Newsom’s sweeping health care promises to Californians remain elusive

Five years ago, while running for governor, Gavin Newsom pledged to transform California’s medical care into a single-payer system similar to those in Canada and Western Europe.

Newsom backed the single payment legislation, which had been passed by the state Senate, saying there was no reason to wait.

I’m tired of politicians saying they support the single payment but it’s too early, too expensive or someone else’s problem, Newsom said.

His position helped solidify support for Newsom among the proposal’s progressive supporters as he dueled with a fellow Democrat, Antonio Villaraigosa.

The bill stalled in the Assembly, and after winning the election, Newsom began to move away from the single payment concept, citing difficult hurdles. One is persuading the federal government to give California the more than $200 billion it spends on Californian health care, about half of the state’s total medical bills.

Newsom continued to push for universal health care, meaning all nearly 40 million Californians would have some sort of coverage, and he came close last year.

At the time, an estimated 3 million Californians said they were uninsured in the spring of 2022, notes a report from the Public Policy Institute of California, citing census data. Nearly seven in 10 (68%) are Latino, about 38% are noncitizens, and 80% are on low or moderate incomes (below 400% of the federal poverty line).

Part of the gap was closed in the 2022-23 budget, tapping into what appeared to be a nearly $100 billion budget surplus, by expanding medical coverage to undocumented immigrants otherwise ineligible for federally subsidized insurance.

Beginning January 1, 2024, Medi-Cal will be available to all income-eligible Californians under the reported final 2022-23 budget.

Expanding the Medi-Cal California version of the federal Medicaid program was made easier during the COVID-19 pandemic when federal authorities relaxed eligibility requirements. This year, enrollments surpassed 15 million, or nearly 40 percent of the state’s population.

Under his California Blueprint, universal health care is still Newsom’s stated goal. However, at the moment, coverage appears to be shrinking, and with the state facing chronic budget deficits, achieving it before the end of Newsom’s governorship would be difficult, if not impossible.

The federal government’s ongoing pandemic enrollment policy is expiring, and hundreds of thousands of Californians who have benefited from it will need to prove their eligibility once again.

Newsom’s revised 2023-24 budget, unveiled last month, expects Medi-Cal enrollment to drop by more than a million people, still more than a third of the state’s population but away from the universal coverage Newsom has sought as single payer replace.

Supporters of the single payment are, of course, annoyed by Newsom’s failure to deliver on his 2018 promise. They gave him some heat when he appeared at last month’s state Democratic Party convention.

Covering all Californians would be expensive. Medi-Cal coverage costs the federal and state governments about $10,000 in writing. No one knows exactly how many Californians are still missing coverage today, but 2 million is as good a number as any, and including many more in Medi-Cal could potentially cost another $20 billion a year.

Meanwhile, supporters of the single payment have not given up. Last week, the California Senate approved Senate Bill 770, aimed at implementing a single-payer coverage plan developed by the Healthy California for All Commission, which Newsom created in 2019.

The bill would direct state agencies to begin talks with federal officials about participating in a single-payer system in California.

It’s time we made real progress toward eliminating the inequities and injustices of our fractured health care system, said a co-author of the bill, State Senator Scott Wiener, a Democrat from San Francisco.

As Newsom has finally learned, that’s a lot easier said than done.