{"id":15408,"date":"2026-09-08T09:00:00","date_gmt":"2026-09-08T09:00:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=15408"},"modified":"2026-09-08T09:00:00","modified_gmt":"2026-09-08T09:00:00","slug":"its-triage-californias-next-governor-will-face-destabilizing-surge-in-uninsured","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=15408","title":{"rendered":"\u2018It\u2019s Triage\u2019: California\u2019s Next Governor Will Face Destabilizing Surge in Uninsured"},"content":{"rendered":"

By the time Democrat Xavier Becerra left Washington, D.C., more Americans than ever<\/a> had health insurance, owing partly to his work over the years to pass, defend, and expand the Affordable Care Act.<\/p>\n

It\u2019s an achievement the former congressman and former U.S. secretary of Health and Human Services often touts<\/a> as he campaigns for California governor<\/a> against Republican Steve Hilton, a former Fox News commentator.<\/p>\n

But should Becerra cruise to victory in November, as polling suggests<\/a>, he will face what may be the steepest decline in health insurance coverage in a generation, one that will land especially hard in his home state.<\/p>\n

By 2030, the number of uninsured Californians under 65 is expected to nearly double<\/a> from 2.4 million to 4.6 million, as recently enacted state and federal cuts<\/a> to Medicaid and ACA marketplaces begin to roll back<\/a> historic gains in health coverage, according to a May analysis by the University of California-Berkeley Labor Center. The anticipated rise in the uninsured population could have broad implications for hospital systems, insurers, and the economy.<\/p>\n

In February, Miranda Dietz, the labor center\u2019s healthcare program director, told legislators the changes could end up costing California about 200,000 jobs<\/a>, mostly in the healthcare industry.<\/p>\n

Hospital executives have begun reporting more unpaid medical bills<\/a>, and experts warn health plans will raise premiums further<\/a> as they\u2019re left with enrollees who are, on average, sicker and more expensive to cover.<\/p>\n

\u201cIt\u2019s triage,\u201d said Jessica Altman<\/a>, executive director of Covered California, the nation\u2019s largest state-run health insurance marketplace. \u201cThat\u2019s what the next governor is walking into.\u201d<\/p>\n

California achieved one of the most dramatic drops in its uninsured population<\/a> in the nation, largely credited to the state\u2019s robust adoption of the ACA. If tapped to lead the wealthy, progressive state, Becerra would wrestle with how uninsured Californians get care and who pays as the Trump administration shrinks a federal safety net he once oversaw.<\/p>\n

Becerra has some experience pushing back against Washington, D.C. As California attorney general, he successfully defended<\/a> many provisions of the Affordable Care Act, including access to birth control<\/a>.<\/p>\n

Becerra said he would issue an executive order<\/a> to keep those affected by federal cuts insured. But he has not detailed how the state would backfill as much as $30 billion<\/a> in federal funding California stands to lose annually.<\/p>\n

At a policy forum hosted by Politico last month, Becerra promised Californians<\/a> would not lose health coverage despite federal cutbacks, saying he would push the industry to eliminate waste from \u201cattorneys, accountants, pencil pushers\u201d that cost consumers billions.<\/p>\n

\u201cI\u2019m going to ask them to help me extract some of that waste and put it into healthcare, which helps us cover the cost of keeping Californians insured,\u201d he said.<\/p>\n

His opponent, Hilton, is trying to appeal to voters opposed to President Donald Trump<\/a>, despite receiving the president\u2019s endorsement, and has stumped on cutting off coverage for Californians without legal status<\/a>, which is paid for with state funds. Hilton has vowed to use those savings to issue state income tax breaks<\/a>, calling it an immediate antidote to high costs.<\/p>\n

\u201cWe all understand that the healthcare system is a mess and needs major reform,\u201d Hilton said in an interview. \u201cThe quickest thing we can do on healthcare costs is actually to tax people less.\u201d<\/p>\n

Left Behind?<\/strong><\/p>\n

In 2010, Becerra was part of U.S. House Speaker Nancy Pelosi\u2019s leadership team and helped whip up votes to pass the law. He also had a hand in crafting it, though his attempt to include a government-backed coverage option failed.<\/p>\n

A decade later, when lawmakers considered him for the nation\u2019s top healthcare job, Becerra said his primary mission would be to carry out President Joe Biden\u2019s vision to expand access and cut costs under the Affordable Care Act.<\/p>\n

Before the ACA, some 50 million Americans<\/a> \u2014 roughly 1 in 6 \u2014 were uninsured. Within a few years of the law\u2019s passage in 2010<\/a>, its expansion of Medicaid eligibility and financial aid to lower-income marketplace enrollees helped slash the U.S. uninsured rate by nearly half.<\/p>\n

Millions more gained coverage during the covid-19 pandemic after Becerra implemented a freeze on Medicaid disenrollment<\/a> and administered generous but temporary tax credits that put the cost of Obamacare plans within reach for more people<\/a>.<\/p>\n

As Biden\u2019s health secretary, Becerra launched aggressive public awareness campaigns, loosened enrollment rules<\/a>, and distributed hundreds of millions in grants to pay consumer assistants, also known as healthcare navigators<\/a>, to help enrollees wade through paperwork.<\/p>\n

\u201cOne of the common things we would hear from him as a leader was, \u2018Who\u2019s being left behind?\u2019\u201d said Benjamin Sommers, a Harvard health policy professor who was a deputy assistant secretary<\/a> under Becerra.<\/p>\n

Under Biden and Becerra, the percentage of people with health insurance reached a historical high of 92%<\/a>, or 310 million Americans having health coverage in 2024.<\/p>\n

Republican Response<\/strong><\/p>\n

But conservatives said those policies inflated enrollment<\/a> by attracting fraudulent and wasteful coverage. In response, the second Trump administration has tightened enrollment windows<\/a> and toughened income reporting.<\/p>\n

\u201cIt\u2019s simple and easy to say, well, the numbers are up so the program must be working,\u201d said Edmund Haislmaier<\/a>, a senior research fellow at the Heritage Foundation, a conservative think tank. \u201cMy argument would be that\u2019s the wrong metric.\u201d<\/p>\n

Last summer, the GOP-led Congress passed Trump\u2019s One Big Beautiful Bill Act, which Republicans argued preserves Medicaid<\/a> for those who need it most while rooting out fraud and waste<\/a>. Altogether, the law is expected to cut Medicaid spending by $900 billion-plus<\/a> over a decade.<\/p>\n

Congress also allowed enhanced premium tax credits<\/a> for Obamacare plans to expire last year, spiking premium payments<\/a> for middle-income Americans and driving down enrollment by nearly 3 million<\/a> this year.<\/p>\n

\u201cWe are now witnessing almost a wholesale reversal of pretty much all those policies\u201d that helped cover millions more Americans, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.<\/p>\n

For Eric Maciel, the $800 monthly cost of a Covered California plan is too much. To avoid injury, the 28-year-old stays home more and rarely plays pickup soccer at the park \u2014 the other players, he added, can get pretty rough.<\/p>\n

\u201cThat\u2019s another car note,\u201d Maciel said. \u201cI\u2019d be left with nothing.\u201d<\/p>\n

Health economists say Maciel is the type of customer insurers need to stabilize their risk pools: young, healthy, and less costly.<\/p>\n

Hilton criticized state leaders for passing a revised provider tax<\/a> he asserts will send premiums soaring and said he wants to inject more competition into California\u2019s health insurance market \u2014 but he offered no specific ideas.<\/p>\n

Playing Defense<\/strong><\/p>\n

Higher-than-expected<\/a> state costs coupled with federal cuts have prompted California to retreat on healthcare coverage. Federal funds account for one-third<\/a> of the state\u2019s budget and more than 60% of spending by Medi-Cal<\/a>, the state\u2019s Medicaid program.<\/p>\n

Gov. Gavin Newsom has frozen enrollment<\/a> for immigrants without legal status, enacted monthly premiums for some, and plans to only temporarily backfill<\/a> federal assistance for legal immigrants such as asylees and refugees.<\/p>\n

Newsom and Democratic lawmakers agreed to delay some cuts<\/a> until July 2027, leaving the next governor to weigh further rollbacks against increased taxes. Becerra, a California native born to Mexican immigrants, opposes what\u2019s known as the billionaire tax<\/a>, on November\u2019s ballot. Last month, he said he supported legislative efforts to penalize large corporations whose workers rely on Medi-Cal, arguing that taxpayers are subsidizing employers\u2019 low wages and paltry benefits.<\/p>\n

County governments, which are legally required<\/a> to provide healthcare to uninsured residents too poor to afford care, are lobbying lawmakers for funding to treat what they describe as a fresh deluge of patients who need free care.<\/p>\n

\u201cIt\u2019s a pretty big cliff if all this stuff goes into effect,\u201d said Dietz, the labor center\u2019s healthcare program director. \u201cAnd there\u2019s a choice whether to make it less bad and maintain coverage for folks.\u201d<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n

This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":"

By the time Democrat Xavier Becerra left Washington, D.C., more Americans than ever had health insurance, owing partly to his work over the years to pass, defend, and expand the Affordable Care Act. It\u2019s an achievement the former congressman and former U.S. secretary of Health and Human Services often touts as he campaigns for California…<\/p>\n","protected":false},"author":0,"featured_media":15409,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15408","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15408"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15408"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15408\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/15409"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}