{"id":11290,"date":"2026-05-01T16:06:21","date_gmt":"2026-05-01T10:36:21","guid":{"rendered":"https:\/\/banitoday.com\/gavin-newsom-early-champion-of-single-payer-moderates-in-the-face-of-fiscal-limits\/"},"modified":"2026-05-01T16:06:21","modified_gmt":"2026-05-01T10:36:21","slug":"gavin-newsom-early-champion-of-single-payer-moderates-in-the-face-of-fiscal-limits","status":"publish","type":"post","link":"https:\/\/banitoday.com\/hi\/gavin-newsom-early-champion-of-single-payer-moderates-in-the-face-of-fiscal-limits\/","title":{"rendered":"Gavin Newsom, Early Champion of Single-Payer, Moderates in the Face of Fiscal Limits"},"content":{"rendered":"<p> <br \/>\n<\/p>\n<div>\n<p>SACRAMENTO, Calif. \u2014 In his earliest days in the governor\u2019s office, Democrat Gavin Newsom huddled with his advisers to consider how to realize a key campaign promise: transforming a healthcare system replete with insurance company intermediaries into the nation\u2019s first state-run single-payer model providing comprehensive coverage to all residents, similar to those in Canada and Taiwan.<\/p>\n<aside class=\"wp-block-kff-shared-sidebar alignright \">\n<\/aside>\n<p>He\u2019d need to secure tax increases to help cover the high cost of a single-payer system, once pegged at <a href=\"https:\/\/www.chhs.ca.gov\/wp-content\/uploads\/2022\/04\/Key-Design-Considerations_April-2022_Final-Report-for-Distribution.pdf#page=29\">about $500 billion<\/a> a year, and Republican President Donald Trump, then in his first term, would have to give California permission to use federal funding to convert the system of coverage from one determined by employment, age, or income.<\/p>\n<p>Neither was politically feasible.<\/p>\n<p>Instead, in the years that followed, Newsom muscled through a compassionate healthcare agenda that poured billions into new benefits, including Medi-Cal coverage for low-income immigrants without legal status and incarcerated people leaving jail or prison, as well as programs for people experiencing homelessness in <a href=\"https:\/\/www.bbc.com\/news\/articles\/cly80zlk1lyo\">America\u2019s richest<\/a> and most populous state. Medi-Cal, the state\u2019s Medicaid program, now includes housing services, including six months of free rent for those in need, and home-delivered healthy meals for low-income Californians with chronic health conditions. He made it a priority to expand mental health and addiction treatment, especially for the tens of thousands living on the streets.<\/p>\n<p>He also tackled the soaring cost of healthcare, including by offering bigger subsidies for low- and middle-income earners to purchase insurance and empowering a new state agency to slow the rise in healthcare spending. Years before <a href=\"https:\/\/trumprx.gov\/\">TrumpRx<\/a>, the president\u2019s program to lower prices for some medicines for people without insurance, Newsom signed into law a policy setting up a state-branded generic prescription drug label known as <a href=\"https:\/\/calrx.ca.gov\/\">CalRx<\/a> to provide lower-price drugs. And amid a federal attack on reproductive rights, Newsom <a href=\"https:\/\/www.gov.ca.gov\/2022\/12\/21\/historic-california-constitutional-amendment-reinforcing-protections-for-reproductive-freedom-goes-into-effect\/\">led efforts to safeguard abortion<\/a>.<\/p>\n<p>The liberal values that guided Newsom\u2019s healthcare ambitions were forged early in his life and cultivated during his two terms as mayor of San Francisco. His approach in the governor\u2019s office is described by allies as socially liberal and fiscally pragmatic. The policies he has supported offer a road map for the direction he would lead the nation, should he run for and be elected president in 2028. Now in his final term as governor, Newsom will be scrutinized for his healthcare record, criticized by liberals as too moderate and by Republicans as too radical.<\/p>\n<div class=\"wp-block wp-block-kff-shared-newsletter  wp-block-kff-shared-newsletter--background-white\" data-type=\"kff-shared\/newsletter\" data-align=\"center\">\n<div class=\"wp-block-kff-shared-newsletter__container\">\n<div class=\"wp-block-kff-shared-newsletter__content\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\" alt=\"Newsletter Icon\" class=\"wp-block-kff-shared-newsletter__img\"\/><\/p>\n<div class=\"wp-block-kff-shared-newsletter__text\">\n<h4 class=\"newsletter__title\">\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n<p class=\"newsletter__description\">\n\t\t\t\t\tSubscribe to KFF Health News&#8217; free Morning Briefing.\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n<p>Newsom, 58, is known for his all-out approach, a style that leads him to take on a barrage of flashy and complicated policy proposals at once, earning him a reputation in some political circles of overpromising and underdelivering. Newsom has notched some successes, but his record is also marked by failures. He hasn\u2019t housed as many people as he envisioned \u2014 there are nearly <a href=\"https:\/\/www.ppic.org\/blog\/homelessness-hits-record-high-in-california-jumps-dramatically-in-rest-of-us\/\">190,000 homeless people<\/a> in California, according to the most recent federal estimates, more than when he became governor. Medicaid spending has more than doubled under his watch, drawing criticism from Republicans, and patients around the state are experiencing problems getting timely medical appointments and quality care.<\/p>\n<p>Newsom\u2019s closest allies argue that he has balanced efforts to make healthcare more equitable, accessible, and affordable. They argue his unmet policy goals are not failures but investments and long-term strategies to better serve poor and marginalized people while containing healthcare costs.<\/p>\n<p>\u201cWe would talk about how you win by losing,\u201d said Mark Ghaly, who served as Newsom\u2019s health and human services secretary until 2024. \u201cThe governor isn\u2019t afraid to fail. But by failing you learn about how to make it successful.\u201d<\/p>\n<p>Although voters in the Democratic stronghold of California have supported many of his ideas, residents have grown increasingly weary in their support. An <a href=\"https:\/\/escholarship.org\/uc\/item\/26b6t6k0\">early 2026 poll<\/a> from the University of California-Berkeley Institute of Governmental Studies showed Newsom\u2019s job approval slipping as he has focused on attacking Trump on the national stage.<\/p>\n<p><a href=\"https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/national-health-expenditure-data\/nhe-fact-sheet\">Rising costs<\/a> have become a top concern for voters across the political spectrum. Two-thirds of the public in January said they worried about being able to afford healthcare for themselves and their families, according to a <a href=\"https:\/\/www.kff.org\/public-opinion\/kff-health-tracking-poll-health-care-costs-expiring-aca-tax-credits-and-the-2026-midterms\/\">KFF national survey<\/a>. And a recent <a href=\"https:\/\/news.gallup.com\/poll\/702596\/one-third-americans-cut-back-cover-healthcare-expenses.aspx\">Gallup poll<\/a> found roughly a third of adults in America have made at least one trade-off to afford healthcare, such as driving less, skipping meals, cutting utility use, rationing prescriptions, or borrowing money.<\/p>\n<p>Despite the criticisms, Newsom\u2019s extensive record on healthcare can give him an edge in a presidential primary contest, said <a href=\"https:\/\/www.lakeresearch.com\/celinda-lake\">Celinda Lake<\/a>, a national Democratic strategist who specializes in healthcare polling. \u201cNewsom has, by far, the most comprehensive and authentic agenda of any Democrat out there,\u201d she said.<\/p>\n<p class=\"has-heading-5-font-size\"><strong>Universal Healthcare<\/strong><\/p>\n<p>Newsom has said that healthcare should be a <a href=\"https:\/\/www.facebook.com\/GavinNewsom\/posts\/healthcare-should-be-a-basic-human-right-republicans-in-washington-are-already-t\/10157128786763117\/\">basic human right<\/a>, not a privilege. Though he backed away from single-payer, he remains steadfast in his support for a universal healthcare system that covers everybody, regardless of immigration status or ability to pay.<\/p>\n<p>When he was mayor of San Francisco, in 2006, he signed into law <a href=\"https:\/\/healthysanfrancisco.org\/wp-content\/uploads\/Kaiser-Survey-of-HSF-Participants-Aug-2009.pdf\">Healthy San Francisco<\/a>, a universal health program that extended care to all uninsured adults who had been unable to access coverage. The program, paid for through a combination of public funds, employer contributions, and a sliding fee scale for patients based on income, became immensely popular, extending care to <a href=\"https:\/\/healthysanfrancisco.org\/wp-content\/uploads\/2010-2011-HSF-Annual-Report.pdf\">85% of adults<\/a> who had been uninsured.<\/p>\n<p>Newsom also waded into the national healthcare debate leading up to the enactment of the Affordable Care Act, pushing for a government-run insurance plan to compete with commercial health insurers. \u201cHealthcare reform without a public option is not reform,\u201d <a href=\"https:\/\/www.youtube.com\/watch?v=ATgWL4ODHcM\">Newsom said in 2009<\/a>.<\/p>\n<p>In 2017, amid his two terms as lieutenant governor, Newsom had launched his run for governor and gained momentum by making healthcare a central pillar of his campaign. During the gubernatorial primary, he said healthcare \u201c<a href=\"https:\/\/www.sacbee.com\/news\/politics-government\/capitol-alert\/article138777138.html\">is the issue of our time<\/a>.\u201d He set himself apart by tacking left and earned a critical endorsement from the California Nurses Association, pledging to fight for single-payer.<\/p>\n<p>\u201cIt\u2019s time for a new approach,\u201d Newsom said during his campaign. \u201cI\u2019m tired of politicians saying they support single-payer but that it\u2019s too soon, too expensive, or someone else\u2019s problem.\u201d<\/p>\n<p>On his first day in office, he signed a series of directives to explore the feasibility of single-payer, in part by seeking federal healthcare waivers that would be needed to fund a new system. He didn\u2019t deliver, but advisers argued he mimicked some components of single-payer, including cost containment, comprehensive benefits, and universal coverage.<\/p>\n<p>\u201cHe looks much more broadly at the healthcare system, and what it can do to help people,\u201d said Newsom Deputy Cabinet Secretary Richard Figueroa. \u201cThere 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.\u201d<\/p>\n<p>The nurses union, however, blasted Newsom for backtracking, arguing he kept the profit-driven insurance system intact and failed to deliver a critical healthcare promise.<\/p>\n<p>Jasmine Ruddy, a lead organizer for the California Nurses Association, said Newsom pulled a bait and switch on Californians, purposely mixing up universal healthcare with single-payer. She pointed to <a href=\"https:\/\/www.chhs.ca.gov\/wp-content\/uploads\/2022\/04\/Key-Design-Considerations_April-2022_Final-Report-for-Distribution.pdf\">a report<\/a> commissioned by the Newsom administration that found single-payer could increase taxes but, in one scenario, would save an estimated $16 billion the first year in state healthcare costs.<\/p>\n<p>\u201cCovering everyone is important, but Newsom is supporting a system that still has insurance premiums, deductibles, and copays,\u201d Ruddy said. \u201cAnd you can still wind up with an enormous hospital bill and medical debt. That is not the same as guaranteeing healthcare for all.\u201d<\/p>\n<p>The pressure is already building for Newsom to get behind single-payer \u2014 <a href=\"https:\/\/www.nationalnursesunited.org\/press\/assemblymember-ash-kalra-california-nurses-association-reintroduce-calcare-legislation\">at home<\/a> and nationally. Ruddy said, \u201cIf he runs for president as a progressive, he has no choice but to support Medicare for all.\u201d<\/p>\n<p class=\"has-heading-5-font-size\"><strong>A Behavioral Health Crisis<\/strong><\/p>\n<p>Newsom has taken an ambitious approach to homelessness, framing it as a public health crisis fueled by a lack of affordable housing and inadequate mental health and addiction care. Arguing that the state had ignored the problem for too long, he took ownership of the challenge by increasing temporary funding for cities and counties to move people off the streets and into housing. At the same time, he called for a statewide push to <a href=\"https:\/\/kffhealthnews.org\/news\/article\/homeless-encampment-sweeps-medicaid-california-calaim-street-medicine\/\">dislodge homeless encampments<\/a>.<\/p>\n<p>Although his policies rankled homeless advocates by sweeping people from their encampments <a href=\"https:\/\/kffhealthnews.org\/news\/article\/california-homeless-crisis-governor-gavin-newsom-political-future\/\">without providing enough<\/a> services or housing, Newsom considers it his highest calling. \u201cThe junction of mental illness, drug addiction, and homelessness was why I had even pursued a life in politics in the first place,\u201d he wrote in his memoir, <em>Young Man in a Hurry<\/em>, published in February.<\/p>\n<p>Since Newsom took office in 2019, California has doled out an unprecedented <a href=\"https:\/\/lao.ca.gov\/Publications\/Report\/5007\">$37 billion<\/a> for homelessness and housing-related programs.<\/p>\n<p>His interest in mental health and addiction, he said, stems from personal experience, and seeing that it touches so many Californians. \u201cIt\u2019s not just about what\u2019s happening on the streets and sidewalks; it\u2019s what\u2019s happening behind closed doors as well,\u201d Newsom said in response to a question from KFF Health News in March. He referenced his grandfather, saying, \u201cHe ultimately took his life, committed suicide.\u201d<\/p>\n<p>In his memoir, Newsom alludes to those family issues. He also references his drinking as mayor of San Francisco, a time when his political celebrity was rising and he had an affair with the wife of his campaign manager. Although he <a href=\"https:\/\/www.sacbee.com\/news\/politics-government\/capitol-alert\/article209176644.html\">never went to traditional rehab<\/a>, he said he stopped drinking until a family friend who operated a rehabilitation center gave him permission to drink again. For all his investments in the healthcare safety net, Newsom\u2019s critics say his policies have weakened access to basic care and failed to solve homelessness.<\/p>\n<p>\u201cDespite all that spending, there are still so many people who can\u2019t even get in to see a doctor, and who might be covered on paper but aren\u2019t able to actually get the care they need,\u201d said Rep. Kevin Kiley, a Republican-turned-independent who is running in a newly drawn House seat and served in the Democratic-controlled state legislature earlier in Newsom\u2019s tenure as governor. \u201cBillions of dollars have gone to immigrants, when our own citizens haven\u2019t had access to healthcare.\u201d<\/p>\n<p>Assembly member David Tangipa, a Fresno Republican, said Newsom is bankrupting the state, referring to ballooning costs in Medi-Cal, which have grown from $100.7 billion in 2019 to $222.4 billion for the fiscal year starting July 1. \u201cIt\u2019s 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,\u201d he said.<\/p>\n<p>Newsom\u2019s healthcare record could be a political liability. \u201cSingle-payer is a perfect example of Gavin Newsom \u2014 that when things get tough, he cuts and runs,\u201d said <a href=\"https:\/\/www.hoover.org\/profiles\/lanhee-j-chen\">Lanhee Chen<\/a>, a health policy fellow at the conservative-leaning Hoover Institution.<\/p>\n<p>Now in his final full year in office, Newsom is confronting massive fiscal challenges.<\/p>\n<p>Recent state financial deficits, worsened by the healthcare cuts in congressional Republicans\u2019 One Big Beautiful Bill Act, have forced Newsom to <a href=\"https:\/\/www.dhcs.ca.gov\/keep-your-Medi-Cal\/Pages\/Medi-Cal-Immigrant-Eligibility-FAQs.aspx\">partially backtrack<\/a> on his expansion, particularly of Medi-Cal. This year, he <a href=\"https:\/\/kffhealthnews.org\/news\/article\/california-newsom-budget-immigrants-medicaid-coverage-medi-cal\/\">froze new enrollments<\/a> for adult immigrants living in the country without authorization.<\/p>\n<p>Yet he is still framing his healthcare record as one of success. In an <a href=\"https:\/\/www.axios.com\/2026\/03\/27\/axios-show-gavin-newsom-extended-interview\">interview with Axios<\/a>, Newsom proclaimed that he had achieved universal healthcare. \u201cWe delivered it,\u201d he said.<\/p>\n<p>But California does not have universal healthcare. Before passage of the One Big Beautiful Bill Act, estimates showed nearly 2.6 million <a href=\"https:\/\/laborcenter.berkeley.edu\/californias-uninsured-in-2024\/\">Californians were uninsured<\/a>, including people who chose to forgo coverage and immigrants without legal status who earned too much money to be eligible for Medi-Cal.<\/p>\n<p>Projections in 2025 showed that <a href=\"https:\/\/calbudgetcenter.org\/resources\/california-health-coverage-progress-disparities-and-policy-threats\/\">6% of Californians<\/a> remained uninsured, lower than the roughly 8% when Newsom took office. Yet the number of uninsured residents is <a href=\"https:\/\/tcf.org\/content\/commentary\/cbo-reaffirms-forecast-of-a-dramatic-reduction-in-health-coverage-in-2026-and-beyond\/\">expected to climb<\/a> as a result of Trump administration healthcare policies. Estimates show the GOP bill will cost the state an estimated <a href=\"https:\/\/www.gov.ca.gov\/wp-content\/uploads\/2025\/05\/newsom-medicaid-impacts-memo.pdf\">$30 billion<\/a> over the next 10 years and result in up to 3.4 million Californians losing coverage.<\/p>\n<p>Even so, Newsom has been reluctant to raise taxes. He opposes one to backfill federal healthcare funding losses through a <a href=\"https:\/\/oag.ca.gov\/system\/files\/initiatives\/pdfs\/25-0024A1%20%28Billionaire%20Tax%20%29.pdf\">one-time 5% levy<\/a> on the state\u2019s <a href=\"https:\/\/www.businessinsider.com\/california-billionaires-list-wealth-tax-2026-1\">more than 200 billionaires<\/a>.<\/p>\n<p>\u201cThat\u2019s not what we need right now, at a time of so much uncertainty,\u201d <a href=\"https:\/\/www.politico.com\/news\/2026\/01\/12\/newsom-unloads-on-california-wealth-tax-proposal-00723732?utm_medium=twitter&amp;utm_source=dlvr.it\">Newsom said<\/a>. \u201cQuite the contrary.\u201d<\/p>\n<\/div>\n<p><br \/>\n<br \/><a href=\"https:\/\/kffhealthnews.org\/insurance\/gavin-newsom-california-single-payer-universal-healthcare-2028\/\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>SACRAMENTO, Calif. \u2014 In his earliest days in the governor\u2019s office, Democrat Gavin Newsom huddled with his advisers to consider how to realize a key campaign promise: transforming a healthcare system replete with insurance company intermediaries into the nation\u2019s first state-run single-payer model providing comprehensive coverage to all residents, similar to those in Canada and [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":10378,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[270],"tags":[],"class_list":{"0":"post-11290","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-2"},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/posts\/11290","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/comments?post=11290"}],"version-history":[{"count":0,"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/posts\/11290\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/media\/10378"}],"wp:attachment":[{"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/media?parent=11290"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/categories?post=11290"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/banitoday.com\/hi\/wp-json\/wp\/v2\/tags?post=11290"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}