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Single-Payer Health Care and the Governor’s Race

Alyssa Dykman June 4, 2018
A stethoscope on a background made of $20 bills

One issue that may prove decisive for Democrats in the 2018 governor’s race is single-payer health care. With the leading Democratic candidates supporting a single-payer system—and the leading Republican candidates in opposition—the race has shed light on the financial, political, and regulatory challenges associated with expanding health coverage across the state.

Last year, the state senate passed a bill (SB 562) that would establish a single-payer health insurance program to cover all Californians. However, the bill was shelved in the state assembly until further notice. According to estimates by the nonpartisan Legislative Analyst’s Office, the bill’s total annual costs would be about $400 billion. Democratic gubernatorial candidates Gavin Newsom and Delaine Eastin have been the most vocal proponents of single-payer health care and have publicly backed the bill. Democratic candidates Antonio Villaraigosa and John Chiang, while supportive of the idea, have expressed concerns over financing and implementation. Both the leading Republican candidates, John Cox and Travis Allen, strongly oppose single-payer health care and have emphasized the need for more competition in the marketplace.

With candidates’ differing positions, how are Californians feeling about single-payer health care today?

The May PPIC Statewide Survey found a majority of California’s likely voters (53%) favor a single-payer state plan. However, if this plan requires raising taxes, support declines to 41%. Across parties, an overwhelming majority of Democratic likely voters (77%) are in favor, while an overwhelming majority of Republicans (74%) are opposed; independent likely voters are divided (46% favor, 46% oppose). Notably, 66% of Democratic likely voters would favor a single-payer system—even if it means higher taxes.

The issue has become a litmus test for Democrats—pitting progressives against pragmatists—but, overall, Democrats express strong support for a single-payer system. Among likely voters who call themselves strong Democrats, 81% are in favor, compared to 69% who say they are not very strong Democrats. Among likely voters who call themselves strong Republicans, 83% are opposed to a single-payer system (the sample size for those calling themselves not very strong Republicans is too small for analysis).

Given partisan divides, the next governor may face significant political hurdles moving forward with single-payer health care. Coupled with statewide challenges, California would need to collaborate with the federal government to implement such a system. In consideration of these factors, the June primary is an opportunity for Californians to determine their future leadership and the state’s policy directions—including a possible step toward single-payer coverage.

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