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Every year, the California Health Care Foundation steps back to ask a fundamental question: Given everything happening in California’s health care system, where can we have the most impact? This year, that question felt more urgent than usual.
The environment we’re operating in right now is unlike anything I’ve seen in my decade at the foundation. Federal policy changes are reshaping the landscape for Medi-Cal and public coverage programs. Californians will elect a new governor this year. Safety net providers are under enormous financial pressure. And the people we serve, Californians with low incomes who depend on Medi-Cal for their care, are facing real consequences.
Against that backdrop, we’ve identified four areas where we’re leaning in with urgency. They don’t represent the full scope of our work, but they’re where we believe CHCF can make the greatest difference right now:
The New Uninsured. Protecting access for millions of Californians threatened by federal funding cuts and policy changes
The Future of Medi-Cal. Building a bold 10-year roadmap for a more effective and sustainable program
Health Care Affordability. Identifying practical solutions to make care more affordable for all Californians
An AI-Powered Workforce. Putting emerging technology to work for safety net providers and their patients
The New Uninsured
For the past decade, California’s uninsured rate moved in one direction: down. That is about to change. H.R. 1 and federal funding cuts threaten coverage for millions of Californians who rely on Medi-Cal and other public programs, including children, seniors, and people with disabilities. We spent years expanding coverage. Now the challenge is to defend those gains.
CHCF is acting to prevent coverage losses where we can and to make sure that Californians who end up losing insurance can still access the essential care they need. That means focusing especially on primary care access. Regardless of what happens with federal and state policy, we can work to ensure people aren’t left without a place to go.
The Future of Medi-Cal
Medi-Cal is the backbone of California’s health care system. Over the last 60 years, it has grown more complex with every expansion and every new federal requirement. That complexity has a cost, and California can no longer afford to ignore it.
I’m excited about the Future of Medi-Cal Commission, which the foundation is supporting. It brings together a remarkable group of leaders to develop a bold 10-year roadmap for a more effective and sustainable program. The goal isn’t just to manage the current crisis. It’s about building something better. We want the next governor to take office with concrete, actionable ideas to modernize Medi-Cal financing and administration. The commission’s findings are due in early 2027, and I think they have real potential to reshape the program.
Health Care Affordability
On health care affordability, we are not making enough progress. Survey after survey tells us that more than half of Californians have skipped or delayed care because of cost. Unexpected medical bills are one of the top financial fears in the state. Like everyone, I’ve received a bill I couldn’t make sense of and spent time on the phone between my plan and my provider trying to sort it out.
The frustrating truth is that safety net providers are telling us they don’t earn enough to survive, and people with commercial insurance are telling us care costs too much. Both things are true, and that tension is real. CHCF is focused on identifying practical solutions, including reducing administrative waste, supporting stronger oversight through the state Office of Health Care Affordability, and giving policymakers the evidence they need to act.
An AI-Powered Workforce
California’s health care workforce is stretched to the breaking point. Burnout, staffing shortages, and administrative burdens are pulling providers away from patients. At the same time, artificial intelligence tools are already making a real difference in clinical settings by reducing paperwork, streamlining documentation, and helping coordinate care.
I’m cautiously optimistic about what’s possible here. We’re not talking about robot doctors. We’re talking about giving a community health worker or a primary care physician at a safety net clinic more time to look their patient in the eye. The foundation is piloting AI tools in safety net settings and working to ensure that as AI is adopted more widely across health care, it works for providers and patients in under-resourced communities, not just well-funded health systems.
Big Challenges, Real Unknowns
These are enormous challenges, and we don’t have all the answers. What I do know is that meeting this moment will require all of us to collaborate in ways we haven’t before, and to be open to approaches that may feel unfamiliar or uncomfortable. There are a lot of unknowns ahead, including the fact that California will have a new governor at this time next year. That transition brings real uncertainty. It also brings a genuine opening to do things differently. The California Health Care Foundation will be ready and offering solutions from day one.
