When he unveiled a new state budget last week, Gov. Gavin Newsom crowed about California becoming the nation’s first state to embrace universal health care coverage.

His budget would accomplish that goal by extending state Medi-Cal coverage to undocumented immigrants of all ages, beginning in 2024.

“I campaigned on universal health care,” Newsom said a day later. “We’re delivering that.”

Not quite.

While running for governor in 2018, Newsom pledged to create a single-payer system for California, making the state the sole supplier of coverage.

“I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem,” Newsom said during the campaign.

That pledge won Newsom the support of single-payer advocates. The California Nurses Association decked out a bus that toured the state with a picture of Newsom’s face and the words: “Nurses Trust Newsom. He shares our values and fights for our patients.”

However, once elected, Newsom did virtually nothing to implement the promise. Instead, as the state’s finances allowed, he extended Medi-Cal coverage incrementally to undocumented immigrants and others lacking private or public coverage.

Along with mandates and subsidies from Obamacare, state actions eventually raised health coverage to 94% of Californians and Newsom’s latest extension to undocumented adults would make it, at least on paper, 100%.

Newsom gets a bit testy when reporters ask him about his 2018 pledge. As he was introducing his budget this month, the state Assembly was beginning to move a single-payer bill for what’s called CalCare, and asked about it, Newsom replied, “I have not had the opportunity to review that plan, and no one has presented it to me.”

“I think that the ideal system is a single-payer system,” Newsom said. “I’ve been consistent with that for well over a decade. … The difference here is when you are in a position of responsibility, you’ve gotta apply, you’ve gotta manifest, the ideal. This is hard work. It’s one thing to say, it’s another to do. And with respect, there are many different pathways to achieve the goal.”

The nurses’ union and other single-payer advocates aren’t satisfied. The San Francisco Chronicle reported union organizer Alyssa Kang told single-payer advocates on a conference call, “So we want to be absolutely clear: This is a flip-flop from a governor who said … ‘I’m tired of politicians saying they support single payer but that it’s too soon, too expensive or someone else’s problem.’ This is absolutely unacceptable, and he cannot be allowed to have it both ways.”

The differences between universal coverage and single-payer are more than semantic. The former includes a wide variety of public and private health insurance plans, many of which have coverage limits and patient co-pays, while the latter would provide unlimited benefits free of out-of-pocket costs, much like Great Britain’s National Health Service.

Related Articles

Providing universal coverage, as Newsom defines it, is doable by spending a few additional billion dollars in the state budget. Single-payer, on the other hand, would require the federal government to give the state the $200-plus billion is now spends on Californians’ health care and the state to raise taxes more than $150 billion a year.

The legislation now pending in the Assembly would create a framework but the taxes are contained in a companion constitutional amendment that would require two-thirds votes in the Legislature and voter approval.

With massive opposition from employers and much of the medical industry, chances for complete approval of the package are iffy at best and it doesn’t appear that Newsom will lift a finger to help it. He’s clearly content to settle for universal coverage.

CalMatters is a public interest journalism venture committed to explaining how California’s state Capitol works and why it matters. For more stories by Dan Walters, go to calmatters.org/commentary.