As the Democratic presidential candidates make the case for Medicare for All without scaring away voters wary of “socialism,” they might look to California for guidance.

Democrats here have created a road map for how to not just talk about health care coverage, but to provide it — all while not abandoning a long-term goal of universal, single-payer coverage.

Gov. Gavin Newsom is about to sign a budget that will make health insurance accessible to an estimated 377,000 lower-income people who don’t have it now. It will also provide help with punishing premium costs to an additional 660,000 middle-income people, according to estimates by the nonpartisan Health Access California. Couples making north of $65,000 a year could get up to $100 a month to help them pay for insurance.

The state will fund those payments by replacing the individual mandate to carry coverage that congressional Republicans and President Trump did away with in 2017. Californians who don’t buy coverage will be charged $695 per adult or 2.5% of household income, whichever is greater.

It’s the kind of action that creates a constituency for Medicare for All among people who have gotten limited help from the federal Affordable Care Act. People like Claire Haas.

She and her husband, Andrew Snyder, pay more than $900 a month for coverage. The Oakland couple both have decent-paying but somewhat insecure jobs — she is a leadership coach/consultant and he is an adjunct college professor.

They’re middle-class people “with a certain stability in our lives,” Haas said. “But we’re having to make hard decisions on a regular basis.”

Every month, Haas said, they’re stretched so thin that they debate whether they should continue to pay for health insurance. They’re frustrated that they’re paying a lot but not getting much coverage. They have to run up more than $6,000 in health care expenses before their coverage begins.

Recently, Snyder decided to forgo some tests that his doctor recommended he undergo because he would have to pay for them out of pocket. It’s the kind of decision families have to make all the time — and not just poor families.

“We make those decisions every month to keep paying because it’s so much money,” Haas said.

Haas, 34, couldn’t even get insurance after she graduated from college. She had a preexisting condition — a heart murmur “that doesn’t cause me any problems at all, but I have one.” When President Barack Obama signed the Affordable Care Act, it ensured that she could be covered — even if, as she concedes, that coverage isn’t great.

“For all the things that the Affordable Care Act doesn’t do, it does give you health care,” Haas said. “It’s not good, but it is coverage.”

But, she and Snyder make too much money to qualify for the federal law’s insurance subsidies.

Haas doesn’t have a favorite presidential candidate yet, much less know which health plans the two dozen hopefuls are supporting. If she had her preference, she’d want everyone to have health insurance. But, knowing how the Affordable Care Act helped her to get insurance, she understands the value of incremental progress.

“I support trying for (universal care) — and failing and ending up with something else that helps a lot of people,” Haas said. “I believe in incremental victories along the way.”

But right now, the Democratic presidential candidates haven’t quite figured out how to talk about health care other than to say that it’s “a right and not a privilege.” Many say they believe in Medicare for All — health care paid for by the federal government — as an aspirational goal, but they also support a variety of incremental steps to get there.

Anthony Wright, executive director of Health Access California, says the state is “providing the road map for the presidential candidates.” Of course, it’s easier to accomplish in a state with a massive budget surplus and a Democratic-dominated Legislature. And, as Wright noted, that “the health policy conversation is different from the health politics conversation. In politics, they’re trying to draw differences between them to get votes.”

Lately, that conversation about health policy has devolved more into a debate over democratic socialism.

It started when former Colorado Gov. John Hickenlooper was booed at the California Democratic Party convention this month when he said that “socialism is not the answer” — a reference to his belief that his rivals for the Democratic presidential nomination are skewing too far left on health care and other issues. On Wednesday, Sen. Bernie Sanders defended democratic socialism as “a higher path, a path of compassion, justice and love” that would defeat the “oligarchs” who control the health care system and jack up prescription drug prices.

Hickenlooper may be desperate for attention — he’s under 1% in most polls — but he has tapped into how voters feel about health care. Although a Kaiser Family Foundation survey in January showed that 54% of respondents supported the idea of Medicare for All, 74% supported a system similar to Medicare — one that would allow people to keep their private insurance if they wanted.

And 52% of the Democrats and Democratic-leaning independents responding to a Kaiser Family Foundation survey in April said they wanted Congress to focus on fixing the Affordable Care Act, compared with 39% who wanted it to pass a Medicare for All plan.

“There’s a lot of confusion out there,” said Liz Hamel, director of public opinion and survey research for the nonpartisan foundation. “There’s a general feeling that you build on the things that are already there. Continue making incremental changes.”

For now, most voters can’t tell the differences among the candidates’ nuanced positions on health care. But Hamel said there is one thing they’re united on: “They just want it to be more affordable.”

Joe Garofoli is The San Francisco Chronicle’s senior political writer. Email: jgarofoli@sfchronicle.com Twitter: @joegarofoli