America’s already threadbare welfare state is on the brink of total collapse. Over the next ten years, national funding for Medicaid, whose benefits 81 million Americans rely upon, will be cut by about $1 trillion. States that expanded Medicaid access under the Affordable Care Act will be hit especially hard. More immediately, in just a few days, on October 1, and again on January 1, various new requirements for Medicaid eligibility will be instituted. This means that receiving and maintaining insurance will suddenly become much more difficult for millions of Americans.

The result of all of these changes, enacted by H. R. 1, or the One Big Beautiful Bill Act, will be to throw states across the country into health and budget crises as their Medicaid funding falls off a cliff, with some of the worst effects of the bill conveniently placed after the midterm elections. There is one state, however, that could avoid that fate, should Proposition 40, or the California Billionaire Tax, pass this November.

The Big Beautiful Bill blasted open a $30 billion hole in annual Medicaid coverage for Californians, a program the state calls Medi-Cal. Prop 40 proposes to backfill much of that loss with a onetime 5 percent tax on billionaire wealth raising an estimated $100 billion, most of it earmarked for health care. It’s a percentage so small that, given the current speed at which their wealth is accumulating, most billionaires in California would earn back the total amount of money lost in a matter of months. While much of the discourse around Prop 40 has understandably been devoted to what it means to tax the billionaires, it is saving Medi-Cal — and not some vague notion of “punishing the rich” — that is the central purpose of the initiative.