Gov. Gavin Newsom signed Senate Bill 770 three years ago, backing a state push to negotiate with Washington over a new way to pay for healthcare in California. The move came after the Healthy California for All Commission endorsed unified financing as the most efficient path to universal coverage, while stopping short of calling for a single-payer system.
SB 770 directed state officials to seek a deal with federal authorities so money now flowing from Washington could be shifted to Sacramento. Federal funds would help cover a broad package of medical, behavioral health, pharmaceutical, dental and vision benefits, along with primary, preventive and wellness care. For nurses who had spent years pressing for single-payer healthcare, it looked less like a breakthrough than a retreat.
The California Nurses Association called Newsom’s approval “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.” That anger carried extra weight because Newsom won the union’s support in 2018 by saying, “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem.”
Once in office, Newsom described single-payer as “aspirational” and turned instead to incremental changes in Medi-Cal. He later said, “I campaigned on universal healthcare” and “We’re delivering that.” The biggest step came in 2022, when the state expanded coverage to all adult undocumented immigrants for implementation in 2024.
That expansion was supposed to ride a nearly $100 billion surplus that never appeared. By 2025, the cost had ballooned to $6.2 billion more than expected, and Newsom and the Legislature froze enrollment as multi-billion-dollar deficits forced a hard stop. The state’s finances did what political promises did not: they drew the line.
The latest blow landed last month, when legislative leaders blocked Assemblymember Ash Kalra’s third attempt to win adoption of a single-payer system and shelved Assembly Bill 1900 without a hearing. The California Nurses Association said the failure to advance AB 1900 showed “a lack of leadership and a capitulation to corporate healthcare interests.”
The pattern is clear now. California still talks about universal coverage, but its leaders have chosen financing experiments and piecemeal expansion over the single-payer overhaul that advocates expected after Newsom’s campaign pledge. The question was never whether the state wanted to move; it was whether it would ever make the political break required to do it. It has not.