SACRAMENTO, Calif. — In his earliest days within the governor’s workplace, Democrat Gavin Newsom huddled along with his advisers to think about how you can notice a key marketing campaign promise: reworking a healthcare system replete with insurance coverage firm intermediaries into the nation’s first state-run single-payer mannequin offering complete protection to all residents, just like these in Canada and Taiwan.
He’d have to safe tax will increase to assist cowl the excessive price of a single-payer system, as soon as pegged at about $500 billion a yr, and Republican President Donald Trump, then in his first time period, must give California permission to make use of federal funding to transform the system of protection from one decided by employment, age, or revenue.
Neither was politically possible.
As a substitute, within the years that adopted, Newsom muscled by a compassionate healthcare agenda that poured billions into new advantages, together with Medi-Cal protection for low-income immigrants with out authorized standing and incarcerated folks leaving jail or jail, in addition to packages for folks experiencing homelessness in America’s richest and most populous state. Medi-Cal, the state’s Medicaid program, now consists of housing companies, together with six months of free hire for these in want, and home-delivered wholesome meals for low-income Californians with persistent well being circumstances. He made it a precedence to develop psychological well being and habit remedy, particularly for the tens of 1000’s dwelling on the streets.
He additionally tackled the hovering price of healthcare, together with by providing greater subsidies for low- and middle-income earners to buy insurance coverage and empowering a brand new state company to sluggish the rise in healthcare spending. Years earlier than TrumpRx, the president’s program to decrease costs for some medicines for folks with out insurance coverage, Newsom signed into legislation a coverage organising a state-branded generic prescription drug label generally known as CalRx to supply lower-price medication. And amid a federal assault on reproductive rights, Newsom led efforts to safeguard abortion.
The liberal values that guided Newsom’s healthcare ambitions had been solid early in his life and cultivated throughout his two phrases as mayor of San Francisco. His strategy within the governor’s workplace is described by allies as socially liberal and fiscally pragmatic. The insurance policies he has supported supply a street map for the route he would lead the nation, ought to he run for and be elected president in 2028. Now in his remaining time period as governor, Newsom might be scrutinized for his healthcare document, criticized by liberals as too reasonable and by Republicans as too radical.
Newsom, 58, is thought for his all-out strategy, a mode that leads him to tackle a barrage of flashy and sophisticated coverage proposals without delay, incomes him a fame in some political circles of overpromising and underdelivering. Newsom has notched some successes, however his document can be marked by failures. He hasn’t housed as many individuals as he envisioned — there are practically 190,000 homeless folks in California, in keeping with the latest federal estimates, greater than when he turned governor. Medicaid spending has greater than doubled beneath his watch, drawing criticism from Republicans, and sufferers across the state are experiencing issues getting well timed medical appointments and high quality care.
Newsom’s closest allies argue that he has balanced efforts to make healthcare extra equitable, accessible, and inexpensive. They argue his unmet coverage targets should not failures however investments and long-term methods to raised serve poor and marginalized folks whereas containing healthcare prices.
“We would talk about how you win by losing,” stated Mark Ghaly, who served as Newsom’s well being and human companies secretary till 2024. “The governor isn’t afraid to fail. But by failing you learn about how to make it successful.”
Though voters within the Democratic stronghold of California have supported lots of his concepts, residents have grown more and more weary of their assist. An early 2026 ballot from the College of California-Berkeley Institute of Governmental Research confirmed Newsom’s job approval slipping as he has targeted on attacking Trump on the nationwide stage.
Rising prices have grow to be a high concern for voters throughout the political spectrum. Two-thirds of the general public in January stated they anxious about having the ability to afford healthcare for themselves and their households, in keeping with a KFF nationwide survey. And a latest Gallup ballot discovered roughly a 3rd of adults in America have made a minimum of one trade-off to afford healthcare, resembling driving much less, skipping meals, slicing utility use, rationing prescriptions, or borrowing cash.
Regardless of the criticisms, Newsom’s intensive document on healthcare may give him an edge in a presidential major contest, stated Celinda Lake, a nationwide Democratic strategist who focuses on healthcare polling. “Newsom has, by far, the most comprehensive and authentic agenda of any Democrat out there,” she stated.
Common Healthcare
Newsom has stated that healthcare ought to be a primary human proper, not a privilege. Although he backed away from single-payer, he stays steadfast in his assist for a common healthcare system that covers all people, no matter immigration standing or skill to pay.
When he was mayor of San Francisco, in 2006, he signed into legislation Wholesome San Francisco, a common well being program that prolonged care to all uninsured adults who had been unable to entry protection. This system, paid for by a mixture of public funds, employer contributions, and a sliding price scale for sufferers based mostly on revenue, turned immensely fashionable, extending care to 85% of adults who had been uninsured.
Newsom additionally waded into the nationwide healthcare debate main as much as the enactment of the Inexpensive Care Act, pushing for a government-run insurance coverage plan to compete with industrial well being insurers. “Healthcare reform without a public option is not reform,” Newsom stated in 2009.
In 2017, amid his two phrases as lieutenant governor, Newsom had launched his run for governor and gained momentum by making healthcare a central pillar of his marketing campaign. In the course of the gubernatorial major, he stated healthcare “is the issue of our time.” He set himself aside by tacking left and earned a vital endorsement from the California Nurses Affiliation, pledging to struggle for single-payer.
“It’s time for a new approach,” Newsom stated throughout his marketing campaign. “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive, or someone else’s problem.”
On his first day in workplace, he signed a collection of directives to discover the feasibility of single-payer, partly by looking for federal healthcare waivers that may be wanted to fund a brand new system. He didn’t ship, however advisers argued he mimicked some elements of single-payer, together with price containment, complete advantages, and common protection.
“He looks much more broadly at the healthcare system, and what it can do to help people,” stated Newsom Deputy Cupboard Secretary Richard Figueroa. “There is also a role for the government to play in cost containment. The governor has been trying to set up some fundamental changes to move toward a more accountable healthcare system.”
The nurses union, nevertheless, blasted Newsom for backtracking, arguing he saved the profit-driven insurance coverage system intact and didn’t ship a vital healthcare promise.
Jasmine Ruddy, a lead organizer for the California Nurses Affiliation, stated Newsom pulled a bait and change on Californians, purposely mixing up common healthcare with single-payer. She pointed to a report commissioned by the Newsom administration that discovered single-payer might improve taxes however, in a single state of affairs, would save an estimated $16 billion the primary yr in state healthcare prices.
“Covering everyone is important, but Newsom is supporting a system that still has insurance premiums, deductibles, and copays,” Ruddy stated. “And you can still wind up with an enormous hospital bill and medical debt. That is not the same as guaranteeing healthcare for all.”
The strain is already constructing for Newsom to get behind single-payer — at residence and nationally. Ruddy stated, “If he runs for president as a progressive, he has no choice but to support Medicare for all.”
A Behavioral Well being Disaster
Newsom has taken an bold strategy to homelessness, framing it as a public well being disaster fueled by a scarcity of inexpensive housing and insufficient psychological well being and habit care. Arguing that the state had ignored the issue for too lengthy, he took possession of the problem by rising short-term funding for cities and counties to maneuver folks off the streets and into housing. On the similar time, he referred to as for a statewide push to dislodge homeless encampments.
Though his insurance policies rankled homeless advocates by sweeping folks from their encampments with out offering sufficient companies or housing, Newsom considers it his highest calling. “The junction of mental illness, drug addiction, and homelessness was why I had even pursued a life in politics in the first place,” he wrote in his memoir, Younger Man in a Hurry, revealed in February.
Since Newsom took workplace in 2019, California has doled out an unprecedented $37 billion for homelessness and housing-related packages.
His curiosity in psychological well being and habit, he stated, stems from private expertise, and seeing that it touches so many Californians. “It’s not just about what’s happening on the streets and sidewalks; it’s what’s happening behind closed doors as well,” Newsom stated in response to a query from KFF Well being Information in March. He referenced his grandfather, saying, “He ultimately took his life, committed suicide.”
In his memoir, Newsom alludes to these household points. He additionally references his consuming as mayor of San Francisco, a time when his political superstar was rising and he had an affair with the spouse of his marketing campaign supervisor. Though he by no means went to conventional rehab, he stated he stopped consuming till a household pal who operated a rehabilitation middle gave him permission to drink once more. For all his investments within the healthcare security internet, Newsom’s critics say his insurance policies have weakened entry to primary care and failed to resolve homelessness.
“Despite all that spending, there are still so many people who can’t even get in to see a doctor, and who might be covered on paper but aren’t able to actually get the care they need,” stated Rep. Kevin Kiley, a Republican-turned-independent who’s operating in a newly drawn Home seat and served within the Democratic-controlled state legislature earlier in Newsom’s tenure as governor. “Billions of dollars have gone to immigrants, when our own citizens haven’t had access to healthcare.”
Meeting member David Tangipa, a Fresno Republican, stated Newsom is bankrupting the state, referring to ballooning prices in Medi-Cal, which have grown from $100.7 billion in 2019 to $222.4 billion for the fiscal yr beginning July 1. “It’s baffling to see this governor attacking the president, when we have our own problems: Doctors are leaving this state, and we have hospitals on the verge of collapse,” he stated.
Newsom’s healthcare document could possibly be a political legal responsibility. “Single-payer is a perfect example of Gavin Newsom — that when things get tough, he cuts and runs,” stated Lanhee Chen, a well being coverage fellow on the conservative-leaning Hoover Establishment.
Now in his remaining full yr in workplace, Newsom is confronting large fiscal challenges.
Current state monetary deficits, worsened by the healthcare cuts in congressional Republicans’ One Massive Stunning Invoice Act, have pressured Newsom to partially backtrack on his enlargement, significantly of Medi-Cal. This yr, he froze new enrollments for grownup immigrants dwelling within the nation with out authorization.
But he’s nonetheless framing his healthcare document as one in every of success. In an interview with Axios, Newsom proclaimed that he had achieved common healthcare. “We delivered it,” he stated.
However California doesn’t have common healthcare. Earlier than passage of the One Massive Stunning Invoice Act, estimates confirmed practically 2.6 million Californians had been uninsured, together with individuals who selected to forgo protection and immigrants with out authorized standing who earned an excessive amount of cash to be eligible for Medi-Cal.
Projections in 2025 confirmed that 6% of Californians remained uninsured, decrease than the roughly 8% when Newsom took workplace. But the variety of uninsured residents is anticipated to climb on account of Trump administration healthcare insurance policies. Estimates present the GOP invoice will price the state an estimated $30 billion over the following 10 years and lead to as much as 3.4 million Californians shedding protection.
Even so, Newsom has been reluctant to lift taxes. He opposes one to backfill federal healthcare funding losses by a one-time 5% levy on the state’s greater than 200 billionaires.
“That’s not what we need right now, at a time of so much uncertainty,” Newsom stated. “Quite the contrary.”
