Gov. Gavin Newsom signed Senate Bill 770 three years ago as California moved toward universal health coverage, but his later decisions pointed elsewhere on single payer healthcare. The bill set state officials on a course to negotiate with federal authorities over moving healthcare money now flowing from Washington to the state.
That approach mattered because roughly 50% of California’s total public and private medical expenditures flow from Washington, and federal funds would partially finance a comprehensive package of medical, behavioral health, pharmaceutical, dental and vision benefits. The Healthy California for All Commission that Newsom appointed to study expansion endorsed unified financing as the most efficient way to provide universal healthcare, but it did not specify a single-payer system.
Newsom's 2018 pledge
During his 2018 campaign for governor, Newsom said, “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem.” After he was elected, he described single-payer as “aspirational” and championed the incremental expansion of Medi-Cal instead of a single-payer system.
He later said, “I campaigned on universal healthcare. We’re delivering that.” California expanded Medi-Cal coverage to all adult undocumented immigrants in 2022, with the expansion set to take effect in 2024. By 2025, the cost of that expansion had ballooned to $6.2 billion more than anticipated, while the state faced multi-billion-dollar deficits.
AB 1900 in the Legislature
The strain on the budget led Newsom and the Legislature to freeze enrollment to stop the cost increase. Last month, legislative leaders blocked Assemblymember Ash Kalra’s third attempt to get a single-payer system adopted and shelved Assembly Bill 1900 without a hearing.
The California Nurses Association called Newsom’s approval of SB 770 “a complete betrayal of nurses’ fight for a single-payer healthcare policy, a fight striving to achieve health justice for our patients and our communities.” After AB 1900 was shelved, the group said, “The failure to advance (AB 1900) shows a lack of leadership and a capitulation to corporate healthcare interests.”
California Nurses Association response
SB 770 left California with a federal financing strategy instead of a direct move to single-payer coverage, and the Legislature’s decision on AB 1900 shows how far that debate has moved from Newsom’s 2018 campaign message. For readers tracking California health coverage, the practical result is a system built around managed expansion and tighter budget limits, not the statewide single-payer plan nurses sought.
