Gavin Newsom, Early Champion of Single-Payer, Moderates in the Face of Fiscal Limits

SACRAMENTO, Calif. — In his earliest days in the governor’s office, Democrat Gavin Newsom huddled with his advisers to consider how to realize a key campaign promise: transforming a healthcare system replete with insurance company intermediaries into the nation’s first state-run single-payer model providing comprehensive coverage to all residents, similar to those in Canada and Taiwan. He’d need to secure tax increases to help cover the high cost of a single-payer system, once pegged at about $500 billion a year, and Republican President Donald Trump, then in his first term, would have to give California permission to use federal funding to convert the system of coverage from one determined by employment, age, or income. Neither was politically feasible. Instead, in the years that followed, Newsom muscled through a compassionate healthcare agenda that poured billions into new benefits, including Medi-Cal coverage for low-income immigrants without legal status and incarcerated people leaving jail or prison, as well as programs for people experiencing homelessness in America’s richest and most populous state. Medi-Cal, the state’s Medicaid program, now includes housing services, including six months of free rent for those in need, and home-delivered healthy meals for low-income Californians with chronic health conditions. He made