Newsom’s Slow Walk on Single-Payer Leaves California’s Universal Health Care Dream to His Successor
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For the political left, government-funded universal health care is a holy grail. So when Gov. Gavin Newsom signed Senate Bill 770 three years ago, many advocates cheered. The bill grew out of a commission Newsom had appointed to study health care expansion. “As our march toward universal coverage continues,” Newsom said at the time, “I am calling on the brightest minds… to serve.”
The commission’s report endorsed “unified financing” as the most efficient path to universal care—but notably stopped short of endorsing a true single-payer system, frustrating some activists.
SB 770 directed state officials to negotiate with the federal government to redirect existing Washington health care dollars (roughly half of California’s total medical spending) into a state-run comprehensive package covering medical, behavioral, dental, and vision care.
But the California Nurses Association, the state’s leading single-payer advocate, opposed the bill. They called Newsom’s approval “a complete betrayal” of their fight for health justice.
Their anger had roots in Newsom’s 2018 campaign for governor, when he won the union’s endorsement 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 pulled back, calling single-payer “aspirational” and citing the difficulty of securing federal cooperation. Instead, he championed incremental expansions of Medi-Cal, the state’s program for the poor. By 2022, coverage was extended to all undocumented immigrants—scheduled to take full effect in 2024.
“I campaigned on universal health care,” Newsom said, subtly shifting from his earlier single-payer pledge. “We’re delivering that.”
But that expansion assumed a nearly 100 billion state surplusthatnevermaterialized. By2025, costs had ballooned 100billion state surplusthatne vermaterialized.By2025,costshadballooned6.2 billion beyond projections, and California faced multi-billion-dollar deficits. Newsom and the Legislature froze enrollment to stop the bleeding.
Last month, legislative leaders blocked Assemblymember Ash Kalra’s latest single-payer attempt—his third. His proposed “CalCare” system, Assembly Bill 1900, was shelved without a hearing. The Nurses Association responded: “The failure to advance this bill shows a lack of leadership and a capitulation to corporate health care interests.”
Meanwhile, SB 770 continued in the background. The state Health and Human Services Agency commissioned UCLA’s Center for Health Policy Research to study how a unified health plan could be implemented. That 181-page report was released last month—just as lawmakers quietly killed Kalra’s bill.
Separately, lawmakers asked UCLA’s California Health Benefits Review Program to cost out AB 1900. The answer: a single-payer system would cost 731.4billionperyear—
morethanthreetimesthestate’sentire731.4billionperyear—morethanthreetimesthestate’sentire238 billion general fund budget—plus a $109 billion reserve.
To make matters worse, the Legislative Analyst’s Office now projects that the roughly 2 million Californians currently without insurance could double by 2030 due to federal and state cutbacks.
A cynical—or realistic—reading of this timeline is that Newsom slow-rolled his 2018 campaign promise. He appointed a commission, signed SB 770, and effectively stretched the single-payer debate out until after he leaves office in 2027.
At recent candidate forums, leading Democratic hopefuls for governor have split on the issue: Tom Steyer and Katie Porter endorsed single-payer, while others offered more modest alternatives. The next governor will inherit what Newsom chose not to finish.
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