The reasoning is that CA uses that tax money in addition to a match provided by the federal government to balance the budget. I’m not a fan of not making it permanent, but the flexibility of re-authorizing the tax each cycle has been very helpful to making sure the CA budget is level. That tax money is returned to the healthcare providers through Medi-Cal so they aren’t really losing anything I think, but the matched money from the federal government can be moved around. Something like that.
I found the federal elections to be exactly what I expected, but I was surprised at the ballot questions here (as well as my local elections where everyone I voted for lost too).