SACRAMENTO — Nearly six years after taking office pledging to be California’s “health care governor,” Democrat Gavin Newsom has pledged tens of billions of dollars in public funding for safety net services for the state’s neediest residents. While directing funding, we have created rules to make health care more accessible and affordable for all Californians.
More than 1 million Californians living in the U.S. without authorization currently qualify for Medi-Cal, the state’s version of Medicaid, and the Golden State provides coverage to low-income individuals regardless of immigration status. It is the first state in the United States to do so. The state is experimenting with Medicaid money to pay for social services such as housing and food assistance, especially for people living on the streets and people with chronic illnesses. And states are forcing the health care industry to rein in rising costs while imposing new rules on doctors, hospitals and insurance companies to provide better and more accessible care.
But Newsom has so far failed to fully realize his most sweeping health policy. And many changes are still not visible to the public. Health care costs continue to rise, homelessness worsens, and many Californians continue to struggle to access basic health care.
Now, some of the governor’s signature health initiatives that could shape his profile on the national stage are in jeopardy with President-elect Donald Trump’s return to the White House. National health policy experts say California stands to lose billions of dollars in health care funding if the Trump administration changes its Medicaid system, as Republicans have suggested it might do. Such a move could force states to make significant cuts to benefits and eligibility.
And a plan to allow immigrants without legal status to sign up for free health care, funded almost entirely by the state, has become a political target for California.
“This is the fuel that fuels the MAGA Republican argument that we are taking taxes from good Americans and providing health care to immigrants,” said Mark Peterson, a medical expert at UCLA. Referring to the “Again Again” movement, he said:
Newsom declined to be interviewed for this article with KFF Health News. In a statement, he acknowledged that much of his work is a work in progress. But despite his efforts to work with Trump, the governor has vowed to protect health care policy during his final two years in office.
“We are approaching the next administration with open hands, not closed fists,” Newsom said. “Ensuring that all Californians have access to quality, affordable health care is a top priority of my administration.”
Mark Ghaley, who served as Health and Human Services Secretary under Newsom, said changing the way health care is paid for and delivered can be difficult. “It wasn’t perfect,” Gurley said. “Implementation is always a pain in a state with 40 million people.”
Ahead of Trump’s inauguration on January 20, Newsom proposed allocating $25 million for anticipated lawsuits against Trump over reproductive health care, disaster relief and other services. His request is pending in the Democratic-controlled state Legislature.
Key initiatives shaping Newsom’s medical legacy include:
medicaid
The possibility of federal cuts looms large in America’s most populous state. California spends $261 billion a year on health and social services, of which nearly $116 billion comes from the federal government. Most of that money goes to Medicaid, which covers more than 1 in 3 Californians. Republican leaders in Washington have floated proposals to introduce Medicaid, which could cut benefits and reduce enrollment.
Additionally, California’s expansion of Medi-Cal to 1.5 million immigrants without legal status is projected to cost the state approximately $6.4 billion in the fiscal year ending June 30. Newsom indicated this month that the state would continue to fund the expansion of migrant health care in the state. It will be applied to the next budget year, but he declined to say whether it will remain applicable in the future.
Advocacy groups stand ready to defend these benefits if President Trump targets California on this issue. “We continue to protect access to health care and we do not want to go backwards,” said California Health Access Interim Executive Director Amanda McAllister Wallner.
generic drugs
Citing the high cost of prescription drugs, Mr. Newsom has poured $100 million into a plan to start producing generic insulin in California in 2022 and a manufacturing plant in the state that will produce a variety of generic drugs. Three years later, California has done neither. But Newsom announced a deal in April to buy large quantities of the opioid recovery drug naloxone, which the state would provide at discounted prices to schools, clinics and other institutions.
“It’s certainly disappointing that there hasn’t been more progress,” said former state Sen. Richard Pan, author of the original generic drug bill.
Regarding generic insulin, Newsom said, “While we acknowledge that insulin is taking longer to get to market than we would have liked, we are committed to providing 30% insulin to everyone who needs it as quickly as possible.” “We remain committed to delivering insulin at an affordable price.”
abortion
The governor led a successful 2022 campaign to enshrine abortion access into the state constitution. He signed legislation ensuring that abortion and miscarriage are not criminalized and allowing out-of-state doctors to perform abortions in California. When mifepristone faced a national ban, it built a stockpile of abortion pills. And it set aside $20 million to help Californians who cannot afford abortion care access it.
Mr. Newsom has made reproductive rights a central tenet of his political agenda, but he has used the country to fund ads and attack Mr. Trump and other Republicans in red states who have rolled back access to abortion. I ran around inside.
After Trump won the election, Newsom called a special session of Congress to prepare for a potential legal battle with the federal government. He told KFF Health News that the state is preparing “in every possible way to protect the rights guaranteed by the California Constitution and to ensure bodily autonomy for all people in our state.” He said he was there.
Rising medical costs
In 2022, Newsom created the Affordable Care Office to set limits on health care costs and penalize industry payers and providers who fail to meet targets. By 2029, California plans to limit annual price hikes for health insurance companies, doctors and hospitals to 3%.
President Trump has expressed concern about the steady rise in health care costs nationwide and the quality of care Americans receive, but his ideas are focused on deregulation and replacing the Affordable Care Act. Experts say this could cost millions more and increase medical costs for patients. . California could lose federal subsidies that have helped offset the premiums for most of the roughly 1.8 million people who buy health insurance from the state’s ACA marketplace, Covered California, leaving patients with no out-of-pocket costs. The amount will increase.
States can use money raised from their own health insurance penalties for the uninsured, which Mr. Newsom adopted after Congress repealed Obamacare’s individual mandate in 2017. The state says state revenue is expected to be $298 million this fiscal year. Ministry of Finance. This represents a portion of the federal health insurance subsidies that California receives, amounting to about $1.7 billion annually.
health and homelessness
Under Newsom, California poured unprecedented public funds into fighting homelessness, but the crisis worsened under Newsom’s watch.
From 2019, when Newsom took office, to 2023, the number of homeless people has decreased even though he has spent more than $20 billion on efforts to take people off the streets, such as converting hotels and motels into homeless housing. The number of people jumped 20% to more than 181,000. He also pumped about $12 billion into CalAIM, an experimental effort to inject social services such as rental and eviction assistance into Medi-Cal.
A state audit this year found the state wasn’t doing a good enough job of tracking the effectiveness of taxpayer money. CalAIM is not serving as many Californians as expected, and patients are facing difficulty receiving new benefits from their health insurance companies.
“The crisis of homelessness on our streets is unacceptable,” Newsom acknowledged. “But we are starting to see progress.”
Experts expect the Trump administration to reverse liberal policies that have allowed Medicaid funds to be used for medical experiments through waivers encouraged by the Biden administration. Notably, Trump attacked Newsom over his handling of homelessness and vowed to do more to get people off the streets. California’s CalAIM waiver expires at the end of 2026.
For example, states could see the federal government move to cut off CalAIM benefits and make Medicaid more restrictive, instead of expanding housing and food assistance.
Mental health and drug use
Newsom launched the most extensive overhaul of California’s behavioral health system in decades, directing billions of dollars in state funding to a new network of treatment facilities and prevention programs.
Two of his most controversial signature initiatives, Proposition 1 and CARE Court, would funnel funding to treatment and housing for Californians with behavioral health conditions, especially at-risk and homeless people. I’m here. And CARE courts allow judges to compel treatment for people suffering from debilitating mental illness or drug use.
Both are stalled by funding issues, implementation is dependent on counties, and both could take years to see significant results. While Newsom aims to expand community-based treatment, Trump promises a return to institutions, moving homeless people and people with severe behavioral health conditions to “large tracts of cheap land.” proposed.
Newsom said he hopes his “innovative” approach will transform behavioral health care “with a focus on people with the most serious illnesses and substance use disorders.”
This article was produced by KFF Health News. KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s core operating programs and an independent source for health policy research, polling, and journalism. is.
