Californians are increasingly anxious about rising health care costs and limited access to mental health services, according to a new statewide poll commissioned by the California Wellness Foundation. The survey highlights how economic pressures and immigration fears are shaping residents’ views of health and well-being.

“Californians don’t see health as a single dimension—it’s about overall quality of life,” said Shakari Byerly, managing partner at Evitarus, the firm that conducted the polling.

Nearly 40% of respondents said they know someone whose mental health has declined due to U.S. Immigration and Customs Enforcement activity. In contrast, one in five said they know someone afraid to seek care because of immigration enforcement. These concerns were especially pronounced in Los Angeles’ Latino community, where 60% reported knowing someone facing financial hardship linked to immigration issues.

“People have long come to California for the California dream,” Byerly said. “Many of these issues strike at the heart of what that dream means—and what people still believe is possible.”

The poll precedes a Nov. 7 forum at UC Riverside, where 11 philanthropic organizations, including the wellness foundation, will host gubernatorial candidates to discuss their health care priorities. Confirmed participants include former U.S. Health and Human Services Secretary Xavier Becerra, State Superintendent Tony Thurmond, former L.A. Mayor Antonio Villaraigosa, and former State Controller Betty Yee.

Nearly 90% of Californians polled said the next governor should prioritize limits on out-of-pocket health costs.

For San Diego resident Lisa Kaczmarczyk, affordability remains a daily struggle. Self-employed and insured through Covered California, she pays about $1,000 a month for premiums, copays, and uncovered expenses. “There are absolutely things that I don’t buy,” she said. “I prioritize groceries and medical bills.”

With enhanced federal subsidies set to expire at the end of the year, she worries her costs could climb even higher. Like half of Californians, Kaczmarczyk has delayed care due to expenses and is looking forward to qualifying for Medicare next year.

Seventy-two percent of respondents said they’re worried they won’t be able to afford to live in California long term—a challenge candidates for governor can’t ignore, said California Wellness Foundation President and CEO Richard Tate.

Among more than 2,000 respondents surveyed in late August and early September, former U.S. Rep. Katie Porter led potential gubernatorial contenders with 20% support, followed by Riverside County Sheriff Chad Bianco at 16% and U.S. Sen. Alex Padilla at 13%.

“What voters want from the next governor is clear,” Tate said. “Affordable housing, health care that doesn’t break the bank, reliable mental health support, and the ability to care for loved ones with dignity and peace of mind.”