By Samantha Young and Anna Gorman and Ana B. IbarraJanuary
8, 2019
SACRAMENTO,
Calif. — Within hours of assuming office Monday, Gov. Gavin Newsom issued a
defiant challenge to the Trump administration with sweeping plans to
expand health coverage to more Californians, pushing for a single-payer system
and insurance for undocumented young adult immigrants.
He also
called for new state-funded subsidies to help people afford health insurance,
coupled with a requirement that all Californians have health insurance. And he
signed an executive order that directs state agencies to work together to
negotiate prescription drug prices.
Newsom
revealed his proposals on Facebook Live, following
a combative inaugural speech earlier in the day in which he vowed to stand up
to a “corrupt” administration in Washington and lead California along a
progressive path.
“Every
person should have access to quality, affordable health care,” Newsom said in
his inaugural speech. “Far-away judges and politicians may try to turn back our
progress. But we will never waver in our pursuit of guaranteed health care
for all Californians.”
Newsom
had campaigned for a
single-payer system, and he said Monday that he remained committed to it. In a letter to
President Donald Trump and congressional leaders, Newsom called on the federal
government to allow California and other states to create a single-payer payer
program.
U.S.
Rep. Ro Khanna (D-Calif.), who is working with Newsom, said Congress needs to
pass a bill that gives states permission to create their own health care
programs and still receive federal funding.
While
that request seems like a long shot in the Republican-controlled Senate, Khanna
said he and other Democratic lawmakers want to start hearings in the
Democratic-controlled House of Representatives — in preparation for when there
is a Democrat in the White House.
“Realistically,
we’re looking at 2021 before this could become law,” Khanna said.
Newsom’s
out-of-the-gate move on single-payer reflects a clear shift from his
predecessor, Democratic Gov. Jerry Brown, who had described the ambitious
proposal — which could cost an estimated $400 billion annually —
as financially impossible.
Newsom’s
announcement also gives momentum to advocates of single-payer both in
California and nationally.
“This
is a necessary first step in getting this program together,” said Stephanie
Roberson, director of government relations at the California Nurses
Association, a group that has been among the most outspoken advocates for
single-payer in the state. “This is definitely a campaign promise that has come
to fruition for us.”
As a
candidate, Newsom had also backed expanding health care to young adultswho are in
the country illegally — a Democratic plan that died in
budget negotiations last year when Brown balked at the estimated cost: $140 million for the first year.
Newsom
said his budget, scheduled to be released Thursday, will set aside state
funding to expand Medi-Cal, California’s version of the federal Medicaid
program for low-income people, to eligible adults up to age 26. That would make
California the first state to provide full Medicaid benefits to unauthorized
immigrant adults.
In
2016, California opened Medi-Cal to all kids up to age 19, regardless of their
immigration status. Since then, more than 250,000 children
have enrolled.
Immigration
and health care advocates estimate that more than 100,000 young adults aged 19
to 25 could enroll if Newsom’s proposal is adopted by the state legislature.
“The
truth is we need every single adult to be covered. That’s the best way to make
sure people thrive,” said Almas Sayeed, with the California Immigrant Policy
Center. “But we’re thrilled that he is picking up a part of this campaign — and
this early on.”
Immigrants
in the country illegally make up almost 60 percent of
California’s roughly 3 million uninsured
residents.
Newsom
also wants California to become the first state to offer subsidies to
middle-class families who struggle to buy health insurance. Under the
Affordable Care Act, people who earn more than 400 percent of the federal
poverty level — about $48,500 a year for an individual or about $100,000 for a
family of four — don’t qualify for federal financial assistance to help them
purchase their own policies. Newsom’s plan would provide state subsidies to
individuals earning up to $72,840 and families of four earning up to $150,600.
To pay
for those subsidies, for which the new governor did not put a price tag, Newsom
said he will ask the Democratic-controlled legislature to impose a health
coverage requirement on Californians — and a penalty for those who don’t
comply.
The
federal tax penalty for uninsured people under the Affordable Care Act went away on Jan. 1, a
provision of the Republican tax bill of 2017.
A state
mandate to have insurance may be the most controversial piece of Newsom’s
proposals, said Larry Levitt, a senior vice president at the Kaiser Family
Foundation. “There would be real concerns raised of whether coverage is
affordable enough to require people to get it,” he said. “Pairing the expansion
in subsidies for people in the middle class with the individual mandate may
make the mandate more palatable.” (Kaiser Health News, which produces
California Healthline, is an editorially independent program of the
foundation.)
In
other moves that don’t require legislative approval, Newsom signed an executive
order creating the new position of California surgeon general, who he said
would promote preventive care and highlight health disparities across
California.
The new
governor also signed an order directing state agencies to collaborate on
purchasing prescription drugs.
Currently,
state agencies negotiate individually with drug companies for prisons or
veterans, for example.
There
are various ways the state could consolidate prescription drug purchasing, and
some would require federal approval, said Erin Trish, associate director of the
USC Schaeffer Center for Health Policy & Economics. A consolidated
negotiator could achieve lower prices, but that could require limiting the
number of covered drugs, Trish said. “You have to be willing to exclude
coverage of drugs to have meaningful bargaining leverage to change prices,” she
added.
This
and Newsom’s other first-day proposals underscore that California has a
governor who intends to focus on health care, Trish and other policy experts
said.
“This
is an issue that he cares about, that California cares about, that he has
experience on and strong opinions on,” she said. “This is the Newsom
administration putting the stake in the ground, saying we are going to take on
health care.”
Samantha
Young: syoung@kff.org,
@youngsamantha
Anna
Gorman: agorman@kff.org,
@AnnaGorman
Ana B.
Ibarra: aibarra@kff.org,
@ab_ibarra
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