California Assembly Bill 1400 was a 2021 proposal to create CalCare, a government-run single-payer healthcare system covering every California resident, and it died on January 31, 2022 without ever reaching a floor vote. The bill’s author, Assemblymember Ash Kalra, pulled it from the Assembly calendar after concluding he was short by double digits of the 41 votes needed to pass. Its collapse marked one of the most high-profile failures in the state’s push for universal healthcare.
What CalCare Would Have Covered
CalCare would have provided comprehensive coverage to every California resident regardless of immigration status. The program was designed to cover standard medical care, prescription drugs, mental health treatment, dental, vision, and long-term care supports. For services covered by CalCare, most existing insurance would have been replaced, including private plans, Medicare, Medi-Cal, and Covered California marketplace coverage.1California Legislative Information. AB 1400 – Guaranteed Health Care for All
A newly created CalCare Board of nine appointed members with healthcare expertise would have run the program, handling provider contracts, payment rates, and a statewide prescription drug formulary. Providers would have been barred from billing CalCare-eligible patients directly or entering private contracts for covered services, keeping care free at the point of service.1California Legislative Information. AB 1400 – Guaranteed Health Care for All
How It Would Have Been Paid For
Estimates placed CalCare’s annual cost between $314 billion and $400 billion, more than the state’s entire general fund budget. AB 1400 itself contained no funding source when introduced in February 2021. In January 2022, Kalra introduced Assembly Constitutional Amendment 11 to fill that gap. ACA 11 proposed roughly $163 billion in new annual tax revenue through three mechanisms. A constitutional amendment was the chosen vehicle because it would have exempted these taxes from the two-thirds legislative supermajority normally required for tax increases.
Gross Receipts Tax
ACA 11 imposed a 2.3% excise tax on a business’s total gross receipts minus the first $2 million in annual revenue. Unlike an income tax, this applied to total revenue rather than profit, meaning businesses with thin margins would have owed tax even in unprofitable years.2California Legislative Information. ACA 11 – Taxes to Fund Health Care Coverage
Payroll Tax
Employers with 50 or more employees would have paid a 1.25% tax on total wages. On top of that, an additional 1% tax applied to each employee’s wages exceeding $49,900 per year. That second layer was technically imposed on the employer but withheld from employee paychecks, so workers earning above that threshold would have seen their take-home pay reduced.2California Legislative Information. ACA 11 – Taxes to Fund Health Care Coverage
Personal Income Surtax
ACA 11 added a graduated surtax on top of California’s existing income tax:
- $149,509 to $299,508: 0.5%
- $299,509 to $599,012: 1.0%
- $599,013 to $1,299,499: 1.5%
- $1,299,500 to $2,484,120: 1.75%
- $2,484,121 and above: 2.5%
Supporters framed these taxes as replacing the premiums, deductibles, and copays Californians already pay. Critics pointed out that the new revenue still fell well short of the program’s projected cost, leaving a gap of at least $150 billion with no identified funding source.2California Legislative Information. ACA 11 – Taxes to Fund Health Care Coverage
Why the Bill Died
Democrats held a supermajority in the California Assembly, meaning the party could pass legislation without a single Republican vote. AB 1400 still couldn’t find 41 supporters within the Democratic caucus.
The California Chamber of Commerce labeled AB 1400 a “job killer” and launched an aggressive lobbying campaign. Dozens of insurers, industry groups, and associations representing doctors and hospitals joined in, denouncing what they called crippling tax increases. For moderate Democrats representing swing districts, voting for the largest tax increase in state history was a steep ask, especially with ACA 11 arriving only weeks before the deadline with no independent fiscal analysis.
The California Democratic Party’s progressive caucus threatened to withhold endorsements from any member who voted against the bill. That ultimatum backfired, generating what was described as fierce anger within the Assembly caucus from members who felt cornered. Rather than rallying reluctant Democrats, the threat hardened opposition.
On January 31, 2022, the final day the bill could pass the Assembly under the legislative calendar, Kalra chose not to bring it to a vote. “It became clear that we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today,” Kalra said in a statement.3Assemblymember Ash Kalra. Assemblymember Ash Kalra Releases Statement on AB 1400 The bill officially died on the third reading file when the deadline passed.4California Legislative Information. AB-1400 Guaranteed Health Care for All Pulling the bill spared Democrats from casting a recorded vote against single-payer, a position that could have drawn progressive primary challengers.
Federal Barriers That Would Have Remained
Even if AB 1400 had passed the legislature and been signed by the governor, two federal legal barriers stood between CalCare and actual implementation.
ERISA Preemption
Federal law overrides state laws that “relate to” employer-sponsored benefit plans. Under the Employee Retirement Income Security Act, states cannot regulate or prohibit self-insured employer health plans, which cover a large share of working Californians.5Office of the Law Revision Counsel. United States Code Title 29 – Section 1144 CalCare could have required fully insured employer plans to fold into the state system, since those remain subject to state insurance regulation. Self-funded plans, where employers pay claims directly rather than purchasing insurance, are shielded from state law. Without a change to federal statute or a congressional waiver, a significant portion of employer-based coverage would have remained outside CalCare’s reach.
Federal Funding Waivers
CalCare’s financial model assumed the state could redirect federal healthcare dollars currently flowing through Medicare, Medicaid, and ACA marketplace subsidies into the new system. Doing that requires federal waivers, including a Section 1332 State Innovation Waiver under the Affordable Care Act. Those waivers come with strict guardrails: the state must show that its plan covers at least as many people, provides benefits at least as comprehensive as existing coverage, keeps out-of-pocket costs at least as affordable, and does not increase the federal deficit.6Centers for Medicare & Medicaid Services. Section 1332 State Innovation Waivers Meeting the deficit-neutrality requirement for a program of this scale would have been an enormous challenge, and approval ultimately depends on whichever presidential administration is in power.
What Has Happened Since
The single-payer push continued after the bill’s death, though subsequent efforts have been more cautious.
In 2023, Kalra introduced AB 1690, an intent-only bill that stated the Legislature’s goal of establishing universal single-payer coverage without including operational details or funding language. It was a placeholder meant to keep the conversation alive. AB 1690 died at the Assembly desk in February 2024 without receiving a hearing.7California Legislative Information. California AB 1690 – Universal Health Care Coverage
Also in the 2023–2024 session, AB 2200, titled the Guaranteed Health Care for All Act, attempted to revive the full CalCare framework with the same single-payer structure as AB 1400.8California Legislative Information. California Assembly Bill 2200 – Guaranteed Health Care for All AB 2200 was held in the Assembly Appropriations Committee in May 2024 and never advanced to a floor vote.
In 2025, Kalra reintroduced a version of the bill for the current legislative session. The latest iteration reportedly takes a different approach by deferring the revenue question, stating the Legislature will design the financing after the policy framework is established. Whether that strategy fares better than the all-at-once approach of AB 1400 remains to be seen. None of the core obstacles have changed: the price tag is still enormous, ERISA still blocks state authority over self-funded employer plans, and federal waivers still require presidential cooperation.