California Commonsense Healthcare

California Commonsense Healthcare Proposal

Section 1: Title

This act shall be known as the California Commonsense Healthcare (CCH) Act.

Section 2: Purpose and Goals

The purpose of the California Commonsense Healthcare is to ensure access to quality, affordable healthcare for all legal residents of California, without regard to income, health status, or any protected characteristics. The goals of the California Commonsense Healthcare are as follows:

Provision of Comprehensive Health Coverage: Ensure that all legal residents of the state have access to a comprehensive health insurance plan that covers all necessary health services.
Net Savings: Achieve a net savings for all Californians by eliminating health insurance premiums, co-payments, and other out-of-pocket expenses.
Cost Control: Control the overall cost of healthcare through cost-saving measures, including reduced administrative expenses, increased system efficiency, and improved health outcomes.
Access to a Full Range of Services: Ensure the availability of a full spectrum of healthcare services, including preventive care, primary care, specialty care, hospitalization, dental, vision, mental health, prescription drug services, and long-term care. Long-term care shall include services such as skilled nursing, home-based care, assisted living, hospice, and other support services necessary for individuals with chronic illnesses, disabilities, or age-related needs.
High-Quality, Evidence-Based Care: Promote the delivery of high-quality, evidence-based healthcare services, with a focus on patient-centered, integrated, and coordinated care.
Minimization of Administrative Burdens: Reduce the administrative burden on both patients and healthcare providers.
Public Health and Wellness: Promote public health through prevention and wellness programs designed to improve the general health and well-being of the state's residents.

Section 3: Right to Healthcare

Healthcare Access: All legal residents of California shall have the fundamental right to access comprehensive, high-quality healthcare services through the California Commonsense Healthcare System (CCH).
Non-Discrimination: The State shall not deny or limit the availability of healthcare services based on a resident’s income, employment status, or health condition.
Equal Treatment: All residents shall receive equal treatment and access to healthcare services, regardless of their socioeconomic status or background.
Protection from Financial Hardship: No resident shall pay for healthcare services, insurance premiums, co-payments, or other out-of-pocket expenses related to medically necessary care.
Right to Choose Providers: Residents shall have the right to choose their healthcare providers from a network of licensed professionals participating in the California Commonsense Healthcare System.

Section 4: Savings

Expected Savings: The implementation of the California Commonsense Healthcare is projected to result in significant long-term savings. This will be achieved by reducing the inefficiencies of the current fragmented healthcare system and improving overall health outcomes for California residents.
Negotiation of Drug Prices: The State shall negotiate directly with pharmaceutical companies to reduce the cost of prescription drugs, including establishing a bulk purchasing program to lower drug prices.
Utilization of Savings: Savings generated through these measures shall be used to enhance the quality and accessibility of healthcare services and to ensure the financial sustainability of the California Commonsense Healthcare.

Section 5: Administration

Board of Directors: The California Commonsense Healthcare shall be governed by a Board of Directors consisting of nineteen (19) members, elected by the residents of California in a manner specified by the State Legislature. To ensure continuity during the initial phase-in period, the Governor shall appoint seven (7) temporary Board members, subject to confirmation by the California State Senate, who shall serve until the first elected Board members are seated. Temporary appointees must not have been affiliated with, employed by, or received compensation from any private health insurance company within the preceding ten (10) years. The Governor is strongly encouraged to appoint individuals with active backgrounds in the healthcare community, including but not limited to physicians, nurses, public health professionals, and patient advocates.
Duties and Responsibilities: The Board of Directors shall be responsible for overseeing the implementation and operation of the California Commonsense Healthcare, including but not limited to:
1. Setting quality standards and cost parameters.
2. Negotiating contracts with healthcare providers.
3. Ensuring the financial sustainability of the system.
Board Composition and Terms:
1. The Board shall consist of nineteen (19) members, who shall serve six-year terms, with a maximum of three (3) terms per member.
2. Members of the Board shall be compensated for their service. As defined by the State Legislature, compensation shall be determined based on the responsibilities and time commitment required of each member.
3. Board members shall be subject to conflict of interest rules and must recuse themselves from any decisions where they have a financial or personal interest.
4. Board meetings shall be held at least quarterly and shall be open to the public, with minutes and decisions published online for transparency.
5. The Board shall have the authority to establish committees, hire staff, and contract with experts as needed to fulfill its responsibilities.
6. Board members shall be elected by the residents of California through a process defined by the State Legislature, which may include provisions for staggered terms to ensure continuity of governance.
7. Elections must be held within two (2) years of the passage of the California Commonsense Healthcare act.
8. The elected Board shall be seated in three cohorts as follows:
  1. First election (2 years following passage): Seven (7) members shall be elected by the residents of California.
  2. Second election (4 years following passage): An additional six (6) members shall be elected.
  3. Third election (6 years following passage): A final six (6) members shall be elected, completing the full complement of nineteen (19).
9. The temporary appointees shall vacate their seats as elected members are seated following the first election.
10. The election process and rules shall be defined by the State Legislature and may include provisions for staggered terms, voter eligibility, campaign finance limits, and other necessary procedures to ensure fair and representative governance.

Section 6: Implementation

Phase-in Period: The California Commonsense Healthcare act shall be phased in over a period of four (4) years, with the goal of complete coverage and a smooth transition for patients, healthcare providers, and employers. This phased implementation will include public education, outreach efforts, and the enrollment of eligible residents.
Specific Timelines:

Within ninety (90) days of passage, and lasting until full implementation of California Commonsense Healthcare:

In addition to current Medi-Cal eligiblity, all individual eligible Californians whose income is at or below 250% of the Federal Poverty Level shall be eligible for Medi-Cal at no cost.

Within one (1) year of passage, and lasting until full implementation of California Commonsense Healthcare:

Health, vision, and dental coverage will be mandated for all health insurance plans, with coverages determined by the CCH Board.
In addition to current Medi-Cal eligiblity, all individual eligible Californians whose income is at or below 400% of the Federal Poverty Level shall be eligible for Medi-Cal at no cost.

Within two (2) years of passage, and lasting until full implementation of California Commonsense Healthcare:

The CCH Board shall have developed and implemented a working plan for full implementation.
All individual California legal residents shall have access to the Medi-Cal program with rates determined by the CCH Board for those with incomes above 400% of the Federal Poverty Level.

End of Year Four:

Full implementation of the California Commonsense Healthcare.

Central malpractice insurance: The state shall establish a centralized malpractice insurance fund, which will be administered according to the guidelines set forth by the CCH Board.

Coverage will include:

Legal defense costs
Settlements and judgments
Mediation and arbitration services
Risk management and loss prevention programs
Provider education and training on malpractice prevention

Providers will be automatically enrolled upon joining the California Commonsense Healthcare (CCH).

Section 7: Smart Health Access System (SHAS)

Implementation of a Digital Health Identity System:
Within three (3) years of the passage of this Act, the State shall develop and implement a Smart Health Access System (SHAS) to streamline patient access, provider payments, care coordination, public health research, and real-time service utilization tracking across the California Commonsense Healthcare System (CCH) and all approved private insurance plans.
SHAS Access Options:
All legal residents of California shall be issued a secure California Health Access ID (CHAI), available in both digital and physical formats:
1. The digital version shall be accessible via a secure mobile app and digital wallets.
2. A physical smart card shall be available by request for accessibility, offline use, or emergencies.
3. Both formats shall integrate with healthcare providers, pharmacies, labs, and insurers statewide.
CHAI Digital Credentials Shall Include, but not be limited to:
1. Unique health ID number
2. Encrypted health history and prescriptions
3. Claims and billing history
4. Emergency instructions
5. Consent preferences and settings
6. Organ donor status
Interoperability and Open Standards:
The SHAS system shall be built on open-source, privacy-first standards to ensure full interoperability across:
1. Public CCH providers and systems
2. Regulated private insurers and care providers
3. Pharmacies, diagnostic labs, specialists, and emergency responders
Benefits and System Improvements:
The integration of SHAS will:
1. Improve care coordination by giving every provider access to up-to-date health records.
2. Reduce duplicate tests, procedures, and administrative friction.
3. Enable faster response in emergencies with real-time access to critical patient data.
4. Power public health research that helps California detect, prevent, and treat disease more effectively.
Mandatory Provider Integration:
All licensed healthcare providers and insurers operating in California shall be required to:
1. Use SHAS for recordkeeping, billing, eligibility verification, and compliance.
2. Report service outcomes and health quality metrics through SHAS infrastructure.

The SHAS shall be administered under strict privacy and security standards consistent with HIPAA, the California Consumer Privacy Act (CCPA), and additional CCH-specific data governance regulations.

Section 8: Parallel Private Insurance Framework

(a) Permitted Scope of Private Insurance:
Private insurance providers may offer supplemental and parallel coverage, subject to the following conditions:

Supplemental Plans may cover services not included in CCH (e.g. elective procedures, luxury accommodations, alternative treatments).
Parallel Plans may offer core services already covered under CCH only if:

They do not bill more than the CCH-set maximums for any covered service.
Providers accept both CCH and private plan patients without discriminatory wait times or prioritization.
Patients retain the right to use CCH services at any time, regardless of private plan status.

(b) Prohibition on Duplication of Core CCH Services at Higher Cost:
No private insurance plan may require patients to pay more than CCH for identical services, nor may they exclude patients from access to public services due to enrollment in a private plan.

(c) Taxation and Reporting:
Private insurers must pay an annual Healthcare System Participation Fee, set by the CCH Board, and submit quarterly reports on coverage, claims, and patient satisfaction metrics.

Section 9: Insurance Utility Commission (IUC)

(a) Establishment of the Insurance Utility Commission (IUC):
An independent public body, the Insurance Utility Commission, shall be established to regulate all private health insurance entities operating in California.

(b) Responsibilities of the IUC:

Set annual profit margin caps for private insurers operating in the parallel market.
Review and approve all private plan benefit designs and pricing structures.
Monitor and enforce standards of care, equity, and accessibility across public and private systems.
Investigate consumer complaints, ensure compliance with billing laws, and issue penalties for violations.
Publish an annual report detailing private insurer performance, cost trends, and regulatory compliance.

(c) Public Representation and Transparency:
The IUC shall include thirteen (13) representatives from:

The CCH Board
Consumer advocacy groups
The medical community
Health economists and data scientists
At least four (4) California residents unaffiliated with insurers

All IUC meetings shall be public, and regulatory decisions shall be published online for public review.

Section 10: Quality and Access Provisions

Provider Participation and Choice
1. All licensed healthcare providers within California shall be required to participate in the California Commonsense Healthcare (CCH). Providers may also contract with approved private insurance plans, subject to the following standards of equity, transparency, and patient rights.
Payment Equity and Standards

Providers shall accept standardized CCH payment rates for all services covered under CCH, regardless of whether the patient is using CCH or a parallel private plan.
No provider may charge more for the same service to a private plan than they would receive from CCH.
Patients shall not be billed directly for any service covered under CCH.

Equal Access and Anti-Discrimination

Providers must treat CCH and private plan patients equally in scheduling, prioritization, and access to covered services.
Private plan membership shall not entitle patients to jump queues or gain faster access to medically necessary services also covered by CCH.
All patients retain the right to use CCH services at any time, regardless of private insurance status.

Dual System Integration and Transparency

All services, whether delivered under CCH or through private coverage, must be recorded in the Smart Health Access System (SHAS) for coordination, quality tracking, and transparency.
Providers must disclose when a service offered is not covered by CCH and may result in additional charges under a private plan.

Quality Assurance Across Systems

All providers must meet uniform care quality standards as set by the CCH Board and enforced by the Insurance Utility Commission (IUC).
Performance metrics, outcomes, and patient satisfaction data must be submitted to both CCH and IUC.
The CCH Board shall have the authority to revoke CCH participation for providers who violate access, billing, or discrimination rules.

Service Expansion through Private Innovation (Optional Services Only)

Private insurance plans may fund services not included in CCH, such as elective procedures, luxury accommodations, or expanded wellness offerings, as long as:
Such services are not substitutes for essential CCH services.
The offerings are fully disclosed and opt-in only for patients.
Pricing is approved by the IUC and must not burden CCH infrastructure.

Patient Bill of Rights
The CCH Board shall issue a comprehensive California Patient Bill of Rights, guaranteeing:

Equal treatment regardless of payer
Transparent cost information
Access to grievance procedures via CCH and IUC
A clear, published list of all services covered under CCH and where private coverage may apply

Section 11: Regulation

Compliance with Laws and Regulations: The California Commonsense Healthcare shall be subject to all applicable state and federal laws, including those pertaining to quality standards, cost controls, privacy, and consumer protection.
Regulatory Authority: The CCH Board shall have the authority to set policies, negotiate payment rates, and ensure the delivery of high-quality healthcare services to all legal residents of California. The Board shall ensure compliance with all applicable laws and regulations.

Section 12: Funding

Funding Sources: The California Commonsense Healthcare shall be funded through the following sources:

A single percentage payroll tax shall be imposed on employers on all earnings above 250% of the Federal Poverty Level. The tax rate will be six (6) percent. All funds collected through this tax shall be used to fund the California Commonsense Healthcare program.
A single percentage payroll tax shall be imposed on employees on all earnings above 250% of the Federal Poverty Level. The tax rate will be six (6) percent. All funds collected through this tax shall be used to fund the California Commonsense Healthcare program.
The CCH board will oversee the implementation and administration of the employee and employer taxes.
After the CCH program is fully implemented, any funds collected through the payroll taxes for the fiscal year not used shall be returned to the taxpayers.
The tax rate may be adjusted in the future based on the needs of the program, the rate may only be changed by a super majority vote by the CCH Board.
There shall only be one tax rate for all income levels as a percentage of earnings.
All funds collected through the payroll tax shall be dedicated to the California Commonsense Healthcare program.
Funds shall be collected and administered by the California Department of Revenue, with oversight from the CCH Board to ensure proper allocation and use.
The employee and employer tax shall start at the beginning of the fiscal year one (1) year after the CCH act is passed.
Existing state healthcare funds shall be redirected to fund the California Commonsense Healthcare program.
Any available federal funds may be utilized.
The California legislature shall provide funds for the program as part of the state budget. In addition, the legislature may allocate funds for specific initiatives or programs within the California Commonsense Healthcare system.
Grants and donations from public and private sources may be accepted to support specific programs or initiatives within the California Commonsense Healthcare.
Funding mechanisms shall be designed to ensure the long-term sustainability of the California Commonsense Healthcare System while minimizing the financial burden on individuals.

Use of Medicaid (Medi-Cal) Funds

Authorization for Medi-Cal Integration: The California Commonsense Healthcare (CCH) shall be authorized to utilize available Medi-Cal funds for the healthcare coverage of all individuals eligible under Medi-Cal eligibility guidelines. Medi-Cal funds will be integrated into the CCH funding structure to ensure that individuals covered by Medi-Cal continue to receive services, including preventive care, specialty care, mental health services, and long-term care within the CCH framework.
The State of California will maintain and coordinate the Medi-Cal program under the broader umbrella of CCH, ensuring that existing Medi-Cal resources are effectively utilized and that eligibility and benefits remain consistent with current federal Medicaid guidelines.
The California Department of Health Care Services (DHCS) shall work with the Centers for Medicare & Medicaid Services (CMS) to ensure smooth integration, compliance with Medicaid laws, and proper reimbursement for services provided through the CCH system during the transition period as defined in Section 14 of this Act.

Medicare funds

All eligible Medicare beneficiaries who reside in California and are enrolled in Medicare shall continue to receive Medicare benefits.
California Commonsense Healthcare (CCH) shall utilize available Medicare funds for the healthcare coverage of eligible residents who qualify under federal Medicare guidelines.
The State of California shall enter into agreements with the Centers for Medicare and Medicaid Services (CMS) to facilitate the transfer, administration, and distribution of Medicare funds for eligible individuals who are residents of California, ensuring alignment with existing federal programs and regulations.
Medicare beneficiaries will be integrated into the California Commonsense Healthcare for services beyond the scope of Medicare coverage, such as preventive care, specialty care, and long-term care.

Section 12A: Stock-Based Compensation Levy

Imposition of Tax: A Stock-Based Compensation Levy shall be imposed on all stock-based compensation issued to employees, officers, directors, or contractors by any employer operating within the State of California. This levy shall apply to all forms of equity compensation, including but not limited to restricted stock units (RSUs), stock options, performance shares, and employee stock purchase plan (ESPP) shares.
Tax Rate: The levy shall be assessed at a rate of six (6) percent on the employer and six (6) percent on the employee or recipient, for a combined rate of twelve (12) percent, consistent with the payroll tax structure established under Section 12 of this Act.
Taxable Event: The taxable event for the Stock-Based Compensation Levy shall occur at the time of issuance or grant of the stock-based compensation, based on the fair market value of the stock at the time of issuance as determined by the closing price of the stock on the date of grant, or by an independent valuation for privately held companies.
Valuation for Private Companies: For stock issued by privately held companies, the fair market value shall be determined using a 409A valuation or equivalent independent appraisal conducted within ninety (90) days prior to the date of issuance. The CCH Board may establish additional valuation standards as needed.
Employer Responsibilities: Employers shall be responsible for:
- Calculating and withholding the employee's six (6) percent levy at the time of issuance.
- Remitting both the employer and employee portions to the California Department of Revenue on a quarterly basis.
- Reporting all stock-based compensation issuances to the CCH Board annually.
No Double Taxation: To prevent double taxation, stock-based compensation that has been subject to the Stock-Based Compensation Levy under this section shall not be subject to the standard CCH payroll tax under Section 12 upon vesting, exercise, or sale of the same shares.
Use of Funds: All funds collected through the Stock-Based Compensation Levy shall be dedicated exclusively to the California Commonsense Healthcare program.

Section 12B: Luxury Real Estate Transfer Fee

Imposition of Fee: A Luxury Real Estate Transfer Fee shall be imposed on all transfers of real property located within the State of California where the total consideration paid equals or exceeds five million dollars ($5,000,000).
Fee Rate: The fee shall be assessed as follows, applied to the total transfer price based on the applicable tier:
- $5,000,000 – $10,000,000: 1.0% of the total transfer price
- $10,000,001 – $25,000,000: 1.5% of the total transfer price
- $25,000,001 and above: 2.0% of the total transfer price
Responsible Party: The fee shall be the responsibility of the seller of the property. However, the parties to a transaction may negotiate allocation of the fee between buyer and seller, provided the full amount is remitted to the State.
Administration: The Luxury Real Estate Transfer Fee shall be collected by the County Recorder at the time of recordation of the transfer deed, and remitted to the California Department of Revenue within thirty (30) days of collection.
Exemptions: The following transfers shall be exempt from the Luxury Real Estate Transfer Fee:
- Transfers between spouses or domestic partners.
- Transfers to a revocable living trust where the transferor is the beneficiary.
- Transfers resulting from the death of a property owner via inheritance or probate.
- Transfers to a non-profit organization qualifying under Section 501(c)(3) of the Internal Revenue Code.
Use of Funds: All funds collected through the Luxury Real Estate Transfer Fee shall be dedicated exclusively to the California Commonsense Healthcare program.

Section 12C: Corporate Windfall Profit Assessment

Purpose: The Corporate Windfall Profit Assessment is established to ensure that California-operating corporations that experience extraordinary, above-market profit gains contribute a proportional share toward the funding of the California Commonsense Healthcare System.
Applicability: The Corporate Windfall Profit Assessment shall apply to any corporation or business entity with annual gross revenues exceeding ten million dollars ($10,000,000) that operates, is incorporated, or derives more than 25% of its revenue within the State of California.
Definition of Windfall Profits: Windfall profits shall be defined as any net after-tax profits representing a profit margin in excess of ten percent (10%) of annual gross revenues in a given fiscal year. Only the profits above the 10% profit margin threshold shall be subject to the assessment. For clarity, profit margin shall be calculated as net after-tax profit divided by annual gross revenue, expressed as a percentage.
- Example: If a business earns $50,000,000 in gross revenue and $8,000,000 in net profit, its profit margin is 16%. The windfall portion is the 6% above the 10% threshold, equal to $3,000,000, which would be subject to the 10% assessment — resulting in a $300,000 CCH contribution.
Assessment Rate: A Corporate Windfall Profit Assessment of ten (10) percent shall be imposed on all profits that exceed the windfall threshold as defined in subsection (c).
Reporting and Payment:
- Corporations subject to this assessment shall file an annual Windfall Profit Declaration with the California Department of Revenue within ninety (90) days of the close of their fiscal year.
- Payment shall be due within one hundred twenty (120) days of the close of the fiscal year.
- The CCH Board may establish penalties for late filing or payment. The California Department of Revenue shall conduct audits to verify reported figures.
Appeals Process: Any corporation that disputes its assessment may file an appeal with the California Department of Revenue within sixty (60) days of receiving its assessment notice. The CCH Board shall establish a formal appeals process, including an independent review panel.
Use of Funds: All funds collected through the Corporate Windfall Profit Assessment shall be dedicated exclusively to the California Commonsense Healthcare program.

Section 13: Transition of State Health Agencies

Purpose: To ensure continuity of care, legal compliance, and operational stability during the phase-in of the California Commonsense Healthcare System, this section establishes the framework for the orderly transition of authority, functions, personnel, contracts, and assets from existing state health agencies to the CCH Board.
Department of Health Care Services (DHCS) — Transition and Dissolution: The California Department of Health Care Services (DHCS), currently responsible for administering the Medi-Cal program and related health care delivery programs, shall transfer all relevant authority, functions, programs, contracts, data systems, and personnel to the CCH Board in accordance with the following:
1. Within ninety (90) days of passage of this Act, the DHCS Director shall submit a comprehensive Transition Plan to the CCH Board and the California Legislature, detailing the full scope of DHCS functions, active contracts, federal agreements, and staffing.
2. All Medi-Cal contracts, provider agreements, and federal waiver arrangements currently administered by DHCS shall be transferred to and administered by the CCH Board no later than the end of Year Two of the phase-in period.
3. All DHCS employees whose roles are directly transferable to CCH administration shall be offered equivalent positions within the CCH system. No employee shall be terminated solely as a result of the transition without a minimum of one hundred eighty (180) days notice and placement assistance.
4. DHCS shall cease to exist as an independent department upon the full implementation of CCH at the end of Year Four, at which point all remaining functions, obligations, and authority shall have been fully transferred to the CCH Board.
5. During the transition period, DHCS shall continue to fulfill all federal Medicaid obligations and shall cooperate fully with the CCH Board to maintain uninterrupted coverage for all current Medi-Cal beneficiaries.
California Department of Public Health (CDPH) — Continued Operation and Coordination: The California Department of Public Health (CDPH) shall continue to operate as an independent state agency. Its core public health functions — including communicable disease surveillance, environmental health, emergency preparedness, vital records, and facility licensing — are complementary to and not duplicated by CCH. However, CDPH shall be subject to the following coordination requirements:
1. CDPH shall formally coordinate with the CCH Board on all matters relating to public health data, disease surveillance, and population health strategy.
2. CDPH's facility licensing authority shall be exercised in alignment with quality standards set by the CCH Board under Section 10 of this Act.
3. The CCH Board and CDPH shall enter into a formal Memorandum of Understanding (MOU) within one (1) year of passage of this Act, defining the division of responsibilities, data sharing protocols, and joint public health initiatives.
4. The State Legislature may, by majority vote, consolidate CDPH functions under the CCH Board following full implementation if such consolidation is determined to improve efficiency and public health outcomes.
California Health and Human Services Agency (CHHS): The California Health and Human Services Agency, which serves as the parent agency for both DHCS and CDPH, shall oversee the transition process and ensure inter-agency coordination throughout the phase-in period. The CHHS Secretary shall serve in an ex-officio advisory capacity to the CCH Board during the transition.
Federal Compliance: Nothing in this section shall be construed to relieve the State of California of its obligations under federal Medicaid and Medicare law during the transition period. The CCH Board shall work with the California Department of Justice and relevant federal agencies to ensure all federal compliance obligations are maintained without interruption.

Section 14: Initiative Supremacy, Legislative Non-Interference, and Amendment Protections

Voter Authority: This Act is enacted by the people of California pursuant to the initiative power reserved to the people under Article II of the California Constitution. As a voter-approved initiative statute, this Act shall take precedence over any conflicting statute, regulation, executive order, or agency action enacted or taken by the California State Legislature, the Governor, or any state agency, to the extent permitted by state and federal law.
Legislative Non-Interference: The California State Legislature shall not enact any statute, create any agency, or establish any program that has the purpose or effect of:
1. Delaying, undermining, defunding, or preventing the implementation of this Act;
2. Duplicating or replacing the functions of the California Commonsense Healthcare System with a parallel system not authorized by this Act;
3. Diverting funds designated for the California Commonsense Healthcare System to any other purpose.
Any statute, agency, or program found to conflict with the purposes of this Act shall be void and without effect to the extent of such conflict.
Restriction on Amendment or Repeal: Consistent with Article II, Section 10(c) of the California Constitution, this Act may not be amended or repealed by the Legislature except by a statute that is submitted to and approved by the voters of California. Any legislative amendment must be consistent with and in furtherance of the core purposes of this Act as stated in Section 2, and shall not reduce the scope of coverage, eligibility, or funding protections established herein.
Permitted Legislative Actions: Notwithstanding subsection (c), the Legislature may, without voter approval, enact statutes that:
1. Appropriate additional funds to support the implementation or operation of the California Commonsense Healthcare System;
2. Make technical, administrative, or conforming changes that do not alter the substantive rights, benefits, or funding established by this Act;
3. Establish enforcement mechanisms or penalties consistent with the purposes of this Act.
Any such legislative action shall require a two-thirds (2/3) supermajority vote of both chambers of the California Legislature.
Mandatory Implementation: No state agency, officer, or employee shall refuse, delay, or obstruct the implementation of this Act on the basis of legislative inaction, legislative opposition, or the existence of any competing legislative proposal. The CCH Board shall have standing to seek injunctive relief in any California court of competent jurisdiction to compel implementation of this Act consistent with its terms and timelines.
Conflicting Ballot Measures: If any provision of this Act conflicts with any other measure approved by the voters at the same election, the provisions of the measure receiving the highest number of affirmative votes shall prevail, consistent with Article II, Section 10(b) of the California Constitution.

Section 15: Conclusion

The adoption of the California Commonsense Healthcare will provide comprehensive access to high-quality, affordable healthcare for all legal residents of California. This system will replace the existing fragmented healthcare structure with a more efficient, cost-effective model, ensuring that every resident receives care without financial hardship. The California Commonsense Healthcare System aims to reduce administrative costs, promote public health, and ensure long-term sustainability while guaranteeing that all residents can access the care they need.

If any part of this proposal is found to be unconstitutional, the remainder of this proposal shall remain in effect.

SUMMARY:

The California Commonsense Healthcare (CCH) Act proposes a publicly administered healthcare system to provide comprehensive, high-quality care to all legal residents of California regardless of income or health status. It eliminates premiums and out-of-pocket costs, controls expenses through efficiency and negotiated drug prices, and ensures equal access across public and private providers. A phased four-year rollout includes a digital health ID system (SHAS) for streamlined care and data sharing. Private insurers may offer supplemental coverage but cannot exceed CCH costs. The system is funded through payroll taxes and existing public funds, aiming for equity, cost savings, and improved health outcomes.