Updated Jan. 9, 4:27 p.m.
The fight to expand coverage under the Affordable Care Act never petered out in California, even as the federal government moved repeatedly to dismantle the Obama-era policy.
Now, advocates for universal health care may have a new ally in Gov. Gavin Newsom. In his first budget this week, the governor is expected to revive ideas to improve access that fell flat under predecessor Jerry Brown.
Newsom said in a statement Monday that his budget will fund Medi-Cal coverage for undocumented young adults, who are currently excluded from the program, and improve subsidies for low and middle-income Californians on the individual market.
These were goals that universal health care advocates fought for aggressively last year. Democratic lawmakers requested $1 billion to make these and other changes, but then-governor Brown did not set aside money in the budget, citing the need to build up the rainy day fund. Their requests lined up with a larger package of bills under the “#Health4All” campaign.
Anthony Wright, director of consumer group Health Access which backed the campaign, applauded the new governor’s announcement in a statement.
“Last year, voters supported Gov. Newsom in a health care election, and were clamoring not just to protect their care, but for the real, tangible steps to improve access and affordability,” he said.
Experts say the existing support from lawmakers who favor expanding health coverage should allow Newsom to make forward progress on the issue.
When advocates were pushing a single-payer system overhaul last year, a special Assembly committee found the plan would require federal approval that’s unlikely to be granted, and could cost hundreds of billions of dollars.
“However, the proposals [Newsom’s] put on the table right now are considerably short of that,” said Marian Mulkey an independent consultant who was on the committee.
She said Newsom’s piecemeal approach of increasing subsidies and expanding coverage to undocumented adults is more doable financially.
“Those are more within the ballpark of funds that California might be able to allocate to this purpose through its normal budget process,” she said.
The state Legislative Analyst's Office estimates it would cost an additional $140 million to expand coverage to undocumented adults up to age 26, or nearly $3 billion to cover all adults.
Newsom said the budget will detail financial assistance for individuals earning up to $72,840 and families of four earning up to $150,600 who currently buy insurance in the Covered California marketplace but don’t receive subsidies.
He proposed funding the expansion, at least partially, by creating a statewide individual insurance coverage mandate. It would replace the one zeroed out by the Trump administration in 2017, which required people to either buy insurance or pay a fine.
Many health care economists predict that an individual mandate will prevent healthy consumers from leaving the market, therefore maintaining a low cost of care for all.
Sally Pipes, president of a conservative think-tank called the Pacific Research Institute, said those views are “divorced from reality.”
“The last four years of Obamacare have proven that even a government directive hasn’t compelled the young and healthy to buy insurance they can’t afford,” she said in an email. “Reinstating the mandate at the state level would effectively be a tax hike on poor and working-class Californians.”
Newsom is also expected to carve out budget items that improve health and education services for children, particularly those who’ve experienced trauma.