SACRAMENTO, Calif. — In his earliest days within the governor’s workplace, Democrat Gavin Newsom huddled together with his advisers to contemplate easy methods to 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, much 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 means of 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 applications 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 lease 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 hundreds residing on the streets.
He additionally tackled the hovering price of healthcare, together with by providing larger subsidies for low- and middle-income earners to buy insurance coverage and empowering a brand new state company to gradual 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 regulation a coverage establishing a state-branded generic prescription drug label referred to as CalRx to offer lower-priced medicine. 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 cast early in his life and cultivated throughout his two phrases as mayor of San Francisco. His method within the governor’s workplace is described by allies as socially liberal and fiscally pragmatic. The insurance policies he has supported supply a highway map for the course he would lead the nation, ought to he run for and be elected president in 2028. Now in his last time period as governor, Newsom will probably be scrutinized for his healthcare report, criticized by liberals as too reasonable and by Republicans as too radical.
Newsom, 58, is understood for his all-out method, a mode that leads him to tackle a barrage of flashy and sophisticated coverage proposals directly, incomes him a fame in some political circles of overpromising and underdelivering. Newsom has notched some successes, however his report can also be marked by failures. He hasn’t housed as many individuals as he envisioned — there are practically 190,000 homeless folks in California, in line with the latest federal estimates, greater than when he grew to become 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 objectives aren’t failures however investments and long-term methods to higher serve poor and marginalized folks whereas containing healthcare prices.
“We’d speak about the way you win by dropping,” stated Mark Ghaly, who served as Newsom’s well being and human companies secretary till 2024. “The governor isn’t afraid to fail. However by failing you study easy methods to make it profitable.”
Though voters within the Democratic stronghold of California have supported a lot 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 turn out to be a high concern for voters throughout the political spectrum. Two-thirds of the general public in January stated they frightened about with the ability to afford healthcare for themselves and their households, in line 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, similar to driving much less, skipping meals, chopping utility use, rationing prescriptions, or borrowing cash.
Regardless of the criticisms, Newsom’s in depth report on healthcare may give him an edge in a presidential main contest, stated Celinda Lake, a nationwide Democratic strategist who makes a speciality of healthcare polling. “Newsom has, by far, essentially the most complete and genuine agenda of any Democrat on the market,” she stated.
Common Healthcare
Newsom has stated that healthcare needs 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 potential to pay.
When he was mayor of San Francisco, in 2006, he signed into regulation 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 means of a mix of public funds, employer contributions, and a sliding charge scale for sufferers based mostly on revenue, grew to become immensely common, 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 Reasonably priced Care Act, pushing for a government-run insurance coverage plan to compete with industrial well being insurers. “Healthcare reform with no public choice isn’t 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 main, he stated healthcare “is the difficulty of our time.” He set himself aside by tacking left and earned a crucial endorsement from the California Nurses Affiliation, pledging to struggle for single-payer.
“It’s time for a brand new method,” Newsom stated throughout his marketing campaign. “I’m bored with politicians saying they assist single-payer however that it’s too quickly, too costly, or another person’s drawback.”
On his first day in workplace, he signed a sequence of directives to discover the feasibility of single-payer, partly by in search of federal healthcare waivers that will be wanted to fund a brand new system. He didn’t ship, however advisers argued he mimicked some parts of single-payer, together with price containment, complete advantages, and common protection.
“He seems way more broadly on the healthcare system, and what it could possibly do to assist folks,” stated Newsom Deputy Cupboard Secretary Richard Figueroa. “There’s additionally a task for the federal government to play in price containment. The governor has been attempting to arrange some elementary modifications to maneuver towards a extra 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 crucial healthcare promise.
Jasmine Ruddy, director of the Nationwide Nurses United and California Nurses Affiliation’s neighborhood and Medicare for All campaigns, stated Newsom pulled a bait and swap 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 situation, would save an estimated $16 billion the primary yr in state healthcare prices.
“Masking everyone seems to be vital, however Newsom is supporting a system that also has insurance coverage premiums, deductibles, and copays,” Ruddy stated. “And you may nonetheless wind up with an unlimited hospital invoice and medical debt. That’s not the identical as guaranteeing healthcare for all.”
The strain is already constructing for Newsom to get behind single-payer — at dwelling and nationally. Ruddy stated, “If he runs for president as a progressive, he has no alternative however to assist Medicare for all.”
A Behavioral Well being Disaster
Newsom has taken an formidable method 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 non permanent funding for cities and counties to maneuver folks off the streets and into housing. On the identical 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 psychological sickness, drug habit, and homelessness was why I had even pursued a life in politics within 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 applications.
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 nearly what’s taking place on the streets and sidewalks; it’s what’s taking place behind closed doorways as effectively,” Newsom stated in response to a query from KFF Well being Information in March. He referenced his grandfather, saying, “He finally took his life, dedicated suicide.”
In his memoir, Newsom alludes to these household points. He additionally references his ingesting as mayor of San Francisco, a time when his political movie star 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 ingesting till a household buddy who operated a rehabilitation heart 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 unravel homelessness.
“Regardless of all that spending, there are nonetheless so many individuals who can’t even get in to see a physician, and who could be lined on paper however aren’t capable of really get the care they want,” 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 personal residents haven’t had entry 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 now have our personal issues: Medical doctors are leaving this state, and we now have hospitals on the breaking point,” he stated.
Newsom’s healthcare report may very well be a political legal responsibility. “Single-payer is an ideal instance of Gavin Newsom — that when issues get robust, he cuts and runs,” stated Lanhee Chen, a well being coverage fellow on the conservative-leaning Hoover Establishment.
Now in his last full yr in workplace, Newsom is confronting large fiscal challenges.
Current state monetary deficits, worsened by the healthcare cuts in congressional Republicans’ One Huge Stunning Invoice Act, have compelled Newsom to partially backtrack on his growth, notably of Medi-Cal. This yr, he froze new enrollments for grownup immigrants residing within the nation with out authorization.
But he’s nonetheless framing his healthcare report as one in all 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 Huge 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 subsequent 10 years and end in as much as 3.4 million Californians dropping protection.
Even so, Newsom has been reluctant to lift taxes. He opposes one to backfill federal healthcare funding losses by means of a one-time 5% levy on the state’s greater than 200 billionaires.
“That’s not what we’d like proper now, at a time of a lot uncertainty,” Newsom stated. “Fairly the opposite.”