By Dan Walters, CalMatters
This commentary was originally published by CalMatters.
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Universal healthcare provided by government is the holy grail for those on the political left, so its advocates in California cheered — or at least most did — when Gov. Gavin Newsom signed Senate Bill 770 three years ago.
The legislation stemmed from a commission Newsom appointed to study how healthcare could be expanded, saying, “As our march toward universal coverage continues I am calling on the brightest minds — from public and private sectors — to serve in the Healthy California for All Commission to improve the health of our state.”
The commission’s report endorsed a “system of unified financing” as the most efficient way of providing universal healthcare. But it didn’t specify a single-payer system, which angered some advocates of that approach.
SB 770 directed state officials to negotiate with federal authorities to shift healthcare money now flowing from Washington – roughly 50% of the state’s total public and private medical expenditures – to the state.
Federal funds would partially finance a “comprehensive package of medical, behavioral health, pharmaceutical, dental, and vision benefits, which includes primary, preventive and wellness care services.”
The California Nurses Association, the chief single-payer advocate, opposed the measure, describing Newsom’s approval as “a complete betrayal of nurses’ fight for a single-payer healthcare policy, a fight striving to achieve health justice for our patients and our communities.”
While campaigning for governor in 2018, Newsom won the union’s backing by declaring, “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem.”
Once elected, however, Newsom edged away from the pledge, describing it as “aspirational” and citing the inherent difficulty of getting the federal government to cooperate.
Instead, Newsom championed the incremental expansion of Medi-Cal, the state’s healthcare program for the poor, a goal that seemingly was met in 2022 when coverage was expanded to all adult undocumented immigrants, to take effect in 2024.
“I campaigned on universal healthcare,” Newsom said in a subtle deviation from his 2018 single-payer pledge. “We’re delivering that.”
However, the expansion assumed that the state had a nearly $100 billion surplus, which never materialized. By 2025 the expansion’s cost had ballooned to $6.2 billion more than anticipated and the state was experiencing multi-billion-dollar deficits. Newsom and the Legislature froze enrollment to stop the hemorrhage.
Last month, legislative leaders blocked Assemblymember Ash Kalra’s third attempt to get a single-payer system, dubbed CalCare, adopted, shelving the San Jose Democrat’s Assembly Bill 1900 without a hearing.
It disappointed the California Nurses Association, which said in a statement, “The failure to advance (AB 1900) shows a lack of leadership and a capitulation to corporate healthcare interests.”
However, SB 770, the bill Newsom signed in 2023, has been operating in the background, with the state Health and Human Services Agency commissioning a study by the UCLA Center for Health Policy Research on how a unified healthcare plan could be implemented.
UCLA’s 181-page report was released last month, just as legislative leaders were softly killing Kalra’s legislation.
They had also asked UCLA, specifically its California Health Benefits Review Program, to estimate the financial impact of AB 1900. They were told that single-payer would cost $731.4 billion a year — more than three times the state’s $238 billion general fund budget — plus a $109 billion reserve fund.
Meanwhile, the Legislative Analyst’s Office, in a new report, projects that the 2 million Californians who lack health insurance will likely double by 2030 due to federal and state cutbacks.
A cynical — or realistic — view of this chain of events is that Newsom slow-rolled his 2018 campaign pledge by appointing a commission and signing SB 770, ensuring that the single-payer issue could be stretched out until his successor took office in 2027.
When questioned at forums, some leading Democratic candidates — most notably Tom Steyer and Katie Porter — endorsed single-payer while others offered less drastic alternatives.
It’s déjà vu.
This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.
