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‘It’s Triage’: California’s Next Governor Will Face Destabilizing Surge in Uninsured
‘It’s Triage’: California’s Next Governor Will Face Destabilizing Surge in Uninsured. Originally published by KFF Health News.
By Christine Mai-Duc · 2026-09-08T13:35:03.509Z
By the time Democrat Xavier Becerra left Washington, D.C., more Americans than ever https://www.census.gov/library/publications/2025/demo/p60 288.html had health insurance, owing partly to his work over the years to pass, defend, and expand the Affordable Care Act. It’s an achievement the former congressman and former U.S. secretary of Health and Human Services often touts https://www.facebook.com/reel/1244587377503375 as he campaigns for California governor https://kffhealthnews.org/health care costs/california governor race single payer healthcare becerra cma steyer/ against Republican Steve Hilton, a former Fox News commentator. But should Becerra cruise to victory in November, as polling suggests https://www.ppic.org/publication/ppic statewide survey californians and the environment july 2026/ , 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. By 2030, the number of uninsured Californians under 65 is expected to nearly double https://laborcenter.berkeley.edu/over two million more californians projected to lack health insurance by 2030/ from 2.4 million to 4.6 million, as recently enacted state and federal cuts https://kffhealthnews.org/health industry/one big beautiful bill medicaid work requirements affordable care act immigrants/ to Medicaid and ACA marketplaces begin to roll back https://www.cbo.gov/system/files/2026 02/51298 2026 02 healthinsurance.pdf 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. In February, Miranda Dietz, the labor center’s healthcare program director, told legislators the changes could end up costing California about 200,000 jobs https://calmatters.digitaldemocracy.org/hearings/278674 t=2259&f=a82b0941e6b5b20288ba193528a779ae , mostly in the healthcare industry. Hospital executives have begun reporting more unpaid medical bills https://www.nytimes.com/2026/07/30/business/aca obamacare health insurance.html , and experts warn health plans will raise premiums further https://kffhealthnews.org/insurance/eroding aca enrollment higher insurance rates/ as they’re left with enrollees who are, on average, sicker and more expensive to cover. “It’s triage,” said Jessica Altman https://hbex.coveredca.com/executive/ , executive director of Covered California, the nation’s largest state run health insurance marketplace. “That’s what the next governor is walking into.” California achieved one of the most dramatic drops in its uninsured population https://laborcenter.berkeley.edu/californias health coverage gains under the affordable care act whats at stake in california v texas/ : :text=California%20had%20the%20largest%20reduction%20in%20its,California%20more%20affordable%20as%20of%20June%202019.%5B5%5D in the nation, largely credited to the state’s 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. Becerra has some experience pushing back against Washington, D.C. As California attorney general, he successfully defended https://publichealth.berkeley.edu/articles/news/what does california attorney general xavier becerras record tell us about what he might do as secretary of hhs many provisions of the Affordable Care Act, including access to birth control https://kffhealthnews.org/courts/californias top lawyer cements his role as health care defender in chief/ . Becerra said he would issue an executive order https://www.xavierbecerra2026.com/priorities/health care/ to keep those affected by federal cuts insured. But he has not detailed how the state would backfill as much as $30 billion https://ahea.assembly.ca.gov/system/files/2026 01/ca budget and policy center impact of federal funding cuts 2 pager.pdf in federal funding California stands to lose annually. At a policy forum hosted by Politico last month, Becerra promised Californians https://www.politico.com/news/2026/08/11/becerra pledges to keep all californians insured after trump health care cuts 01034749 would not lose health coverage despite federal cutbacks, saying he would push the industry to eliminate waste from “attorneys, accountants, pencil pushers” that cost consumers billions. “I’m 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,” he said. His opponent, Hilton, is trying to appeal to voters opposed to President Donald Trump https://www.latimes.com/california/story/2026 07 22/gop gubernatorial candidate steve hilton pleads case to anti trump voters , despite receiving the president’s endorsement, and has stumped on cutting off coverage for Californians without legal status https://kffhealthnews.org/elections/california governor becerra hilton immigrant healthcare medicaid medi cal/ , which is paid for with state funds. Hilton has vowed to use those savings to issue state income tax breaks https://www.facebook.com/TheSteveHilton/videos/as governor i will stop gavin newsoms 20 billion free healthcare for illegal imm/4205708453092330/ , calling it an immediate antidote to high costs. “We all understand that the healthcare system is a mess and needs major reform,” Hilton said in an interview. “The quickest thing we can do on healthcare costs is actually to tax people less.” Left Behind? In 2010, Becerra was part of U.S. House Speaker Nancy Pelosi’s 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. A decade later, when lawmakers considered him for the nation’s top healthcare job, Becerra said his primary mission would be to carry out President Joe Biden’s vision to expand access and cut costs under the Affordable Care Act. Before the ACA, some 50 million Americans https://www.kff.org/event/50 million uninsured the faces behind the/ — roughly 1 in 6 — were uninsured. Within a few years of the law’s passage in 2010 https://www.latimes.com/archives/la xpm 2010 mar 22 la na healthcare passage22 2010mar22 story.html , its expansion of Medicaid eligibility and financial aid to lower income marketplace enrollees helped slash the U.S. uninsured rate by nearly half. Millions more gained coverage during the covid 19 pandemic after Becerra implemented a freeze on Medicaid disenrollment https://www.kff.org/medicaid/10 things to know about the unwinding of the medicaid continuous enrollment provision/ and administered generous but temporary tax credits that put the cost of Obamacare plans within reach for more people https://www.hhs.gov/sites/default/files/fact sheet hhs american rescue plan health insurance coverage.pdf . As Biden’s health secretary, Becerra launched aggressive public awareness campaigns, loosened enrollment rules https://www.cbpp.org/blog/lower premiums more time to enroll will boost marketplace enrollment , and distributed hundreds of millions in grants to pay consumer assistants, also known as healthcare navigators https://www.kff.org/private insurance/navigator funding restored in federal marketplace states for 2022/ , to help enrollees wade through paperwork. “One of the common things we would hear from him as a leader was, ‘Who’s being left behind?’” said Benjamin Sommers, a Harvard health policy professor who was a deputy assistant secretary https://hsph.harvard.edu/profile/ben sommers/ under Becerra. Under Biden and Becerra, the percentage of people with health insurance reached a historical high of 92%, or 310 million Americans having health coverage in 2024. Republican Response But conservatives said those policies inflated enrollment https://aspe.hhs.gov/reports/aca exchange enrollment 2026 by attracting fraudulent and wasteful coverage. In response, the second Trump administration has tightened enrollment windows https://www.kff.org/affordable care act/8 things to watch for the 2026 aca open enrollment period/ and toughened income reporting. “It’s simple and easy to say, well, the numbers are up so the program must be working,” said Edmund Haislmaier https://www.heritage.org/staff/edmund haislmaier , a senior research fellow at the Heritage Foundation, a conservative think tank. “My argument would be that’s the wrong metric.” Last summer, the GOP led Congress passed Trump’s One Big Beautiful Bill Act, which Republicans argued preserves Medicaid https://www.npr.org/2026/07/31/nx s1 5870960/republican ads healthcare medicaid 2026 midterms for those who need it most while rooting out fraud and waste https://www.whitehouse.gov/releases/2025/07/president trumps one big beautiful bill is now the law/ . Altogether, the law is expected to cut Medicaid spending by $900 billion plus https://www.kff.org/medicaid/allocating cbos estimates of federal medicaid spending reductions across the states enacted reconciliation package/ over a decade. Congress also allowed enhanced premium tax credits https://www.kff.org/affordable care act/state based efforts will provide limited relief from enhanced tax credit expiration/ for Obamacare plans to expire last year, spiking premium payments https://kffhealthnews.org/priced out/ for middle income Americans and driving down enrollment by nearly 3 million https://www.kff.org/affordable care act/how has aca marketplace enrollment changed across states in 2026/ this year. “We are now witnessing almost a wholesale reversal of pretty much all those policies” that helped cover millions more Americans, said Sabrina Corlette, co director of the Center on Health Insurance Reforms at Georgetown University. 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 — the other players, he added, can get pretty rough. “That’s another car note,” Maciel said. “I’d be left with nothing.” Health economists say Maciel is the type of customer insurers need to stabilize their risk pools: young, healthy, and less costly. Hilton criticized state leaders for passing a revised provider tax https://kffhealthnews.org/health industry/mco medicaid provider taxes matching funds threatened cms house california/ he asserts will send premiums soaring and said he wants to inject more competition into California’s health insurance market — but he offered no specific ideas. Playing Defense Higher than expected https://kffhealthnews.org/health care costs/california medi cal medicaid budget shortfall loan general fund costs/ state costs coupled with federal cuts have prompted California to retreat on healthcare coverage. Federal funds account for one third https://calbudgetcenter.org/resources/federal funds drive one third of californias state budget/ of the state’s budget and more than 60% of spending by Medi Cal https://www.chcf.org/wp content/uploads/2025/01/MediCalFederalGovernmentPolicyAtAGlance.pdf : :text=In%20FY%202024%E2%80%9325%2C%20the%20Medi%2DCal%20budget%20totals,federal%20government%20can%20provide%20under%20current%20law. , the state’s Medicaid program. Gov. Gavin Newsom has frozen enrollment https://kffhealthnews.org/insurance/california governor gavin newsom immigrant health care medicaid president/ for immigrants without legal status, enacted monthly premiums for some, and plans to only temporarily backfill https://caimmigrant.org/california budget delays worst medi cal cuts for immigrants but gaps remain and the fight continues/ federal assistance for legal immigrants such as asylees and refugees. Newsom and Democratic lawmakers agreed to delay some cuts https://jasonsisney.substack.com/p/fyi summaries of 2026 27 state budget until July 2027, leaving the next governor to weigh further rollbacks against increased taxes. Becerra, a California native born to Mexican immigrants, opposes what’s known as the billionaire tax https://pro.stateaffairs.com/ca/news/california democratic party and becerra divided on billionaire tax , on November’s 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’ low wages and paltry benefits. County governments, which are legally required https://kffhealthnews.org/health care costs/indigent care uninsured medicaid aca obamacare one big beautiful bill california/ 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. “It’s a pretty big cliff if all this stuff goes into effect,” said Dietz, the labor center’s healthcare program director. “And there’s a choice whether to make it less bad and maintain coverage for folks.” KFF Health News https://kffhealthnews.org/about us is a national newsroom that produces in depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF https://www.kff.org/about us . This article https://kffhealthnews.org/elections/xavier becerra longtime health coverage champion california gubernatorial race uninsured rate/ first appeared on KFF Health News https://kffhealthnews.org and is republished here under a Creative Commons Attribution NonCommercial NoDerivatives 4.0 International License https://creativecommons.org/licenses/by nc nd/4.0/ .