SACRAMENTO, Calif. — Six years after he entered workplace vowing to be California’s “well being care governor,” Democrat Gavin Newsom has steered tens of billions in public funding to security internet providers for the state’s neediest residents whereas engineering guidelines to make well being care extra accessible and reasonably priced for all Californians.
Greater than one million California residents dwelling within the U.S. with out authorization now qualify for Medi-Cal, the state’s model of Medicaid, making California among the many first states to cowl low-income folks no matter their immigration standing. The state is experimenting with Medicaid cash to pay for social providers akin to housing and meals help, particularly for these dwelling on the streets or with persistent ailments. And the state is forcing the well being care trade to rein in hovering prices whereas imposing new guidelines on medical doctors, hospitals, and insurers to supply better-quality, extra accessible care.
Nonetheless, Newsom has up to now failed to completely ship on his most sweeping well being care insurance policies — and lots of modifications will not be but seen to the general public: Well being care prices proceed to rise, homelessness is worsening, and lots of Californians nonetheless battle to get fundamental medical care.
Now, a few of Newsom’s signature well being initiatives, which may form his profile on the nationwide stage, are in peril as Donald Trump returns to the White Home. In line with nationwide well being coverage specialists, California stands to lose billions of {dollars} in well being care funding ought to the Trump administration alter Medicaid packages as Republicans have indicated is probably going. Such a transfer may power the state to dramatically slash advantages or eligibility.
And though permitting immigrants with out authorized standing to enroll in free well being care has been funded nearly totally with state cash, it makes California a political goal.
“That’s gas to feed the Republican MAGA argument that we’re taking tax {dollars} from good Individuals and offering well being care to immigrants,” stated Mark Peterson, a well being care skilled at UCLA, referring to the “Make America Nice Once more” motion.
Newsom declined an interview with KFF Well being Information. In a press release, he acknowledged that a lot of his initiatives are works in progress. However though he’ll try and work with Trump, the governor vowed to guard his well being care agenda in his last two years in workplace.
“We’re approaching the incoming administration with an open hand, not a closed fist,” Newsom stated. “It’s a prime precedence of my administration to make sure that high quality well being care is obtainable and reasonably priced for all Californians.”
Mark Ghaly, a former Well being and Human Providers secretary beneath Newsom, stated remodeling the way in which well being care is paid for and delivered will be bumpy. “We didn’t do it completely,” Ghaly stated. “Implementation is at all times messy in a state of 40 million folks.”
Forward of Trump’s Jan. 20 inauguration, Newsom has proposed allocating $25 million to problem Trump on reproductive well being care, catastrophe reduction, and different providers. His request is pending within the state’s Democratic-controlled legislature.
Listed below are the key initiatives that can form Newsom’s well being care legacy:
Medicaid
Potential federal cuts loom giant in America’s most populous state. Of the whopping $261 billion California spends yearly on well being care and social providers, almost $116 billion flows from the federal authorities. Most of that goes to Medicaid, which covers greater than 1 in 3 Californians. GOP leaders in Washington have floated concepts to kneecap Medicaid, which may slash advantages or minimize enrollment.
As well as, California’s enlargement of Medi-Cal to 1.5 million immigrants with out authorized standing is projected to price the state roughly $6.4 billion for the fiscal yr ending June 30. Newsom recommended in early December that the state would proceed to fund the immigrant well being care enlargement within the upcoming funds yr however declined to say whether or not he would protect the protection in future years.
Advocacy teams are readying to defend these advantages ought to Trump goal California over the difficulty. “We need to proceed to guard entry to care and never see a rollback,” stated Amanda McAllister-Wallner, interim government director of Well being Entry California.
Generic Medicine
Citing the excessive price of pharmaceuticals, Newsom in 2022 plowed $100 million into his plan to supply generic insulin for California and launch a state manufacturing plant to supply a spread of generic medicine. Three years later, California has finished neither. Newsom did, nonetheless, announce a deal in April to buy in bulk the opioid reversal drug naloxone, which the state made out there to varsities, well being clinics, and different establishments at a reduction.
“It’s definitely disappointing that there isn’t far more progress on it,” stated former state Sen. Richard Pan, who authored the authentic generic drug laws.
On generic insulin, Newsom acknowledged “that it’s taken longer than we hoped to get insulin in the marketplace, however we stay dedicated to delivering $30 insulin out there to all who want it as quickly as we are able to.”
Abortion
The governor helped lead the profitable 2022 marketing campaign to enshrine entry to abortion within the state structure. He signed legal guidelines to make sure abortions and miscarriages will not be criminalized and to permit out-of-state medical doctors to carry out abortions in California; constructed a stockpile of abortion remedy when mifepristone confronted a nationwide ban; and put aside $20 million to assist Californians who can’t afford abortion care to entry it.
Newsom, who has made reproductive rights a central tenet of his political agenda, additionally funded adverts and traversed the nation attacking Trump and different Republicans in purple states who’ve rolled again abortion entry.
After Trump received the election, Newsom referred to as a particular legislative session to prepared for potential authorized battles with the federal authorities. He advised KFF Well being Information the state is getting ready “in each doable strategy to shield the rights assured in California’s Structure and guarantee bodily autonomy for all these in our state.”
Rising Well being Care Prices
In 2022, Newsom created the Workplace of Well being Care Affordability to set limits on well being care spending and impose penalties on trade payers and suppliers that fail to satisfy targets. By 2029, California will cap annual worth will increase for well being insurers, medical doctors, and hospitals at 3%.
Whereas Trump has voiced concern concerning the regular rise of well being care prices nationally — and the standard of well being care Individuals are receiving — his concepts have targeted on deregulation and changing the Inexpensive Care Act, which specialists say may price hundreds of thousands their well being protection and enhance affected person well being care spending. California may probably lose federal subsidies which have helped offset insurance coverage premiums for a lot of the roughly 1.8 million individuals who purchase their well being protection from Lined California, the state’s ACA market, which might enhance affected person out-of-pocket prices.
The state may use cash it raises from its personal medical insurance penalty on the uninsured, which Newsom adopted after the Obamacare particular person mandate was zeroed out by Congress in 2017. These state revenues are projected to be $298 million this fiscal yr, in accordance with the state Division of Finance. That’s a fraction of the federal medical insurance subsidies California receives — roughly $1.7 billion yearly.
Well being and Homelessness
Below Newsom, California has spent unprecedented public cash on tackling homelessness, but the disaster has worsened beneath his watch.
From 2019, when Newsom took workplace, to 2023, homelessness jumped 20% to greater than 181,000, regardless of his funneling greater than $20 billion into attempting to get folks off the streets, together with changing inns and motels into homeless housing. He has additionally plowed roughly $12 billion into CalAIM, an experimental effort to infuse Medi-Cal with social providers, together with rental and eviction help.
A state audit final yr discovered the state isn’t doing an excellent job of monitoring the effectiveness of taxpayer cash. CalAIM isn’t serving as many Californians as anticipated and sufferers face issue receiving new advantages from well being insurers.
“The homelessness disaster on our streets is unacceptable,” Newsom acknowledged. “However we’re beginning to see progress.”
Specialists anticipate the Trump administration to reverse liberal insurance policies which have allowed Medicaid cash for use for well being care experiments by way of waivers inspired by the Biden administration. Notably, Trump has attacked Newsom for his dealing with of the homelessness disaster and has vowed to extra forcefully transfer folks off the streets. California’s CalAIM waiver ends on the finish of 2026.
As an alternative of increasing housing and meals help, for example, the state may as a substitute see federal strikes to finish CalAIM advantages and make Medicaid extra restrictive.
Psychological Well being and Substance Use
Newsom has launched probably the most intensive overhaul of California’s behavioral well being system in many years, directing billions in state funding towards a brand new community of therapy amenities and prevention packages.
Two of his most controversial signature initiatives, Proposition 1 and CARE Court docket, infuse cash into therapy and housing for Californians with behavioral well being situations, particularly homeless folks dwelling in disaster. And CARE Court docket permits judges to compel therapy for these affected by debilitating psychological sickness and substance use.
Each have been hamstrung by funding challenges, depend on counties for implementation, and will take years to supply noticeable outcomes. Whereas Newsom has sought to increase community-based therapy, Trump has promised a return to institutionalization and recommended homeless folks and people with extreme behavioral well being situations be moved to “giant parcels of cheap land.”
Newsom stated he hopes his “progressive” approaches will rework behavioral well being care with “a laser give attention to folks with probably the most critical sickness and substance use problems.”
This text was produced by KFF Well being Information, which publishes California Healthline, an editorially unbiased service of the California Well being Care Basis.
