When Gavin Newsom ran for California governor in 2018, his support<\/a> for a state-run single-payer healthcare system was considered a risky move and earned him hefty labor endorsements<\/a>.<\/p>\n Today, leading Democrats in the wide-open race to succeed Newsom have embraced single-payer as a political necessity, an answer to voters fed up with rising premiums and other spiraling healthcare costs.<\/p>\n But with no clear front-runner, they are sparring among themselves 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\u2019s most populous state.<\/p>\n Healthcare and political experts said the concept of single-payer has shifted from progressive pipe dream a decade ago to today\u2019s mainstream talking points in a state where Democrats outnumber Republicans nearly 2 to 1. Democrats have pledged the model as the best way to lower costs in an attempt 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 \u201cdisaster\u201d and \u201csocialism.\u201d<\/p>\n \u201cIn many ways, single-payer healthcare has become a progressive litmus test,\u201d said Larry Levitt, a former White House policy adviser and a healthcare expert at KFF, a health information nonprofit that includes KFF Health News.<\/p>\n 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\u2019s approach to healthcare reform.<\/p>\n Xavier Becerra, the former U.S. Health and Human Services secretary, who for decades backed single-payer healthcare in Congress, has come under criticism from opponents for a nuanced but clear shift away from single-payer. It 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.<\/p>\n At a May 5 debate put on by CNN, Becerra declared his support<\/a> for \u201cMedicare for All,\u201d a proposal for a federally run system<\/a> that\u2019s been stalled for years, but he declined to say whether he\u2019d pursue a California-led effort. He said his immediate focus would be on mitigating the drastic federal cuts expected to hit low-income and disabled enrollees in Medi-Cal, the state\u2019s Medicaid program, which covers more than a third of residents.<\/p>\n Becerra is counting on voters not to distinguish between the often-confused terms<\/a> single-payer, Medicare for All, and universal coverage, noting during the debate that \u201cCalifornians don\u2019t care what you call it, so long as they have affordable healthcare.\u201d<\/p>\n \u201cA lot of people aren\u2019t clear what single-payer is, and they need a metaphor to understand it,\u201d said Celinda Lake, a Democratic strategist and one of the lead pollsters for former President Joe Biden\u2019s 2020 campaign.<\/p>\n Billionaire activist Tom Steyer, who\u2019s touted his self-funding as a signal he can\u2019t be bought<\/a>, has emerged as the race\u2019s most vocal advocate of single-payer after opposing it<\/a> during a short-lived 2020 presidential bid.<\/p>\n As governor, Steyer has said, he would pass legislation backed by the California Nurses Association that has failed to come to fruition under Newsom\u2019s tenure. Pressed on how he would cover the estimated $731.4 billion cost<\/a>, Steyer told KFF Health News that \u201cGod is going to be in the details.\u201d<\/p>\n At a forum last year<\/a>, former U.S. Rep. Katie Porter said she didn\u2019t believe achieving such a system was realistic in the near term, but the Orange County Democrat later told party delegates that she would \u201cdeliver single-payer<\/a>.\u201d Former Los Angeles Mayor Antonio Villaraigosa and San Jose Mayor Matt Mahan, Democrats who are trailing their competitors in the polls, don\u2019t support single-payer. The top two vote-getters \u2014 regardless of party \u2014 advance to the November general election.<\/p>\n Some of the most seasoned politicians have failed to deliver single-payer. Newsom, who campaigned on the promise of being a \u201chealthcare governor,\u201d dialed back his ambitions<\/a> upon taking office, choosing instead to pursue \u201cuniversal access<\/a>\u201d to health coverage under a series of Medi-Cal expansions and efforts to contain healthcare spending<\/a>.<\/p>\n Vermont, which remains the only state to pass<\/a> a single-payer healthcare law, reversed course<\/a> when leaders there couldn\u2019t identify a funding source.<\/p>\n To enact single-payer, California would need permission<\/a> from the federal government to redirect billions of dollars from Medicaid, Medicare, and other funding that currently flows to the system \u2014 approval not likely to come from the Trump administration.<\/p>\n More than half of adults nationally say healthcare costs will have a major impact<\/a> on whom they vote for in November, according an April KFF poll.<\/p>\n Danielle Cendejas, a Los Angeles-based Democratic consultant who works with state legislative candidates, said single-payer healthcare increasingly appears on candidate questionnaires from small-business advocates<\/a> as well as hyperlocal Democratic clubs<\/a>, in state legislative races<\/a> and national union endorsements<\/a>.<\/p>\n What most California voters want to hear, Cendejas said, is how candidates plan to give them more immediate relief from higher premiums, expensive drug costs, and long waits to access care.<\/p>\n The high price tag doesn\u2019t faze Jennifer Easton, a 63-year-old Democrat from Oakland, who said other countries with similar models have proved they can lower costs. She said she supports a single-payer health system because it\u2019s clear to her that Americans have reached the limits of working within the existing system. But she isn\u2019t expecting any of the current candidates to succeed in implementing one, and she hasn\u2019t decided whom to support.<\/p>\n \u201cNo one can in four years,\u201d she said. Seeing a candidate enthusiastically support the concept gives her a good idea of their philosophy. \u201cIt is, if we\u2019re lucky, a 20-year, 25-year plan.\u201d<\/p>\n Rob Stutzman, a Republican political consultant who advised former Gov. Arnold Schwarzenegger, said while Americans may be supportive<\/a> of single-payer in polls<\/a>, focus groups suggest that approval drops quickly when voters realize it could mean losing their current doctor or insurance plan.<\/p>\n At the CNN debate, Steve Hilton, the Republican candidate President Donald Trump has endorsed, said Californians would end up with subpar patient care and \u201ctaxes sky high to pay for it,\u201d like in his native United Kingdom.<\/p>\n Instead, Hilton suggested the state stop providing \u201cfree healthcare for illegal immigrants who shouldn\u2019t even be in the country in the first place.\u201d<\/p>\n<\/div>\n\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n
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