Over the past decade, California voters have seen numerous measures on state and local ballots intended to expand health care services and coverage. While state-level measures to extend coverage for underinsured and uninsured people have fared poorly, county efforts to increase funding for their emergency medical and trauma networks — often providers of last resort for medically indigent Californians — have met with some success.

This executive summary of a report by Blue Sky Consulting Group describes the measures that have appeared on county and state ballots, outlines the health-related issues presented to voters, tallies election outcomes, and places them within the context of state and county health care financing structures. A selection of measures is also presented as brief case studies.

The historical review shows that ballot measures in California are a powerful means for health policy change and financing at the state and county levels. The authors conclude that as counties continue to face fiscal constraints, it is likely that county health ballot measures will become more common. And as health care reform continues to be debated at the federal and state level, Californians may again see major health coverage proposals on the statewide ballot.

Both the executive summary and the full report are available as Document Downloads.