from the U.S. Department of Health and Human Services to allow existing federal health care funds to flow into CalCare. States can request these types of waivers to redesign how federal health funds are used, as long as coverage standards are met.

That waiver could be pursued under the current federal administration or a future administration taking office in January 2029.

Employer Contributions

Employers currently account for approximately 25 percent of California’s health care spending through job based insurance premiums.

Under CalCare, those payments would likely be redirected into the public system through a payroll based contribution. Instead of paying private insurance companies, employers would contribute to a statewide health fund that covers everyone.

For many businesses, this could simplify administration and remove the burden of negotiating and managing private insurance plans.

Any Remaining Financing

Currently, individuals and households cover about 25 percent of health care spending through premiums, out of pocket costs, and other payments.

During the first several years of implementation, while administrative savings are being realized, additional revenue would likely be required to replace those individual payments.

Financing options to cover this short term funding need could include:

• • • Higher payroll contributions for large corporations;
    • A capital gains tax on large scale businesses and investors;
    • A tax on extreme wealth, or;
    • A combination of these approaches.

The goal would be to stabilize the system during the transition period. Over time, projected savings from eliminating private insurance overhead and negotiating lower prices would reduce the need for elevated revenue levels.

Is It Realistic?

California has considered universal health care before.

In 2006 and 2008, the Legislature passed single payer bills that were ultimately vetoed by then Governor Arnold Schwarzenegger.

Those votes demonstrated that universal health care legislation can move through the Legislature. Whether it becomes law depends on both legislative support and executive approval.

Recent polling has shown strong support for single payer health care among California voters, including high levels of support (86 percent) among Democratic voters.

Bottom Line

CalCare proposes:

• • • Health care for everyone
    • Coverage regardless of citizenship status
    • A system that could significantly reduce overall health spending by eliminating private insurance overhead
    • A model that builds on funds already being spent in California

At its core, CalCare is a proposal to reorganize existing health care dollars into one streamlined, universal system.