Leading Democrats in California’s gubernatorial race are increasingly embracing a single-payer healthcare system as a key issue, despite the challenges of funding and implementation.
When Gavin Newsom campaigned for California governor in 2018, his endorsement of a state-run single-payer healthcare system was seen as a bold and risky move. It ultimately garnered him significant support from labor unions.
Fast forward to today, and the landscape has shifted dramatically. As the race to succeed Newsom heats up, leading Democratic candidates are now positioning single-payer healthcare as a political imperative. This shift comes in response to growing voter frustration over escalating premiums and healthcare costs.
With no clear front-runner emerging in the race, candidates are engaging in debates and political advertisements to assert their commitment to a government-run healthcare model. However, none have provided a detailed plan on how California would finance comprehensive health coverage for its 40 million residents. This lack of clarity leaves voters uncertain about which candidate has a viable strategy for implementing such a system in the nation’s most populous state.
Healthcare experts note that the perception of single-payer healthcare has evolved from a progressive ideal to a mainstream political talking point in California, where Democrats outnumber Republicans nearly two to one. As the June 2 primary approaches, candidates are touting single-payer as the best solution to address affordability concerns among voters. In contrast, the top two Republican candidates have dismissed government-run healthcare as a “disaster” and a form of “socialism.”
“In many ways, single-payer healthcare has become a progressive litmus test,” said Larry Levitt, a former White House policy adviser and healthcare expert at KFF, a health information nonprofit.
Despite the growing prominence of single-payer in political discourse, many voters remain unclear about what the term actually means. Levitt pointed out that voters do not necessarily expect the next governor to achieve a single-payer system; instead, the term serves as an indicator of a candidate’s overall approach to healthcare reform.
Xavier Becerra, the former U.S. Secretary of Health and Human Services, has faced criticism for his nuanced shift away from single-payer healthcare. This change followed his endorsement from the California Medical Association, a powerful group that has historically opposed single-payer legislation in the state.
During a May 5 debate hosted by CNN, Becerra expressed his support for “Medicare for All,” a federally run healthcare proposal that has faced significant obstacles in Congress. However, he refrained from committing to a California-led single-payer initiative, stating that his immediate focus would be on addressing anticipated federal cuts to Medi-Cal, California’s Medicaid program, which serves over a third of the state’s residents.
Becerra emphasized that voters are more concerned with the affordability of healthcare than the specific terminology used, asserting that “Californians don’t care what you call it, so long as they have affordable healthcare.”
Democratic strategist Celinda Lake noted that many voters lack a clear understanding of single-payer healthcare and often require a metaphor to grasp its implications. Billionaire activist Tom Steyer has emerged as a prominent advocate for single-payer in this race, despite having previously opposed it during a brief presidential campaign in 2020.
As governor, Steyer has pledged to support legislation backed by the California Nurses Association, which has struggled to gain traction under Newsom’s administration. When questioned about how he would fund the estimated $731.4 billion cost of a single-payer system, Steyer remarked, “God is going to be in the details.”
Former U.S. Representative Katie Porter has expressed skepticism about the feasibility of achieving a single-payer system in the near term. Nevertheless, she later assured party delegates that she would “deliver single-payer.” Other candidates, such as former Los Angeles Mayor Antonio Villaraigosa and San Jose Mayor Matt Mahan, do not support single-payer and are trailing in the polls. The top two candidates, regardless of party affiliation, will advance to the November general election.
Historically, seasoned politicians have struggled to deliver on single-payer promises. Newsom, who campaigned as a “healthcare governor,” tempered his ambitions upon taking office and instead focused on achieving “universal access” to health coverage through Medi-Cal expansions and cost containment measures.
Vermont remains the only state to have enacted a single-payer healthcare law, but it ultimately reversed course when leaders could not identify a sustainable funding source.
To implement a single-payer system in California, state leaders would require federal approval to redirect billions of dollars from Medicaid, Medicare, and other funding streams—an unlikely scenario given the current political climate.
Healthcare costs are a significant concern for voters, with more than half of adults nationwide indicating that these costs will heavily influence their voting decisions in the upcoming November elections, according to an April KFF poll.
Danielle Cendejas, a Democratic consultant based in Los Angeles, noted that single-payer healthcare is increasingly appearing on candidate questionnaires from small-business advocates and local Democratic clubs, reflecting its growing importance in both state and national races.
Many California voters are eager to hear how candidates plan to provide immediate relief from rising premiums, high drug costs, and long wait times for care. Jennifer Easton, a 63-year-old Democrat from Oakland, supports a single-payer system, citing examples from other countries that have successfully lowered costs. However, she remains skeptical about the current candidates’ ability to implement such a system, viewing it as a long-term goal rather than an immediate solution.
“No one can do it in four years,” she said. For Easton, a candidate’s enthusiastic support for single-payer is indicative of their broader healthcare philosophy. “It is, if we’re lucky, a 20-year, 25-year plan.”
Republican political consultant Rob Stutzman, who advised former Governor Arnold Schwarzenegger, pointed out that while polls may show public support for single-payer, focus group discussions reveal that approval wanes when voters realize it could mean losing their current doctors or insurance plans.
During the CNN debate, Republican candidate Steve Hilton, endorsed by former President Donald Trump, warned that Californians could face subpar patient care and “sky-high taxes” to fund a single-payer system, drawing on his experiences from the United Kingdom.
Instead, Hilton suggested that the state should cease providing “free healthcare for illegal immigrants who shouldn’t even be in the country in the first place.”
As the race continues to unfold, the debate over single-payer healthcare remains a pivotal issue for candidates and voters alike, shaping the future of healthcare policy in California.
According to KFF Health News, the ongoing discussions around single-payer healthcare reflect broader national conversations about healthcare reform and affordability.