Gavin Newsom hasn’t delivered single-payer health care in California. Does it matter?
When an effort to create government-run universal health care died in California died last week, finger-pointing immediately began.
The California Nurses Association and Assembly Speaker Anthony Rendon criticized the bill author, Assemblyman Ash Kalra, for not bringing the bill up for a vote. Progressive activists blamed powerful health care groups for scuttling the effort. And some political pundits blamed those progressives for threatening to pull endorsements from lawmakers who didn’t support it, putting pressure on Kalra to not bring the bill up at all for fear of alienating his colleagues.
Amid all the drama, Democratic Gov. Gavin Newsom seemed to escape unscathed.
Newsom had vocally supported creating a single-payer health system on the campaign trail, earning him the enthusiastic support and financial backing of the California Nurses Association.
While campaigning for governor in 2017, he urged lawmakers to advance a bill that would have created a framework for single-payer, so called because the government would replace insurance companies and private citizens as the payer for health services.
“You have my firm and absolute commitment, as your next governor, that I will lead the effort to get it done,” Newsom told reporters during the event where he endorsed the single-payer bill in 2017. “We will get universal health care in the state of California. We will make sure it happens.”
Since taking office, he has taken some steps toward increasing health coverage, including expanding eligibility for undocumented immigrants to get insurance and increasing subsidies for middle-income families to buy health plans. But he hasn’t endorsed any legislation to implement single-payer since taking office the way he did while campaigning.
When asked last month about his stance on the single-payer proposal this year, Assembly Bill 1400, he told reporters he hadn’t even read it.
In theory, failure to endorse single-payer legislation could present a challenge to Newsom politically, said Melissa Michelson, a political science professor at Menlo College.
“The opposition could say, ‘You say you’re for single payer, but you haven’t endorsed any bills, you’re not lobbying any bills,’” Michelson said. “‘Talk is cheap, why aren’t you actually trying to make this happen?’”
But that argument is most likely to come from a Democratic challenger, and so far no prominent ones have filed to oppose him in 2022.
“I think the real answer is this probably doesn’t hurt him at all,” Michelson said.
Despite support for the concept of single-payer on the left, actually implementing such a system in California presents a monumental challenge. It would require unprecedented waivers from the federal government, possibly including an act of Congress. It would also require a plan to transition all 40 million Californians into the new system, as well as a massive tax increase, although single-payer advocates argue a single-payer system would save money overall.
Regardless of how it’s structured, some elements of the health care industry, including insurance companies, will lose out in such a system, guaranteeing any politician who backs such a plan will make powerful enemies. Such a coalition made up of groups representing insurers, doctors and other factions of the industry came out in strong opposition to AB 1400.
“If the governor wanted a bill, he’d get a bill,” said Mike Madrid, a Republican political strategist. “I do think he’s keenly aware of how fraught this issue is, otherwise he would have done this in the first year of his administration.”
Garry South, a longtime Democratic political strategist who has worked with Newsom, said the death of Kalra’s single-payer bill won’t affect Newsom’s reelection.
“There probably will be some disgruntlement among some of the progressive groups that he didn’t come forward and support it,” South said. “I just don’t think there’s any long-term consequence for him at all, and frankly I think he’s probably relieved he doesn’t have to weigh in on this.”
Daniel Zingale, who served as Newsom’s top strategist at the start of his term, said Newsom really does support single-payer health care and believes the current system is unsustainable because of rapidly rising costs.
“He understands and agrees this is the system that makes the most sense,” Zingale said. “There’s frustration among all of us (who support single-payer) about how hard it is to take that from concept to reality in America.”
AB 1400 left many big questions related to implementation to be determined, such as how to transition the state’s 40 million residents onto state coverage. And it would have required lawmakers and voters to endorse a massive tax increase.
Anthony Wright, who runs the consumer advocacy group Health Access, said Newsom is working in his own way to advance single-payer. He pointed to requests Newsom has made to the federal government for the waivers California would need to use federal health care dollars for a state-run system.
Newsom is also working toward universal coverage with his budget proposal to extend eligibility for the state’s low-income health program to all undocumented immigrants, Wright said. Although single-payer would go much farther than universal coverage, that concept is still a key goal for backers.
Wright serves on the Healthy California for All Commission, which is due to produce a report this spring. Newsom has pointed to the commission as part of his work toward a single-payer system.
“I would be surprised if it didn’t sort of have a conclusion of moving toward a universal system with unified financing,” Wright said of the commission’s work. “The other benefit that the report will hopefully provide is to flesh out the other details of what such a system would look like.”
Wright said Newsom is also making progress toward universal, affordable health coverage through his budget proposal, which aims to make it less expensive for people to buy insurance through the state’s Covered California marketplace, create an Office of Health Care Affordability aimed at lowering overall costs, and expand eligibility for the state’s low-income health plan for undocumented immigrants regardless of age.
Even so, California is far from implementing a single-payer system. Zingale said he could see such a policy passing in California within a decade, but a faster timeline is harder to envision.
If Newsom decides to run for president in the future, the death of a single payer bill on his watch could become an issue for him, but by then he’ll likely be judged on what he accomplishes in his second term, if he wins reelection, Michelson said.
“I think we all anticipate that he plans to run for president,” Michelson said. “He’s got that whole second term as governor to build up those credentials, and it’s going to be those things that are recent that are top of voters’ minds… Unless a more progressive candidate is going to challenge him and make hay of this, it’s going to go through the 24-hour news cycle, and we’re all going to forget about it.”
This story was originally published February 9, 2022 at 5:00 AM with the headline "Gavin Newsom hasn’t delivered single-payer health care in California. Does it matter?."