California Democratic candidates for governor can\u2019t stop talking about single-payer health care, but differences are apparent in this year’s campaign.<\/p>\n
The idea of a government-run universal health care program that would replace private insurance as the sole payer of health care costs faces as many headwinds as ever.<\/p>\n
It had fallen onto the backburner after Gov. Gavin Newsom and Democratic lawmakers failed to get it done, with some balking at the $392 billion estimated annual cost.<\/p>\n
Health advocates have since turned their focus to the impending Trump administration cuts to Medi-Cal, the state\u2019s expanded government health coverage for low-income residents.<\/p>\n
Even so, the progressive rallying cry of \u201cMedicare for All\u201d has become a staple of Democratic platforms. San Jose Mayor Matt Mahan, has positioned himself against a state-level, single-payer healthcare system, favoring a focus on reducing waste and bureaucracy in the existing system instead.<\/p>\n
Mahan has criticized fellow candidates for promising to quickly deliver a single-payer, state-run health care system, arguing that such promises are not realistic.<\/p>\n
Climate activist and Democratic gubernatorial candidate Tom Steyer was opposed to single payer when he briefly ran for president in 2020, but changed his mind in December. The billionaire candidate told party delegates at their convention last month that because he is not beholden to corporate interests, \u201cI can state the simple fact that we need a single-payer health care system in California.\u201d<\/p>\n
Former Orange County U.S. Rep. Katie Porter endorsed the policy in a video and declared to party delegates that as governor, she would \u201cdeliver single-payer health care.\u201d Porter, a longtime single-payer supporter in the past, had declined to commit to the issue last year over feasibility concerns, telling Po<\/a>litico<\/a> she didn\u2019t think the idea was \u201crealistic in the next couple of years.\u201d<\/p>\n State Superintendent of Public Instruction Tony Thurmond, former Controller Betty Yee and former U.S. Health and Human Services Secretary Xavier Becerra have all said they support it.<\/p>\n Bay Area Rep. Eric Swalwell, who polls show is statistically tied for lead in the race with Porter, Steyer and Republican frontrunners Steve Hilton and Chad Bianco, would focus instead on creating a public option, a spokesperson said, an alternative that attempts to lower costs by creating a state-run plan to compete with private insurance.<\/p>\n Newsom\u2019s unfulfilled promise<\/p>\n Setting up single payer in California would require the federal government\u2019s approval for the state to repurpose federal dollars that currently pay for Medicare, Medicaid and veterans\u2019 health coverage, which the Trump administration would almost certainly deny. It would also likely require a hefty state tax hike, though advocates say it would save the state money in the long run in lower drug prices and administrative savings, and save Californians out-of-pocket costs.<\/p>\n Daniel Panush, a consultant who worked on health care policy in the Legislature for two decades, said those two factors make him believe the perennial Democratic promises to establish single-payer healthcare are usually merely \u201caspirational.\u201d<\/p>\n \u201cIt\u2019s easy to make promises,\u201d he said. \u201cWe all want to see the plan.\u201d<\/p>\n Plus, California is in a budget deficit for the fourth year in a row, and its existing public health care programs face immediate peril from Trump administration cuts. More than 500,000 Californians are expected to lose Medi-Cal coverage this year, rising to 1.8 million in the future, and hundreds of thousands of others are expected to lose coverage through the Covered California marketplace after federal premium subsidies expired last year.<\/p>\n Advocates for a single-payer system like Rachel Linn Gish, spokesperson for the consumer group Health Access California, say it\u2019s \u201cinevitable\u201d that it\u2019s part of gubernatorial candidates\u2019 platforms. But she is not particularly hopeful about its short-term prospects. Though advocates want to see single payer in the long term, she said, \u201cwe also want to see short-term solutions: how (candidates are) going to start on Day One to protect Medi-Cal, Covered California, coverage for immigrants and LGBTQ care.\u201d<\/p>\n \u201cSometimes it feels like single-payer is the future health system of California, and always will be,\u201d said Daniel Zingale, a former strategic adviser to Gov. Gavin Newsom, who famously ran on the issue.<\/p>\n During his 2017 campaign for governor, Newsom said Californians had \u201cmy firm and absolute commitment, as your next governor, that I will lead the effort to get it done.\u201d The stance secured him the endorsement of the California Nurses Association, but it remains one of Newsom\u2019s biggest unfulfilled promises.<\/p>\n The governor launched a commission in 2018 to study single payer and asked for a federal waiver to allow it, which was a nonstarter with the first Trump administration. Since then, he has passed on supporting any of the nurses\u2019 union\u2019s efforts.<\/p>\n Democratic lawmakers, too, have failed to bring the issue close to his desk, with one attempt flaring out in public in 2022 after Assemblymember Ash Kalra, a San Jose Democrat, couldn\u2019t muster enough legislative support and didn\u2019t want to alienate colleagues by forcing them to take a vote. He tried again in 2024, but lawmakers killed it before it reached the Assembly floor.<\/p>\n Over the past eight years, Newsom has shifted his strategy to instead address \u201cuniversal access\u201d to health care by providing subsidies for Covered California and gradually expanding Medi-Cal to cover some undocumented immigrants. It has resulted in more than 94% of the state\u2019s residents having health insurance, a practical effect that advocates like Health Access applaud despite their long-term support for single payer.<\/p>\n And Newsom\u2019s administration has made some smaller moves toward single payer, with the governor in 2023 signing a law requiring the state to research the kinds of waivers it would need from the federal government. A public report on the issue was due in November but has not yet been released.<\/p>\n The idea has always put progressive Democrats at odds with powerful private interests such as insurers, hospitals, doctors and the California Chamber of Commerce, which generally opposes tax increases, wants to preserve employers\u2019 choice of insurance companies and doesn\u2019t want the state to spend on \u201ca new, unwieldy government bureaucracy,\u201d said spokesperson John Myers.<\/p>\n Why single payer keeps failing<\/p>\n Now, with Newsom termed out and leaving office at the end of this year, those running to replace him are picking up the same big promises. The same groups are opposed.<\/p>\n \u201cThere\u2019s a reason that similar proposals have failed to gain traction in the past: The effort is more symbolic than serious,\u201d Myers said.<\/p>\n Democrats pushing for single payer are unfazed. A spokesperson for Porter did not respond when asked how she would get single payer done despite past failed attempts. As for Steyer, spokesperson Danni Wang wrote in a statement that \u201che knows the fight won\u2019t be easy\u201d against \u201cWashington politicians and corporate interests that profit from high health care costs.\u201d<\/p>\n