Angela Hart and Christine Mai-Duc | KFF Well being Information
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 web providers for the state’s neediest residents whereas engineering guidelines to make well being care extra accessible and reasonably priced for all Californians.
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Greater than 1,000,000 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 individuals no matter their immigration standing. The state is experimenting with Medicaid cash to pay for social providers comparable to housing and meals help, particularly for these dwelling on the streets or with power ailments. And the state is forcing the well being care trade to rein in hovering prices whereas imposing new guidelines on docs, hospitals, and insurers to offer better-quality, extra accessible care.
Nevertheless, Newsom has thus far failed to completely ship on his most sweeping well being care insurance policies — and plenty of modifications aren’t but seen to the general public: Well being care prices proceed to rise, homelessness is worsening, and plenty of Californians nonetheless battle to get primary 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. Based on nationwide well being coverage consultants, 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 pressure 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 fully with state cash, it makes California a political goal.
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“That is fuel to feed the Republican MAGA argument that we are taking tax dollars from good Americans and providing health care to immigrants,” stated Mark Peterson, a well being care skilled at UCLA, referring to the “Make America Great Again” 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 and work with Trump, the governor vowed to guard his well being care agenda in his remaining two years in workplace.
“We are approaching the incoming administration with an open hand, not a closed fist,” Newsom stated. “It is a top priority of my administration to ensure that quality health care is available and affordable for all Californians.”
Mark Ghaly, a former Well being and Human Providers secretary underneath Newsom, stated remodeling the best way well being care is paid for and delivered may be bumpy. “We didn’t do it perfectly,” Ghaly stated. “Implementation is always messy in a state of 40 million people.”
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 here are the most important initiatives that can 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 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 lower enrollment.
As well as, California’s growth 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 12 months ending June 30. Newsom advised in early December that the state would proceed to fund the immigrant well being care growth within the upcoming finances 12 months 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 want to continue to protect access to care and not see a rollback,” stated Amanda McAllister-Wallner, interim govt director of Well being Entry California.
Generic medication
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 medication. Three years later, California has performed neither. Newsom did, nonetheless, 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 reduction.
“It’s certainly disappointing that there isn’t much more progress on it,” stated former state Sen. Richard Pan, who authored the unique generic drug laws.
On generic insulin, Newsom acknowledged “that it’s taken longer than we hoped to get insulin on the market, but we remain committed to delivering $30 insulin available to all who need it as soon as we can.”
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 aren’t criminalized and to permit out-of-state docs to carry out abortions in California; constructed a stockpile of abortion medicine 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 advertisements and traversed the nation attacking Trump and different Republicans in crimson 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 instructed KFF Well being Information the state is making ready “in every possible way to protect the rights guaranteed in California’s Constitution and ensure bodily autonomy for all those 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 fulfill targets. By 2029, California will cap annual worth will increase for well being insurers, docs, and hospitals at 3%.
Whereas Trump has voiced concern in regards to the regular rise of well being care prices nationally — and the standard of well being care People are receiving — his concepts have centered on deregulation and changing the Inexpensive Care Act, which consultants say may price hundreds of thousands their well being protection and improve affected person well being care spending. California may probably lose federal subsidies which have helped offset insurance coverage premiums for many of the roughly 1.8 million individuals who purchase their well being protection from Coated California, the state’s ACA market, which might improve 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 12 months, 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
Underneath Newsom, California has spent unprecedented public cash on tackling homelessness, but the disaster has worsened underneath 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 individuals 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 providers, together with rental and eviction help.
A state audit final 12 months discovered the state isn’t doing job of monitoring the effectiveness of taxpayer cash. CalAIM isn’t serving as many Californians as anticipated and sufferers face problem receiving new advantages from well being insurers.
“The homelessness crisis on our streets is unacceptable,” Newsom acknowledged. “But we are starting 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 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 individuals 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 essentially the most in depth overhaul of California’s behavioral well being system in a long time, 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 Courtroom, infuse cash into therapy and housing for Californians with behavioral well being situations, particularly homeless individuals dwelling in disaster. And CARE Courtroom 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 advised homeless individuals and people with extreme behavioral well being situations be moved to “large parcels of inexpensive land.”
Newsom stated he hopes his “innovative” approaches will remodel behavioral well being care with “a laser focus on people with the most serious illness and substance use disorders.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.
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