sacramento — Nearly six years after taking office, he vowed to be California’s “healthycaring governor“Democrat Gavin Newsom has dedicated tens of billions of public funds to provide safety net services to the state’s residents who need them most, while crafting rules to make them more accessible and affordable for all Californians Healthcare.
More than one million California residents living in the U.S. without authorization are now eligible for Medi-Cal, the state’s version of Medicaid, making the Golden State one of the first in the country to receive Medicaid. Covers low-income people regardless of their immigration status. The state is experimenting with using Medicaid funds to pay for social services like housing and food assistance, especially for those who live on the streets or have chronic medical conditions. The state is forcing the health care industry Controlling soaring costs Apply simultaneously new rules Helping doctors, hospitals and insurance companies provide better, more accessible care.
However, Newsom has so far failed to fully deliver on his most comprehensive health care policy, and many of the changes are yet to be known to the public: Health care costs continue to rise risehomeless is getting worsemany Californians still have difficulty accessing basic medical services.
Now, with President-elect Trump back in the White House, some of the governor’s signature health initiatives that could impact his image on the national stage are in danger. California stands to lose billions of dollars in health care funding if Trump administration changes Medicaid, state health policy experts say as a republican indicated It is possible. The move could force the government to drastically cut benefits or eligibility.
Although a program to allow undocumented immigrants to participate in free medical care has been funded almost completely With state funding, it makes California a political target.
“This gives impetus to the Republican ‘Make America Great Again’ argument that we’re moving from Good Americans take away tax dollars and provide health care to immigrants.
Newsom declined to be interviewed by KFF Health News for this article. He acknowledged in a statement that many of his initiatives are in progress. While 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 open hands, not closed fists,” Newsom said. “My administration’s top priority is ensuring that quality health care is available and affordable for all Californians.”
Mark Ghaly, the former Health and Human Services secretary under Newsom, said changing the way health care is paid for and delivered can be bumpy. “We didn’t do it perfectly,” Galli said. “With a population of 40 million, implementation is always chaotic.”
Ahead of Trump’s January 20 inauguration, Newsom $25 million proposed Trump is expected to face lawsuits over reproductive health care, disaster relief and other services. His request is pending in the state’s Democratic-controlled Legislature.
Here are the key initiatives shaping Newsom’s health care legacy:
Medicaid
Potential federal cuts loom in the nation’s most populous state. amazing California spends $261 billion Each year, the federal government spends nearly $116 billion on health care and social services. Much of that goes to Medicaid, which covers more than One-third of Californians. Republican leaders in Washington have pledged Kneecap Medicaidwhich could cut benefits or reduce enrollment.
Additionally, California expands Medi-Cal to 1.5 million Undocumented immigrants are expected to cost the state about $6.4 billion in the fiscal year that ends June 30. funds, but refuse to disclose Whether he will retain coverage for years to come.
Advocacy groups are ready to defend those benefits if Trump targets California on this issue. “We want to continue to protect access to care and not have a rollback,” said Amanda McAllister-Wallner, interim executive director of the California Health Services Organization.
generic drugs
Given the high cost of prescription drugs, Newsom 2022 plowed US$100 million Join his plan to produce generic insulin for California Launch of national manufacturing plant Produces a range of generic drugs. Three years later, California has done neither. However, Newsom did announce deal In April, the state made bulk purchases of the opioid reversal drug naloxone available to schools, clinics and other facilities Discount.
“It’s certainly disappointing that more progress has not been made on this,” said former state Sen. Richard Pan, the report’s author. Original generic drug legislation.
Regarding generic insulin, Newsom acknowledged that “bringing insulin to market is taking longer than we would have liked, but we remain committed to getting $30 insulin to everyone who needs it as quickly as possible.”
abortion
Governor helps lead 2022 campaign to success Provide access to abortion In the state constitution. He signed laws to ensure abortion and miscarriage not convicted and allow out-of-state doctor Abortion access in California; an inventory created abortion pill When mifepristone faces a nationwide ban; and set aside $20 million to help Californians People who cannot afford abortion care.
Newsom has made reproductive rights a core principle of his political agenda, funded advertising and traveling across the country to attack Trump and other red-state Republicans who have rolled back abortion access.
After Trump won the election, Newsom called a special legislative session to prepare for a possible legal battle with the federal government. He told KFF Health News the state is preparing to “protect the rights guaranteed by the California Constitution in every way possible and ensure the bodily autonomy of all people in our state.”
rising medical costs
In 2022, Newsom created office of health care affordability Set limits on health care spending and impose penalties on industry payers and providers who fail to meet targets. California will limit annual price increases for health insurance companies, doctors and hospitals to 3% through 2029.
While Trump has expressed concern about the steady rise in health care costs across the country and the quality of care Americans receive, his thoughts have largely focused on deregulation and Replacing the Affordable Care Actexperts say it could cost Health insurance for millions and increased patient health care spending. California could lose federal subsidies that once helped offset insurance premiums For most rough 1.8 million This will increase patients’ out-of-pocket costs for those who purchase health insurance from Covered California, California’s ACA marketplace.
The state can use funds raised from own health insurance penalties Newsom took the measure after Congress zeroed out Obamacare’s individual mandate in 2017. $298 million this fiscal yearaccording to the state Department of Finance. That’s just a fraction of the federal health insurance subsidies California receives—approximately $1.7 billion per year.
health and homelessness
Under Newsom, California unprecedented amounts of public money were spent to address homelessness, but the crisis worsened under his leadership.
Homelessness surges 20% from 2019, when Newsom takes office, to 2023 More than 181,000That’s despite spending more than $20 billion trying to get people off the streets, including converting hotels and motels into homeless housing. He also put about $12 billion into CalAIM, a experimental effort arrive Integrating Medi-Cal with social servicesincluding rental and eviction assistance.
one state audit This year saw the state do a poor job of tracking the effectiveness of taxpayer dollars. CalAIM serves fewer Californians than expected, and patients face enrollment difficulties new benefits From health insurance companies.
“The homeless crisis on our streets is unacceptable,” Newsom acknowledged. “But we are 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 for his handling of the homelessness crisis and vowed to take stronger measures Get people off the streets. California’s CalAIM exemption expires at the end of 2026.
For example, instead of expanding housing and food assistance, the state might see the federal government take action to end CalAIM benefits and enact Medicaid restrictions are tighter.
mental health and substance abuse
Newsom enacted the most sweeping overhaul of California’s behavioral health system in decades, directing billions of dollars in state funds to build a network of new treatment facilities and prevention programs.
Two of his most controversial signature moves, Proposition 1 and Hong Yan Courtinjecting funding for treatment and housing for Californians with behavioral health issues, especially homeless individuals living in crisis. CARE courts allow judges to mandate treatment for people with mental illness and substance abuse.
Both are hampered by funding challenges, rely on counties for implementation, and could take years to produce noticeable results. Newsom seeks to expand community-based treatment, while Trump promises a return to institutionalization and proposes moving homeless people and people with serious behavioral health issues to “large chunks of cheap land”.
Newsom said he hopes his “innovative” approach will transform behavioral health care by “focusing on people with the most serious illnesses and substance use disorders.”
This article was created by KFF Health Newsa national newsroom that produces in-depth journalism on health issues and is one of the organization’s core operating programs Cave — one An independent source of health policy research, polling and news.
