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

The California gubernatorial race has entered a high-stakes phase, yet a cornerstone issue that once dominated state political discourse—single-payer health care—has largely faded into the background. Among the top five candidates vying for the governor’s seat, only billionaire Tom Steyer maintains an unequivocal stance in favour of a state-based single-payer system.

The shift is notable given California’s history of coming close to enacting “CalCare,” its own version of single-payer. While proponents argue that such a model would align California with the rest of the industrialized world, the current political climate has seen candidates either pivot away from the concept or express significant doubts regarding its feasibility.

The Shifting Political Landscape

Tom Steyer, who previously campaigned for president on a “public option” platform, has reversed his position to support single-payer, earning the endorsement of the California Nurses Association. Conversely, Democratic candidate Katie Porter has expressed concern over the feasibility of implementing the system at the state level in the near future, suggesting We see a matter better suited for the federal government.

California Nurses Association

The current frontrunner, Xavier Becerra, has retreated from his past support for single-payer, aligning his platform with the status quo. His campaign has secured the endorsement of the California Medical Association, a group known for its opposition to single-payer models. Meanwhile, Republican candidates Steve Hilton and Chad Bianco are campaigning on platforms focused on reducing access to state-funded health care, particularly for undocumented immigrants.

Did You Know? In 2017, Governor Gavin Newsom posted on the social media platform X that he was tired of politicians labelling single-payer as “too soon” or “too expensive,” yet his administration has since shifted to prioritizing “universal access to health care coverage” over a full single-payer transition.

The Cost and Consequences of Inaction

The debate over single-payer is heavily influenced by projected costs, with estimates ranging from $400 billion to $731 billion annually. Critics argue these figures are prohibitive against a projected 2027 state budget of approximately $349 billion. However, advocates suggest these estimates often ignore the existing, high costs of premiums, co-pays, and deductibles that residents already pay under the current system.

The implications of this inaction are becoming increasingly apparent. The administration has warned that health care costs could potentially double by October 2025, with insurance premiums for state exchange plans facing a possible 97 percent increase. Recent budget adjustments include cuts to health care coverage for immigrants, raising concerns about the stability of the state’s current health insurance landscape.

Expert Insight: The transition from the “single-payer” rhetoric of 2018 to the current focus on “universal access” suggests a significant pivot in California’s policy trajectory. While the current model aims to ensure most residents have some form of insurance, it leaves the underlying issue of rising out-of-pocket costs largely unaddressed, creating a potential fiscal cliff for many households.

Looking Ahead

If the state continues to rely on private and public insurance expansion rather than a structural shift to single-payer, analysts expect that rising premiums and co-pays will remain a primary concern for California voters. A possible next step for the state involves navigating the hurdle of federal waivers, which are required to divert Medicare and Medicaid funds toward a state-run system—a request that remains unlikely to be approved under current federal dynamics.

The System Is Not Sustainable – Tom Steyer on Why California Needs Single-payer Healthcare

Should the cost of living continue to rise alongside health insurance premiums, the pressure on the next administration to either champion or abandon single-payer is likely to intensify. Future legislative sessions may determine whether the state attempts to revive “CalCare” or continues to manage the limitations of the existing insurance-based framework.

Frequently Asked Questions

Why is single-payer health care considered “off the table” for most candidates?
Most candidates point to the high estimated annual costs, which range from $400 billion to $731 billion, as being unaffordable given the state’s projected $349 billion annual budget.

What is the difference between “single-payer” and “universal access to health care coverage”?
“Universal access” signifies that most residents have some form of private or public insurance, whereas “single-payer” would create a publicly funded, freely available resource that eliminates out-of-pocket costs like co-pays and deductibles.

What obstacles prevent California from enacting its own single-payer system?
To implement a state-level system, California requires federal permission to redirect Medicare and Medicaid funds, a move that is considered highly unlikely under the current federal administration.

How do you believe the rising costs of private insurance will influence the priorities of voters in the upcoming election?