The long and winding road: reflections on California's 'year of health reform'.

California's recent failed attempt to expand health coverage broadly offers lessons for future coverage expansion efforts. Policy efforts are most likely to advance if they are bipartisan; address the needs of both insured and uninsured residents; deliver short-term progress within the context of long-term goals; rely on broad and sustainable financing; strike a balance between specificity and flexibility; and occur within a clearer framework of state and federal responsibilities.