In California Governor’s Race, Xavier Becerra Walks Away From Single-Payer

One of the most notable retrenchments of California Gov. Gavin Newsom’s early years in office was his backing away from the idea of a “single payer” form of health care, a cause he loudly championed as a candidate that won him the endorsement of the most powerful nurses’ union in the state.

Now, leading Democratic gubernatorial candidate Xavier Becerra, once Newsom’s attorney general, secretary of Health and Human Services under President Joe Biden and himself a longtime proponent of single payer, appears to be following the same path.

One difference: Becerra has made his break from single payer prior to the election, not after it.

In some ways, that is a straight pragmatic decision. Even single payer’s most ardent supporters — including Assemblymember Ash Kalra (D-San Jose), who has introduced multiple bills to the state Legislature on the topic — acknowledge the process is likely to take years and outlast any single governor’s tenure.

Still, it’s a significant policy shift for Becerra, a 12-term U.S. congressman who by his own account has for decades backed single payer plans, in which a government-created agency is responsible for coordinating health care for all residents, with no premiums, co-pays or deductibles.

“Since my early years in Congress, I have been an advocate for single payer,” Becerra said in a statement on a campaign website that since has been replaced with a 12-point plan for health care in California.

“While I believe single payer is possible, I believe we also need to pursue immediate wins,” the candidate added. “We can deliver real relief now, while building toward a universal, single-payer CalCare system that puts people before profits.”

At a time when President Donald Trump and the GOP-led Congress are gutting both Medicaid (known as Medi-Cal in California) and food assistance programs, lower-income Californians will take all the relief they can find. But under a Becerra administration, a truly revolutionary idea like single payer is going to wait.

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Newsom ran his campaign for governor in 2018 by touting several progressive themes, including universal preschool and heightened environmental regulations. But it was his embrace of single-payer health care that won him the endorsement of the powerful California Nurses Association/National Nurses United, which represents more than 100,000 caregivers in the state. (Disclosure: The union is a financial supporter of Capital & Main.)

Once in office, though, Newsom almost immediately began backing away from single payer, instead pushing incremental changes to programs like Medi-Cal. (Under heavy budget pressure, Newsom ultimately reversed some of those changes, including freezing California’s enrollment of undocumented adults in the state.)

Becerra is following suit. In a candidate meeting with doctors from the California Medical Association this spring, “He said very clearly that, at this point, he wasn’t supportive of single payer,” CMA president Dr. Rene Bravo told the Bay Area public media outlet KQED.

That stance won Becerra the endorsement of the CMA, whose doctors oppose any single-payer system. The nurses union, meanwhile, has thrown its support behind billionaire Tom Steyer, a full proponent of single payer.

“Nurses have been fighting to win guaranteed, single payer health care for decades: at the state level with CalCare, and at the federal level with Medicare for All,” CNA president Sandy Reding said in a statement endorsing Steyer. “Tom Steyer stands with us in that fight. He understands incrementalism won’t work.”

Aides to Becerra said his position is nuanced, but that a standalone system of single payer in California won’t make progress in the current political atmosphere in Washington. Such a system would rely in part on the federal government allowing Medicaid and Medicare funds to be reallocated into the new program, and the Trump-directed agencies involved wouldn’t do that, they said.

“Single payer is the right goal, but we need to be realistic about what’s possible under the Trump Administration,” Jonathan Underland, a spokesperson for the Becerra campaign, told Capital & Main in response to questions about the candidate’s position. “This president has slashed Medi-Cal to the bone, handing tax breaks to billionaires while 3 million Californians risk losing their coverage.”

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As HHS secretary under Biden, Becerra directed the federal response to the COVID-19 pandemic, which included extended subsidies that swelled enrollment in health plans through the Affordable Care Act. He also oversaw updates in 2023 that permanently allowed the oral contraceptive mifepristone to be prescribed via telehealth and delivered by mail.

Becerra’s approach to health care if elected governor appears to focus on boosting preventive care and allocating state funds to maintain support for people whose coverage is threatened by federal cuts to Medi-Cal and CalFresh, the state’s food assistance program.

The candidate said he would issue an executive order on his first day in office “directing state agencies to maintain coverage continuity for every Californian affected by federal cuts or Medi-Cal rollbacks,” according to the plan posted to his website. The federal cuts are expected to reduce Medi-Cal funding by as much as $30 billion a year. Becerra’s plan does not explain how the state would pay to preserve coverage.

Elsewhere, Becerra wants the state to invest more heavily in primary care, and to expand both telehealth services and the CalRx program, through which the state either produces its own drugs or uses its buying power to negotiate lower costs from pharmaceutical companies. He also said he would move to slap fees on large companies that don’t offer health care to their employees whose wages are so low they qualify for Medi-Cal, “so that corporations who shift their health care costs onto taxpayers pay their fair share.”

The candidate also is proposing a dedicated state fund to grow California’s health care workforce. The fund would include money to help individual providers and caregivers repay loans, get housing assistance in “high-cost” areas, and target incentives for primary care, women’s care, rural medicine, behavioral health and dentistry.

“Becerra’s commitment is simple: expanding affordable coverage to everyone who needs it, and protecting Californians who are losing care because of Trump’s cuts,” said Underland.

All of that work is incremental. None of it packs the punch — or the complexity — of starting down the road toward a single-payer plan.

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