SACRAMENTO, Calif. — Six years after he entered workplace vowing to be California’s “health care governor,” Democrat Gavin Newsom has steered tens of billions in public funding to security internet companies for the state’s neediest residents whereas engineering guidelines to make well being care extra accessible and inexpensive for all Californians.
Greater than 1,000,000 California residents residing 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 cover low-income people no matter their immigration standing. The state is experimenting with Medicaid cash to pay for social companies corresponding to housing and meals help, particularly for these residing on the streets or with persistent illnesses. And the state is forcing the well being care business to rein in soaring costs whereas imposing new rules on medical doctors, hospitals, and insurers to offer better-quality, extra accessible care.
Nonetheless, Newsom has to date failed to totally ship on his most sweeping well being care insurance policies — and plenty of adjustments are usually not but seen to the general public: Well being care prices proceed to rise, homelessness is worsening, and plenty of Californians nonetheless battle to get fundamental medical care.
Now, a few of Newsom’s signature well being initiatives, which might form his profile on the nationwide stage, are in peril as Donald Trump returns to the White Home. Based on 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 might 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 almost entirely 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 People 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 an announcement, he acknowledged that lots of his initiatives are works in progress. However though he’ll try to work with Trump, the governor vowed to guard his well being care agenda in his remaining two years in workplace.
“We’re approaching the incoming administration with an open hand, not a closed fist,” Newsom stated. “It’s a high precedence of my administration to make sure that high quality well being care is obtainable and inexpensive for all Californians.”
Mark Ghaly, a former Well being and Human Companies secretary below Newsom, stated remodeling the best way well being care is paid for and delivered might be bumpy. “We didn’t do it completely,” Ghaly stated. “Implementation is all the time 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 companies. His request is pending within the state’s Democratic-controlled legislature.
Listed here are the foremost initiatives that may form Newsom’s well being care legacy:
Medicaid
Potential federal cuts loom massive in America’s most populous state. Of the whopping $261 billion California spends yearly on well being care and social companies, 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 might slash advantages or minimize enrollment.
As well as, California’s growth of Medi-Cal to 1.5 million immigrants with out authorized standing is projected to value the state roughly $6.4 billion for the fiscal yr ending June 30. Newsom instructed in early December that the state would proceed to fund the immigrant well being care growth 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 value of prescribed drugs, Newsom in 2022 plowed $100 million into his plan to provide generic insulin for California and launch a state manufacturing plant to provide a spread of generic medication. Three years later, California has accomplished neither. Newsom did, nevertheless, announce a deal in April to buy in bulk the opioid reversal drug naloxone, which the state made obtainable to varsities, well being clinics, and different establishments at a discount.
“It’s definitely disappointing that there isn’t rather more progress on it,” stated former state Sen. Richard Pan, who authored the original generic drug legislation.
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 obtainable to all who want it as quickly as we will.”
Abortion
The governor helped lead the profitable 2022 marketing campaign to enshrine access to abortion within the state structure. He signed legal guidelines to make sure abortions and miscarriages are not criminalized and to permit out-of-state doctors to carry out abortions in California; constructed a stockpile of abortion medication when mifepristone confronted a nationwide ban; and put aside $20 million to help 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 ads and traversed the nation attacking Trump and different Republicans in pink states who’ve rolled again abortion entry.
After Trump received the election, Newsom known as a particular legislative session to prepared for potential authorized battles with the federal authorities. He informed KFF Well being Information the state is getting ready “in each doable technique to defend 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 Office of Health Care Affordability to set limits on well being care spending and impose penalties on business payers and suppliers that fail to fulfill targets. By 2029, California will cap annual value 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 People are receiving — his concepts have targeted on deregulation and replacing the Affordable Care Act, which specialists say might value millions their health coverage and improve affected person well being care spending. California might probably lose federal subsidies which have helped offset insurance 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 improve affected person out-of-pocket prices.
The state might use cash it raises from its own health 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 year, in line with the state Division of Finance. That’s a fraction of the federal medical insurance subsidies California receives — roughly $1.7 billion annually.
Well being and Homelessness
Beneath Newsom, California has spent unprecedented public money on tackling homelessness, but the disaster has worsened below his watch.
From 2019, when Newsom took workplace, to 2023, homelessness jumped 20% to more than 181,000, regardless of his funneling greater than $20 billion into making an attempt to get folks off the streets, together with changing lodges and motels into homeless housing. He has additionally plowed roughly $12 billion into CalAIM, an experimental effort to infuse Medi-Cal with social services, together with rental and eviction help.
A state audit final yr discovered the state isn’t doing a great job of monitoring the effectiveness of taxpayer cash. CalAIM isn’t serving as many Californians as anticipated and sufferers face problem receiving new benefits from well being insurers.
“The homelessness disaster on our streets is unacceptable,” Newsom acknowledged. “However we’re beginning to see progress.”
Consultants count on the Trump administration to reverse liberal insurance policies which have allowed Medicaid cash for use for well being care experiments via waivers encouraged by the Biden administration. Notably, Trump has attacked Newsom for his dealing with of the homelessness disaster and has vowed to extra forcefully move people off the streets. California’s CalAIM waiver ends on the finish of 2026.
As a substitute of increasing housing and meals help, for example, the state might as an alternative see federal strikes to finish CalAIM advantages and make Medicaid more restrictive.
Psychological Well being and Substance Use
Newsom has launched probably the most intensive overhaul of California’s behavioral well being system in a long time, directing billions in state funding towards a brand new community of remedy services and prevention packages.
Two of his most controversial signature initiatives, Proposition 1 and CARE Court, infuse cash into remedy and housing for Californians with behavioral well being situations, particularly homeless folks residing in disaster. And CARE Courtroom permits judges to compel remedy 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 provide noticeable outcomes. Whereas Newsom has sought to broaden community-based remedy, Trump has promised a return to institutionalization and instructed homeless folks and people with extreme behavioral well being situations be moved to “large parcels of inexpensive land.”
Newsom stated he hopes his “revolutionary” approaches will rework behavioral well being care with “a laser give attention to folks with probably the most severe sickness and substance use problems.”
This text was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation.
