Health care is Newsom's biggest unfinished business. Trump is making the job harder

SACRAMENTO – Almost six years after taking office he vowed to be a Californian “healtha caring ruler,” Democrat Gavin Newsom directed tens of billions in public funding to safety services for the state's neediest citizens while engineering laws to make health care affordable and accessible to all Californians.

More than a million Californians living in the US without authorization are now eligible for Medi-Cal, the state's version of Medicaid, making the Golden State the first in the nation to receive assistance. include low-income people regardless of their immigration status. The state is testing Medicaid money to pay for social services such as housing and food assistance, especially for those living on the streets or with chronic illnesses. And the state is forcing the health care industry to strength in rising costs while placing new rules to doctors, hospitals and insurance companies to provide better quality, more accessible care.

However, Newsom has so far failed to fully deliver on his most sweeping health care policies — and many of the changes have yet to be seen by the public: Health care costs continue to rise. heighthomelessness it gets worseand many Californians still struggle to get basic medical care.

Now, some of the governor's signature health care programs, which could shape his profile on the national stage, are in jeopardy as President-elect Donald Trump returns to the White House. According to national health policy experts, California will lose billions of dollars in health care funding if the Trump administration changes Medicaid programs, like republicans they showed it is possible. Such action could force the state to reduce benefits or eligibility.

And while the plan to allow undocumented immigrants to sign up for free health care is funded almost completely with state money, making California a political target.

“That's the fuel to fuel the Republican MAGA argument that we're taking tax dollars from good Americans and providing health care to immigrants,” said Mark Peterson, a health care expert at UCLA, speaking about the “Make America Great Again” movement.

Newsom declined an interview for this article with KFF Health News. In a statement, he admitted that many of his efforts are works in progress. But while he will try to work with Trump, the governor vowed to protect his health care agenda in his final two years in office.

“We approach the administration with an open hand, not a closed fist,” Newsom said. “It is a top priority for my administration to ensure that quality health care is available and affordable for all Californians.”

Mark Ghaly, former Health and Human Services secretary under Newsom, said changing the way health care is paid for and delivered would be difficult. “We didn't do it right,” said Ghaly. “Use is always dirty in the context of 40 million people.”

Before Trump's inauguration on Jan. 20, Newsom did it is proposed to allocate $25 million with pending lawsuits against Trump regarding reproductive health care, disaster relief and other services. His petition is pending in the Democratic-controlled state Legislature.

Here are the big steps that will shape Newsom's health care legacy:

Medicaid

Potential government cuts are looming large in America's most populous region. It's sarcastic $261 billion in California spending annually for health care and social services, about $116 billion comes from the federal government. Much of that goes to Medicaid, which covers more than that 1 in 3 Californians. GOP leaders in Washington have floating ideas kneecap Medicaidwhich may reduce benefits or reduce enrollment.

In addition, the expansion of California's Medi-Cal to 1.5 million undocumented immigrants are expected to cost the government an estimated $6.4 billion in the fiscal year that ends June 30. Newsom suggested this month that the state would continue to fund health care expansion for immigrants in the coming budget year but he refused to say that you will maintain coverage for years to come.

Advocacy groups are preparing to defend those benefits if Trump targets California on the issue. “We want to continue to protect access to care and not see a rollback,” said Amanda McAllister-Wallner, interim director of Health Access California.

Common Drugs

Calculates the high cost of prescription drugs, Newsom in 2022 cultivated $100 million in his California standard insulin production system and to launch a government manufacturing facility producing a range of generic drugs. Three years later, California has done nothing. Newsom did, however, announce the agreement In April, the state made bulk purchases of the opioid reversal drug naloxone available in schools, health clinics and other facilities. discount.

“It is really disappointing that there is no more progress on it,” said Sen. Richard Pan, who wrote the book. the first rule of general medicine.

Regarding generic insulin, Newsom acknowledged “it has taken longer than we had hoped to get insulin to market, but we are still committed to bringing $30 insulin to everyone who needs it as soon as possible.”

Abortion

The governor helped lead a successful 2022 campaign strengthen access to abortion in the Constitution of the country. He signed laws to legalize abortion and abortion it is not a crime and enabling doctors abroad abortion in California; he built a bunch of abortion pills when mifepristone is facing a national ban; and set aside $20 million to help the people of California who cannot afford abortion care to access it.

Newsom, who has made reproductive rights central to his political agenda, has also sponsored ads and is criss-crossing the country attacking Trump and other Republicans in red states who have rolled back access to abortion.

After Trump won the election, Newsom called a special session to prepare for possible legal battles with the federal government. He told KFF Health News that the state is preparing “in every possible way to protect the rights guaranteed in the California Constitution and ensure the autonomy of the body for all in our state.”

Rising Health Care Costs

In 2022, Newsom created a Office of Health Care Payment imposing limits on health care spending and imposing penalties on industry payers and providers who fail to meet standards. By 2029, California will achieve annual rate increases for health insurers, doctors and hospitals of 3%.

While Trump has expressed concern about the continued rise in national health care costs — and the quality of health care Americans receive — his views have focused on deregulation and instead of the Affordable Care Actexperts say it can be expensive millions of their health insurance and increase spending on patient care. California could lose federal funding that helped it offset insurance premiums probably many times 1.8 million people who buy their health services in Covered California, the state's ACA marketplace, can increase a patient's out-of-pocket costs.

The government can use the money it collects its health insurance premium unconfirmed, Newsom accepted after the individual mandate of Obamacare was passed by Congress in 2017. Those national revenues are expected to $298 million this fiscal yearaccording to the country's Ministry of Finance. That's a fraction of the federal health insurance funding California receives — roughly $1.7 billion a year.

Health and Homelessness

Under Newsom, California has an unprecedented amount of public money has been spent in dealing with homelessness, however the problem has worsened under his watch.

From 2019, when Newsom took office, to 2023, homelessness jumped 20% more than 181,000despite raising more than $20 billion to try to get people off the streets, including converting hotels and motels homeless houses. He also invested nearly $12 billion in CalAIM, i an experimental effort to enter Medi-Cal for public servicesincluding rental and eviction assistance.

A state inspection this year he found that the state is not doing a good job of tracking the effectiveness of taxpayers' money. CalAIM is not serving as many Californians as expected and patients are having a hard time finding it new benefits to health insurers.

“The problem of homelessness on our streets is unacceptable,” Newsom acknowledged. “But we are starting to see progress.”

Experts expect the Trump administration to reverse liberal policies that have allowed Medicaid money to be used for health care testing through waivers. promoted by the Biden administration. In particular, Trump attacked Newsom for his handling of the homelessness crisis and vowed to do it tough. to remove people from the streets. California's CalAIM waiver expires at the end of 2026.

Instead of increasing housing and food assistance, for example, the state could see federal measures to end CalAIM benefits and act Medicaid is very restrictive.

Mental Health and Substance Use

Newsom launched the most comprehensive overhaul of California's behavioral health system in decades, directing billions in state funding to a new network of treatment centers and prevention programs.

His two most controversial signature moves, Proposition 1 again CARE Courtinvest in treatment and housing for Californians with behavioral health conditions, especially homeless people living in crisis. And the CARE Court allows judges to compel treatment for those suffering from serious mental illness and substance abuse.

Both are plagued by financial challenges, rely on states to implement, and can take years to produce tangible results. While Newsom wanted to increase community-based treatment, Trump promised to return to the center and suggested that homeless people and those with severe mental health conditions should be relocated “large parcels of inexpensive land.”

Newsom said he hopes his “innovative” methods will transform behavioral health care with a “laser focus on people with serious illness and substance use disorders.”

This article was produced by KFF Health Newsa national news platform that produces in-depth journalism on health issues and is one of the core applications e KFF – i an independent source of health policy research, polling and journalism.