Despite Progress Under Newsom, Full Health Care Access Remains Elusive for Californians

Gov. Gavin Newsom’s first term in office was marked by significant changes in some Californians’ paths to health care. By first expanding Medi-Cal to include all income eligible people ages 50 and over regardless of their immigration status, then signing a 2022 budget that added the 26-to-49 group, Newsom’s administration stepped closer to its stated ambition of “universal” coverage for all those who reside here.

But that’s not to be confused with the agenda Newsom campaigned on during his first run in 2018. And it certainly doesn’t mean the job is finished.
 

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In fact, Newsom may need his full second term to make real inroads toward ensuring that Californians can receive quality care regardless of their ethnicity, color or income level. He may also need the weight of several of his departments and top officials to realize the goal.

In the end, health coverage without adequate access is health coverage in name only. And California has a long way to go.

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The Newsom who sought the state’s highest office four years ago was an open proponent of a single-payer health system, with the state acting as the sole provider of health care for every resident, and for-profit systems cut out of that delivery loop. In fact, it was Newsom’s strong endorsement of single payer that won him the ardent endorsement of nurses’ unions, some of which campaigned around the state for his election.

“I’m tired of politicians saying they support single payer but that it’s too soon, too expensive or someone else’s problem,” Newsom tweeted at the time. “It’s time for a new approach. Single payer offers a simpler, more effective, more cost-efficient approach to healthcare delivery in CA.”

That was then. Once in office, Newsom gradually distanced himself from the campaign pledge as the practical aspects of single payer, both financial and political, came to the fore. By earlier this year, Newsom had stepped away to the degree that he barely acknowledged a Democratic legislative attempt to revive it.

“I have not had the opportunity to review that plan, and no one has presented it to me,” Newsom said in January of AB 1400, a single payer bill authored by Rep. Ash Kalra (D-San Jose) that had actually been kicking around since 2021. Kalra ultimately pulled the bill when he determined he didn’t have the votes. (The representative discussed the plan in detail with Capital & Main last year.)
 

County health workers remain terribly short-handed, undone by years of budget cuts that are only now beginning to be reversed.

 
With no support from the governor’s office and political opposition on both sides of the aisle, the prospect of single payer in the state remains far off. The Newsom administration’s steady expansion of Medi-Cal coverage is a sidestep, but an important one; by 2024, it will have added health coverage for an additional 1 million low income residents, mostly immigrant workers who previously had no road to such coverage.

But as the past year alone has proved definitively, access to health care itself is going to remain an issue. Kaiser Permanente’s consistent failure to improve its mental health services stands as a glaring example of the kinds of barriers to care that massive managed health organizations often have in place — and the state’s response so far has been muted.

The Department of Managed Health Care (DMHC) began what it called a “non routine survey” of Kaiser’s mental health practices, and the Legislature conducted hearings of its own. In addition, Newsom signed into law a bill that increases tenfold the penalties on health plans that violate things like timely access to care.

But health equity advocates want to see more — and they know Newsom has the power to do it.

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In interviews with several equity experts, a consistent theme emerged when it came to the specifics of delivering on the promise of fair access to health care: The state has the ability to throw its weight around.

“The governor has a ton of authority, and so do some of his top people,” said one policy advocate, who asked not to be identified so as not to inject their organization into the conversation. “It’s strictly a question of the will to enforce the laws.”

California Attorney General Rob Bonta, just elected to a full four-year term, sits in a seat of power. Newsom’s hand-picked appointee to fill out Xavier Becerra’s term after Becerra left in 2021 to join the Biden administration, Bonta has wide latitude to both investigate and act in the interest of enforcing racial justice — and that includes racial disparities in health care access and outcomes, including hospital mergers that lead to facility closures in low income neighborhoods.
 

There’s no reason now to believe Newsom will reverse course and once again champion single payer.

 
“When people think of health care in the state, they don’t first think of the attorney general or the Department of Justice,” said Anthony Wright, executive director of Health Access, a consumer advocacy organization. “But in fact the AG has an important role in how people receive health care.”

Advocates also want to see the state continue to lock down assurances of equal access to both reproductive and gender-affirming care, which are under attack elsewhere in the country. And county health workers remain terribly short-handed, undone by years of budget cuts that are only now beginning to be reversed.

Local health officials are asking Newsom’s administration for a comprehensive review of workforce issues, the better to plan for a future in which city and county services may again be reliably called on. In September the governor vetoed a bill to establish such a review, saying local health should use the state’s recent $300 million boost in funding “for this transformation.”

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From the moment of his first gubernatorial election, Newsom has tried to carve a path forward on health coverage without taking the biggest leap, and there’s no reason now to believe he’ll reverse course and once again champion single payer.

That still rankles some of those who supported Newsom in 2018 over then-Democratic rival Antonio Villaraigosa based largely on Newsom’s vow to get behind a radical overhaul of California’s health system. And it hasn’t escaped their notice that the governor maintains cozy relationships with some of the state’s behemoth insurers and providers.

But with a new four-year term and full Democratic alignment in the halls of power in Sacramento, Newsom still has plenty of opportunity to create, enforce and ensure effective health care for most of its residents. It all comes down to access — and the state’s true interest in elevating the concept beyond the language of campaign.

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