California Governor Race: Single-Payer Healthcare Dominates Debates, But Funding Remains Unclear

When Gavin Newsom ran for California governor in 2018, his support for a state-run single-payer healthcare system was considered a risky move—and it earned him strong labor endorsements. Today, leading Democrats in the wide-open race to succeed Newsom have embraced single-payer as a political necessity, positioning it as the answer to voters frustrated by rising premiums and spiraling healthcare costs.

Yet with no clear front-runner, candidates are sparring in debates and political ads over who is most committed to a government-run model. No candidate has outlined how California would fund comprehensive health coverage for its 40 million residents, leaving voters unable to discern which candidate has a concrete plan for the nation’s most populous state.

Healthcare and political experts say the concept of single-payer has shifted from a progressive pipe dream a decade ago to today’s mainstream talking point in a state where Democrats outnumber Republicans nearly 2 to 1. Democrats have pledged the model as the best way to lower costs, aiming to woo voters worried about affordability as ballots arrive for the June 2 primary. The top two Republicans, meanwhile, have dismissed government-run healthcare as a “disaster” and “socialism.”

“In many ways, single-payer healthcare has become a progressive litmus test.”
— Larry Levitt, former White House policy adviser and healthcare expert at KFF

Few voters fully understand the term single-payer, let alone expect the next governor to achieve it, Levitt said. Rather, he added, the term has become more of a signal to voters about a candidate’s approach to healthcare reform.

Xavier Becerra, the former U.S. Health and Human Services secretary who for decades backed single-payer healthcare in Congress, has faced criticism for a nuanced but clear shift away from the policy. The shift came after Becerra secured an endorsement from the California Medical Association, a powerful group representing doctors and a longtime opponent of single-payer healthcare bills in California.

At a May 5 debate hosted by CNN, Becerra declared his support for “Medicare for All,” a federally run system that has stalled for years, but he declined to say whether he’d pursue a California-led effort. Instead, he emphasized mitigating drastic federal cuts expected to hit low-income and disabled enrollees in Medi-Cal, the state’s Medicaid program, which covers more than a third of residents. Becerra is counting on voters not to distinguish between the often-confused terms single-payer, Medicare for All, and universal coverage, noting during the debate that “Californians don’t care what you call it, so long as they have affordable healthcare.”

“A lot of people aren’t clear what single-payer is, and they need a metaphor to understand it.”
— Celinda Lake, Democratic strategist and lead pollster for Joe Biden’s 2020 campaign

Billionaire activist Tom Steyer, who has touted his self-funding as a signal he can’t be bought, has emerged as the race’s most vocal advocate of single-payer after years of limited engagement in the issue.