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 it a priority to expand mental health and addiction treatment, especially for the tens of thousands living on the streets.
He also tackled the soaring cost of healthcare, including by offering bigger subsidies for low- and middle-income earners to purchase insurance and empowering a new state agency to slow the rise in healthcare spending. Years before TrumpRx, the president’s program to lower prices for some medicines for people without insurance, Newsom signed into law a policy setting up a state-branded generic prescription drug label known as CalRx to provide lower-price drugs. And amid a federal attack on reproductive rights, Newsom led efforts to safeguard abortion.
The liberal values that guided Newsom’s healthcare ambitions were forged early in his life and cultivated during his two terms as mayor of San Francisco. His approach in the governor’s office is described by allies as socially liberal and fiscally pragmatic. The policies he has supported offer a road map for the direction he would lead the nation, should he run for and be elected president in 2028. Now in his final term as governor, Newsom will be scrutinized for his healthcare record, criticized by liberals as too moderate and by Republicans as too radical.
Newsom, 58, is known for his all-out approach, a style that leads him to take on a barrage of flashy and complicated policy proposals at once, earning him a reputation in some political circles of overpromising and underdelivering. Newsom has notched some successes, but his record is also marked by failures. He hasn’t housed as many people as he envisioned — there are nearly 190,000 homeless people in California, according to the most recent federal estimates, more than when he became governor. Medicaid spending has more than doubled under his watch, drawing criticism from Republicans, and patients around the state are experiencing problems getting timely medical appointments and quality care.
Newsom’s closest allies argue that he has balanced efforts to make healthcare more equitable, accessible, and affordable. They argue his unmet policy goals are not failures but investments and long-term strategies to better serve poor and marginalized people while containing healthcare costs.
“We would talk about how you win by losing,” said Mark Ghaly, who served as Newsom’s health and human services secretary until 2024. “The governor isn’t afraid to fail. But by failing you learn about how to make it successful.”
Although voters in the Democratic stronghold of California have supported many of his ideas, residents have grown increasingly weary in their support. An early 2026 poll from the University of California-Berkeley Institute of Governmental Studies showed Newsom’s job approval slipping as he has focused on attacking Trump on the national stage.
Rising costs have become a top concern for voters across the political spectrum. Two-thirds of the public in January said they worried about being able to afford healthcare for themselves and their families, according to a KFF national survey. And a recent Gallup poll found roughly a third of adults in America have made at least one trade-off to afford healthcare, such as driving less, skipping meals, cutting utility use, rationing prescriptions, or borrowing money.
Despite the criticisms, Newsom’s extensive record on healthcare can give him an edge in a presidential primary contest, said Celinda Lake, a national Democratic strategist who specializes in healthcare polling. “Newsom has, by far, the most comprehensive and authentic agenda of any Democrat out there,” she said.
Universal Healthcare
Newsom has said that healthcare should be a basic human right, no