At the end of last month, Gov. Gavin Newsom signed a law to expand state-paid medical coverage to about a quarter of a million Californians.
He did so at a ceremony in Fresno, illustrating his recent official acts as he fought a recall campaign.
“We are investing California’s historic surplus to accomplish the transformative changes we have long dreamed of – including this historic Medi-Cal expansion to ensure that thousands of undocumented elderly Californians, many of whom have served on the front lines of the pandemic, can access essential health care services, ”Newsom said. He added that this “would bring California closer to universal health care coverage and advance global initiatives to ensure California communities come back from the pandemic stronger and healthier than before.”
The phrase “closer to universal health coverage” is the most important part of the announcement, because it evokes – and subtly alters – a promise Newsom made while running for governor there. is three years old.
During its 2018 campaign, the state Senate passed legislation to create a “single-payer health care system” that, in theory, would integrate and replace all other public health insurance systems and private and would integrate millions of Californians without any coverage. Newsom warmly endorsed the measure, saying there was “no reason to wait”.
“I’m tired of politicians saying they support single payer but it’s too soon, too expensive, or someone else’s problem,” Newsom said, praising the California Nurses Association , the main sponsor of the legislation.
The measure, however, contained no funding mechanism and State Assembly Speaker Anthony Rendon suspended the bill, saying it would be irresponsible to act without a way to pay it.
Once elected, Newsom continued to pretend to be a one-payer system, but never devoted political capital to its implementation. Eventually, he stopped using the term and instead adopted the expression “universal health care coverage”, which is not the same thing.
As state finances allow, Newsom has gradually added more Californians to the Medi-Cal program for health care for the poor, including blocks of undocumented immigrants who are not eligible for coverage. federally subsidized medical care, whether through Medi-Cal or the state’s version of Obamacare, dubbed California Covered.
In theory, this incremental approach, if continued, could eventually extend coverage to all Californians, but it would be a big financial boost for a state budget heavily reliant on highly volatile income from income tax. income of high income taxpayers.
When examining the 2017 single-payer bill, it was estimated that providing comprehensive medical coverage to 40 million Californians would cost $ 400 billion a year and that simple inflation would likely bring that amount to $ 450 billion. today.
The biggest hurdle would be persuading the federal government, which currently pays about half of Californians’ health care costs through Medicare, Medi-Cal, Obamacare, and federal and military member coverage, to redirect that money back to the ‘State.
Even if the federal government intervenes, which is highly unlikely, the state would have to absorb local government health spending and money currently paid by private employers, and then raise enough new taxes to close the remaining gap. The gap was estimated at $ 100 billion in 2017; it is surely bigger now.
The bottom line is that even in a state as blue as California and with a lawyer in the governor’s office, single-payer health care is a nearly impossible goal – hence the nomenclature change to “universal health coverage.” health ”and the change in tactics from“ no reason to wait ”to year-over-year incrementalism.
CALmatters is a public service journalism company committed to explaining how the California State Capitol works and why it matters. Dan Walters has been a journalist for almost 60 years, spending most of those years working for California newspapers.