California's Stalled Pursuit of Single-Payer Healthcare

In September 2023 Governor Gavin Newsom signed Senate Bill 770, ordering the state to negotiate with Washington to shift roughly half of California’s public and private health-care spending to a state-run “package” covering medical, pharmacy, dental and vision services. The bill stops short of mandating a single-payer system, instead urging a “system of unified financing.”

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Newsom’s 2018 campaign pledged a single-payer system, saying he was “tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem.” He then formed the Healthy California for All Commission, whose report endorsed unified financing but not a single-payer plan. Key actors include Governor Newsom, the California Nurses Association (CNA) – the lead advocate – Assemblymember Ash Kalra (author of AB 1900), UCLA Center for Health Policy Research, and the Legislative Analyst’s Office (LAO).

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UCLA’s 181-page study projects a single-payer system would cost $731.4 billion annually—three times the $238 billion budget—and require a $109 billion reserve. By contrast, 2022 Medi-Cal expansion, which extended coverage to undocumented adults, relied on a $100 billion surplus that never materialized; by 2025 costs were $6.2 billion higher. The LAO warns that without federal and state funding the uninsured could double to four million by 2030.

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Newsom described SB 770 as an incremental step toward universal coverage, saying the state is “delivering” on his promise while calling a full single-payer system “aspirational.” CNA called the bill “a complete betrayal of nurses’ fight for a single-payer healthcare policy,” accusing the administration of capitulating to corporate interests. The Health and Human Services Agency cited the UCLA analysis to justify continued study of unified financing, while AB 1900 was blocked.

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CNA’s opposition grew after the Senate declined to advance AB 1900, calling the failure “a lack of leadership and a capitulation to corporate healthcare interests.” Tom Steyer and Katie Porter support single-payer reform, while other candidates favor less expansive options, highlighting intra-party disagreement.

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UCLA’s $731.4 billion cost estimate clashes with earlier assumptions that federal dollars could be redirected to fund a unified plan. The $6.2 billion Medi-Cal overrun lacks a detailed breakdown, leaving fiscal uncertainty.

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• “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem.” — Gavin Newsom, 2018 campaign statement

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• “We’re delivering that.” — Gavin Newsom, post-expansion comment

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• “a complete betrayal of nurses’ fight for a single-payer healthcare policy, a fight striving to achieve health justice for our patients and our communities.” — California Nurses Association, statement on SB 770

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• “The failure to advance (AB 1900) shows a lack of leadership and a capitulation to corporate healthcare interests.” — California Nurses Association, response to legislative inaction

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Legislative leaders have postponed AB 1900 while the UCLA study remains under review. Proponents hope a successor will revive single-payer legislation, but fiscal constraints and partisan splits suggest the debate will continue.

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