Universal Health Care Once Seemed on the Horizon in California. What Happened?

California voters are in the thick of a high-stakes governor’s race, in which single-payer health care, an issue that was once central to state politics, has been pushed to the sidelines. Of the top five candidates, only one unequivocally supports a health care model that would finally put California on par with the rest of the industrialized world.

Billionaire Tom Steyer, running as a Democrat, says single-payer is the only way to bring down spiraling health care costs. In 2020, Steyer ran for president on a platform touting a “public option,” and attacking Senator Bernie Sanders’s single-payer health care plan. Now, Steyer has reversed that position, earning the coveted endorsement of the California Nurses Association, one of the state’s most aggressive proponents of single-payer.

Sanders is widely credited with popularizing single-payer or “Medicare for All,” which would make health care a freely available and publicly funded resource much like public schools or libraries. In the face of federal intransigence, single-payer proponents have advocated for states to enact their own programs. Indeed, California has come close to enacting “CalCare,” its own version of single-payer, several times in recent years.

Steyer’s opponent and fellow Democrat Katie Porter has also said she supports single-payer but worries about its feasibility. In a public forum hosted by Politico last year, she said, “I don’t think it’s realistic in the next couple of years for the state to push forward on that,” adding that she believed it was more appropriate for the federal government to take it on instead.

Meanwhile, the current frontrunner, Xavier Becerra, has backed away from supporting single-payer. Becerra, who won the endorsement of a powerful, anti-single-payer lobby group called the California Medical Association, is running on a platform of preserving the status quo.

Meanwhile, the two Republicans polling well enough to potentially win a spot on the November ballot in California’s “free-for-all” primary are Steve Hilton and Chad Bianco. Hilton, a former Fox News host, and Bianco, who is Southern California’s Riverside County Sheriff, are both running on reducing access to state-funded health care, primarily for undocumented immigrants.

At a time when the cost of living in California continues to skyrocket, single-payer health care has been oddly low on the list of candidates’ talking points. Dr. Paul Song, a member of Physicians for a National Health Program and former co-chair of the Campaign for a Healthy California, said there’s good reason for that.

“The number of uninsured as a percent of our California population is at the lowest it’s been in a long time,” Song said in an interview on Rising Up With Sonali. That’s because Governor Gavin Newsom recently oversaw the expansion of insurance coverage to most Californians.

In 2018, then-candidate Newsom won the California Nurses Association’s endorsement for embracing single-payer. But his support for a system that would cover 100 percent of the population over time morphed into what he now calls “universal access to health care coverage.” While it might sound a lot like universal health care, this shift is a sleight of hand. Newsom’s chosen policy merely means almost everyone in the state has some form of private or public health insurance — but it doesn’t address the rising costs of premiums, co-pays, and high out-of-pocket charges.

“It’s easy to have become discouraged based on the false promises of Gavin Newsom when he ran and said he was going to run as a single-payer candidate,” said Song. Since 2018 there have been “numerous attempts where activists have tried to advance legislation only to see it just killed in Sacramento and not even be brought up for a vote,” he added.

Newsom has been accused of deliberately “slow-rolling” single-payer as governor. Song recalled a 2020 incident in which the governor caused a scandal by attending a dinner party at a high-end restaurant during the state’s strict COVID lockdown. “The person he was having dinner with was Dustin Corcoran from the CMA, the California Medical Association, who was one of the largest opponents of our single-payer system,” said Song. It’s the same organization that has backed Becerra for governor, a candidate who only recently surged in the polls after Congressional Rep. Eric Swalwell dropped out of the race.

Angered by Newsom’s backtracking, the California Nurses Association lambasted him in 2023 over his signing of SB 770, a bill that undercut single-payer efforts by expanding health coverage through private insurers. The union called it “a complete betrayal of nurses’ fight for a single-payer health care policy, a fight striving to achieve health justice for our patients and our communities.”

California Nurses Association President Michelle Gutierrez Vo, an adult family medicine nurse at Kaiser Fremont, explained why the union now supports Steyer in an emailed statement. “As a frontline nurse who cares for patients, I know Californians want a governor who supports CalCare.” According to Vo, her organization backs Steyer because he, “understands that we need to take on deep-rooted systematic failures in Sacramento, and that we cannot allow the next governor to repeat the political opportunism that has dominated this issue for too long.”

Song took a dim view of Becerra, saying, “There have been times where he said he was in favor of [single-payer], but you never saw him actively trying to propose anything to make that possible.” Becerra, who made history as the federal government’s first Latino Secretary of Health and Human Services during President Joe Biden’s administration, faced pressure from single-payer advocates to protect Medicare from privatization. According to Song, “What I saw under his watch was the even greater privatization of our health care system.”

Perhaps the largest reason why single-payer is no longer a key issue in the governor’s race is the supposed price tag of government funding for health care. Estimates range from more than $400 billion to $731 billion per year. Given that the state’s projected 2027 budget is on the order of $349 billion annually, single-payer opponents are quick to claim the state simply can’t afford it.

But Song says such estimates don’t account for the savings from switching to single-payer. “If you look at the total number of dollars that are spent on health care, and not to mention the amount of money that comes out of our pocket for co-pays or deductibles, or because we have an employee-sponsored plan, the number of dollars that we don’t get in our salary because the company has to deduct that to pay for health care, we are paying essentially for a universal health care system or a single-payer system, we just are not getting one,” he said.

Many studies have shown that single-payer would garner net savings for individuals. The trouble is that in order to enact it at the state level, state governments need permission from the federal government to divert Medicare and Medicaid funds toward a single-payer system — a request that is highly unlikely to be granted under the Trump administration. Newsom did not attempt to obtain a federal waiver under the Biden administration, although even if he had he would have been unlikely to succeed given that the Democratic president was also an opponent of single-payer.

Ironically, in 2017, Newsom declared on the social media platform X, “I’m tired of politicians saying they support single payer but that it’s too soon, too expensive or someone else’s problem.” Within a few years, he had become precisely such a politician.

Worse, Newsom’s touted substitute for single-payer — “universal access to healthcare coverage” — is about to come apart at the seams. In October 2025, his administration warned that health care costs were about to double thanks to congressional inaction, with insurance premiums for state insurance exchange plans potentially jumping by a whopping 97 percent. To make matters worse, Newsom just released a state budget that includes cuts to immigrants’ health care coverage — the same funding that helped achieve the near-universal health coverage of which he previously boasted.

“We have the money there,” said Song in response to the looming health care crisis. “We just have to make a more efficient system, which is a single-payer system, but we need somebody to champion that.”