Xavier Becerra has promised to be California’s “Health Care Governor.”
Becerra’s agenda is ambitious: He wants California taxpayers to preserve public healthcare coverage threatened by federal funding cuts, maintain publicly funded care for undocumented immigrants, spend more on primary care and the healthcare workforce, and ultimately “build toward”a universal single-payer system.
Those promises may appeal to many California voters. But they come with questions Becerra has yet to answer: What will this cost, and who will pay for it?
That’s no small omission in a state already struggling to pay its bills. California’s enacted budget has an $18.5-billion operating deficit this fiscal year.
Healthcare is already one of the biggest pressures on the state budget. Spending on Medi-Cal has more than doubled over the past decade and is expected to eclipse $219 billion in the 2026-27 fiscal year. The program accounts for roughly 40% of total state spending.
California’s recent experience with Medi-Cal offers a warning about how quickly healthcare promises can outrun their price tags.
Over the past decade, Sacramento has gradually expanded full Medi-Cal coverage to undocumented residents, culminating in coverage for all income-eligible adults starting in 2024. In an October 2025 report, the Legislative Analyst’s Office estimated those expansions to cost roughly $10 billion annually from the general fund — “more than double the initial estimates.”
With the state facing persistent deficits, lawmakers have already begun retrenching. California froze new enrollment for undocumented adults beginning in January. And starting in July 2027, many adults aged 19 to 59 who remain enrolled in Medi-Cal will also face a $30 monthly premium.
Becerra proposes to move in the other direction, offering people taxpayer-funded coverage. His campaign promises to “protect existing coverage from federal rollbacks” and ensure that no Californian is left without care “regardless of income, ZIP code or immigration status.”
He argues that cracking down on Medi-Cal fraud waste and administrative inefficiency could free up money for his healthcare priorities. Those are worthwhile goals. But his campaign offers no estimate of how much those efforts would save — much less whether the savings would actually cover his new commitments.
Then there are the federal dollars disappearing from California’s healthcare system. The expiration of enhanced Obamacare subsidies in January eliminated nearly $2.5 billion in annual federal assistance for residents buying coverage through Covered California.
Sacramento has responded with state money — including $190 million for premium subsidies in 2026 and $300 million for an expanded subsidy program in 2027. Covered California acknowledges that this cannot replace the lost federal assistance.
Yet Becerra promises that on his first day in office he will direct state agencies to “maintain coverage continuity for every Californian affected by federal cuts or Medi-Cal rollbacks.”
That’s a promise with a price tag. So what is that price?
And that’s before getting to Becerra’s longtime goal: the abolition of private health insurance and the creation of a government-run, single-payer healthcare system.
Earlier this year, Becerra reportedly told the California Medical Assn. he would not push for state-level single-payer as governor. But his campaign site promises to “build toward” such a system — without explaining what that entails or how he would finance it.
California has studied the concept before, and the numbers are daunting. In 2022, the nonpartisan Legislative Analyst’s Office estimated that a fully operational CalCare system would cost the state between $494 billion and $552 billion annually — far more than California’s entire budget at the time.
Some of that could come from redirecting existing federal and state healthcare spending. Even so, an earlier LAO analysis concluded that a similar single-payer plan would still require new state taxes in the “low hundreds of billions of dollars” annually.
Becerra hasn’t said what new taxes he would impose, how large they would have to be or which federal funds he expects Washington to turn over. And although he has acknowledged that statewide single-payer would require federal cooperation, he hasn’t explained what California would do if Washington refuses.
Becerra is campaigning on making California more affordable. That’s why the missing numbers matter. Healthcare commitments don’t suddenly become free when the government pays for them. The cost falls somewhere — on taxpayers, employers, patients or other public priorities.
Before voters sign off on Becerra’s healthcare vision, they deserve to see the bill.
Sally C. Pipes, the president of the Pacific Research Institute and a fellow in healthcare policy, is the author of “The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It.” X: @sallypipes
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