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 web providers for the state’s neediest residents whereas engineering guidelines to make well being care extra accessible and reasonably priced for all Californians.
More than one million 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 cover low-income people no matter their immigration standing. The state is experimenting with Medicaid cash to pay for social providers reminiscent of housing and meals help, particularly for these dwelling on the streets or with power ailments. And the state is forcing the well being care business to rein in soaring costs whereas imposing new rules on docs, hospitals, and insurers to offer better-quality, extra accessible care.
However, Newsom has up to now failed to totally ship on his most sweeping well being care insurance policies — and lots of modifications usually are not but seen to the general public: Health care prices proceed to rise, homelessness is worsening, and lots 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 House. According to 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 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 professional at UCLA, referring to the “Make America Great Again” motion.
Newsom declined an interview with KFF Health News. In a press release, he acknowledged that lots of his initiatives are works in progress. But 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 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 Health and Human Services secretary underneath Newsom, stated reworking the way in which well being care is paid for and delivered might be bumpy. “We didn’t do it perfectly,” Ghaly stated. “Implementation is always messy in a state of 40 million people.”
Ahead 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.
Here are the foremost initiatives that can form Newsom’s well being care legacy:
Medicaid
Potential federal cuts loom giant in America’s most populous state. Of the whopping $261 billion California spends yearly on well being care and social providers, practically $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.
In addition, California’s enlargement 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 12 months ending June 30. Newsom urged in early December that the state would proceed to fund the immigrant well being care enlargement 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 problem. “We want to continue to protect access to care and not see a rollback,” stated Amanda McAllister-Wallner, interim government director of Health Access California.
Generic Drugs
Citing the excessive value 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 accessible to varsities, well being clinics, and different establishments at a discount.
“It’s certainly disappointing that there isn’t much 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 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 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 purple 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 Health News the state is getting 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 Health Care Costs
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, docs, and hospitals at 3%.
While Trump has voiced concern in regards to the regular rise of well being care prices nationally — and the standard of well being care Americans are receiving — his concepts have centered on deregulation and replacing the Affordable Care Act, which specialists say might value millions their health coverage and enhance affected person well being care spending. California might probably lose federal subsidies which have helped offset insurance premiums for many of the roughly 1.8 million individuals who purchase their well being protection from Covered California, the state’s ACA market, which might enhance 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. Those state revenues are projected to be $298 million this fiscal year, in accordance with the state Department of Finance. That’s a fraction of the federal medical health insurance subsidies California receives — roughly $1.7 billion annually.
Health and Homelessness
Under Newsom, California has spent unprecedented public money on tackling homelessness, but the disaster has worsened underneath 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 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 services, together with rental and eviction help.
A state audit final 12 months discovered the state isn’t doing a very good 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 crisis on our streets is unacceptable,” Newsom acknowledged. “But we are starting to see progress.”
Experts anticipate the Trump administration to reverse liberal insurance policies which have allowed Medicaid cash for use for well being care experiments by means of 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.
Instead of increasing housing and meals help, as an example, the state might as an alternative see federal strikes to finish CalAIM advantages and make Medicaid more restrictive.
Mental Health and Substance Use
Newsom has launched essentially the most in depth overhaul of California’s behavioral well being system in many years, directing billions in state funding towards a brand new community of therapy services and prevention packages.
Two of his most controversial signature initiatives, Proposition 1 and CARE Court, infuse cash into therapy and housing for Californians with behavioral well being circumstances, particularly homeless individuals dwelling in disaster. And CARE Court permits judges to compel therapy for these affected by debilitating psychological sickness and substance use.
Both have been hamstrung by funding challenges, depend on counties for implementation, and will take years to supply noticeable outcomes. Whereas Newsom has sought to broaden community-based therapy, Trump has promised a return to institutionalization and urged homeless individuals and people with extreme behavioral well being circumstances 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.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation.
Angela Hart:
ahart@kff.org,
@ahartreports
Christine Mai-Duc:
CMaiDuc@kff.org,
@cmaiduc
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