
Nearly six years after taking office, he pledged to be the “governor” of CaliforniahealthRuler of careDemocrat Gavin Newsom directed tens of billions in public funding to safety net services for the state’s neediest residents while engineering rules to make health care more accessible and affordable for all Californians.
More than 1 million Californians living in the United States without authorization are now eligible for Medi-Cal, the state’s version of Medicaid, making the Golden State among the first states in the country to do so. Covering low-income people Regardless of their immigration status. The state is experimenting with Medicaid funds to pay For social services Such as housing and food assistance, especially for those living on the streets or suffering from chronic diseases. The state forces the health care industry to do so Rein in high costs While imposed New rules Doctors, hospitals and insurance companies need to provide better quality and more convenient care.
However, Newsom has so far failed to implement his most sweeping health care policies — and many of the changes are not yet visible to the public: Persistent health care costs In heightHomelessness It gets worseand many Californians are still struggling to obtain basic medical care.
Now, some of the governor’s signature health initiatives, which could shape his profile on the national stage, are at risk as President-elect Donald Trump returns to the White House. According to national health policy experts, California stands to lose billions of dollars in health care funding if the Trump administration changes its Medicaid programs. As Republicans She indicated probably. Such a move could force the state to significantly reduce benefits or eligibility.
Although the plan to allow immigrants without legal status to enroll in free health care has been funded Almost completely With state money, he makes California a political target.
“This is the fuel that fuels the GOP MAGA argument that we are taking tax money from good Americans and providing health care to immigrants,” said Mark Peterson, a health care expert at the University of California, referring to the Make America Great Again movement.
Newsom declined to be interviewed for this article with KFF Health News. He acknowledged in a statement that many of his initiatives are still being implemented. But even though he will try to work with Trump, the governor has vowed to protect his health care agenda in his final two years in office.
“We are approaching the incoming administration with an open hand, not a closed fist,” Newsom said. “It is a top priority of my administration to ensure that high-quality, affordable health care is available to all Californians.”
Mark Ghaly, Newsom’s former Health and Human Services secretary, said changing the way health care is paid for and delivered can be difficult. “We didn’t do it well,” Ghaly said. “Implementation is always chaotic in a country of 40 million people.”
Before Trump’s inauguration on January 20, Newsom did just that He proposed allocating $25 million For expected litigation against Trump over reproductive health care, disaster relief and other services. His application is pending in the state’s Democratic-controlled Legislature.
Here are the key initiatives that will shape Newsom’s health care legacy:
Medicaid
Potential federal cuts loom in America’s most populous state. Of hugeness California spends $261 billion Annually on health care and social services, approximately $116 billion flows from the federal government. Most of that goes to Medicaid, which covers more 1 in 3 California residents. GOP leaders in Washington have floated ideas Medical patellawhich may lead to reduced benefits or reduced enrollment rates.
Additionally, California expanded its Medi-Cal program to 1.5 million Immigrants without legal status are expected to cost the state nearly $6.4 billion for the fiscal year ending June 30. Newsom suggested this month that the state would continue to fund health care expansion for immigrants in the next budget year, but… He refused to say Whether it will maintain coverage in the coming years.
Advocacy groups are prepared to defend these benefits if Trump targets California on the issue. “We want to continue to protect access to care and not back down,” said Amanda McAllister-Walner, interim executive director of Health Access California.
Read more: Beyond deficit reduction, Newsom’s proposals bring additional costs to California
General medicines
Pointing out the high cost of medicines. Newsom in 2022 plowed 100 million dollars In his plan to produce generic insulin for California and Launching a government manufacturing factory To produce a range of generic medicines. Three years later, California has done neither. But Newsom did Announces a deal in April to bulk purchase the opioid reversal drug naloxone, which the state made available to schools, health clinics and other institutions in rival.
“It is certainly disappointing that more progress has not been made on this,” said former state Sen. Richard Pan, who authored the report. Original legislation for generic drugs.
Regarding generic insulin, Newsom acknowledged that “it has taken longer than we hoped to get insulin to market, but we remain committed to making $30 insulin available to all who need it as soon as possible.”
miscarriage
The governor helped lead L.’s successful 2022 campaign Establish access to abortion In the state constitution. He signed laws to ensure abortion and miscarriage They are not criminalized And allow Doctors from outside the country To perform abortions in California; I built a stock of Abortion medication When mifepristone faced a national ban; And set aside $20 million to help Californians Those who cannot afford abortion care can access it.
Newsom, who has made reproductive rights a central plank of his political agenda as well Sponsored ads She criss-crossed the country attacking Trump and other Republicans in red states who have pushed back on abortion access.
After Trump won the election, Newsom called a special legislative session to prepare for potential legal battles with the federal government. He told KFF Health News that the state is preparing “in every way possible to protect the rights guaranteed in the California Constitution and ensure the bodily independence of all those in our state.”
Read more: Ahead of Trump’s second term, California pledges “strict” access to abortion
High health care costs
In 2022, Newsom created Office of Health Care Affordability To set limits on health care spending and impose penalties on industry payers and providers who fail to meet goals. By 2029, California will cap annual rate increases for health insurers, doctors and hospitals at 3%.
Although Trump has expressed concern about the steady rise in health care costs nationally — and the quality of health care Americans receive — his thoughts have focused on deregulation and deregulation. Replacing the Affordable Care ActWhich experts say could cost him Millions from their health coverage Increasing spending on health care for patients. California will likely lose the federal subsidies that helped Insurance premium reimbursement For almost all 1.8 million People who buy their health coverage from Covered California, the state’s ACA marketplace, would increase out-of-pocket costs for the patient.
The state can use the money it collects Her health insurance penalty on the uninsured, which Newsom adopted after Congress repealed Obamacare’s individual mandate in 2017. These state revenues are expected to $298 million this fiscal yearAccording to the state Ministry of Finance. That’s a small fraction of the federal health insurance subsidies California receives — roughly $1.7 billion annually.
Health and homelessness
Under Newsom, California has They spent unprecedented public funds In addressing homelessness, the crisis worsened under his supervision.
From 2019, when Newsom took office, through 2023, homelessness has jumped 20% to 20%. More than 181,000despite having diverted more than $20 billion to try to keep people off the streets, including converting hotels and motels into… Homeless housing. He has also invested nearly $12 billion in CalAIM, which is Experimental effort to Medi-Cal provision of social servicesincluding rental and eviction assistance.
A State audit This year found that the state does not do a good job of tracking the effectiveness of taxpayer dollars. CalAIM is not serving as many Californians as expected and patients are having difficulty receiving treatment New benefits From health insurance companies.
“The homelessness crisis on our streets is unacceptable,” Newsom acknowledged. “But we’re starting to see progress.”
Experts expect the Trump administration to reverse liberal policies that allowed Medicaid funds to be used for health care experiments through waivers Encouraged by the Biden administration. Notably, Trump attacked Newsom over his handling of the homelessness crisis and pledged greater force Moving people off the streets. California’s CalAIM waiver expires at the end of 2026.
Instead of expanding housing and food assistance, for example, the state could instead see federal moves to end CalAIM benefits and provide Medicaid is more restrictive.
Read more: Newsom’s plan seeks to give hope to families of the mentally ill and homeless in California
Mental health and substance use
Newsom launched the most comprehensive overhaul of California’s behavioral health system in decades, directing billions in state funding toward a new network of treatment facilities and prevention programs.
Two of the most controversial signature initiatives, Proposition 1 and Welfare courtpumping money into treatment and housing for Californians with behavioral health conditions, especially homeless people in crisis. CAIR allows judges to impose treatment on those suffering from debilitating mental illness and substance abuse.
Both have been hampered by funding challenges, depend on provinces for implementation, and can take years to achieve noticeable results. While Newsom sought to expand community-based treatment, Trump promised a return to institutions and proposed moving the homeless and those with severe behavioral health conditions to “Large plots of cheap land“.
Newsom said he hopes his “innovative” approaches will transform behavioral health care by “laser focusing on people with the most serious illnesses and substance use disorders.”
This article was produced by KFF Health Newsa national newsroom that produces in-depth journalism on health issues and is one of its core operating programs KFF — that An independent source for health policy research, polling and journalism.
This story originally appeared on Los Angeles Times.