When it comes to health care, who should be driving system change? Since the passage of national health reform, politicians and pundits have dominated the debate. But for health reform to truly take root, we should take our cue from the millions of low-income Californians who have the most at stake — and let their expectations inform implementation. People who fall into this category generally earn less than 200 percent of the federal poverty level, which is about $45,000 a year for a family of four. They also tend to be health-stressed. Evidence indicates a significant amount of their medical needs go unmet. But, as a result of the law, this circumstance could change. The vast majority will either qualify for Medicaid or be eligible for health insurance subsidies to purchase coverage from the state health insurance exchanges.