Hi. I'm Christine Mai-Duc, a KFF Health News correspondent based in San Francisco. When I'm not trying to get two kindergartners out of bed and out the door, I like traveling, eating dessert, and making lists.
By Christine Mai-Duc
As Gov. Gavin Newsom spars with President Donald Trump and courts national attention for a potential presidential bid, at home he's catching flak from the left and the right on health care.
The California Democrat came into office promising to fight for "guaranteed health care for all," and he came close to achieving it. Really close. But as it turns out, that's easier said than done when you're juggling chronic budget deficits, rising health care costs, and shrinking federal support.
Now he's walking the fine line between keeping his early promises to progressives and being tarred as a reckless state executive who has stretched California's spending beyond its means.
After years of political infighting, Newsom and the Democratic-controlled legislature in 2024 broadened California's Medicaid program, Medi-Cal, to all income-eligible children and adults regardless of immigration status.
Now, he's rolling back those expansions in the name of "fiscal prudence."
This year, California froze Medi-Cal enrollment for most adults without legal status, just two years after making them all eligible. On July 1, immigrants not eligible for federal Medicaid — both legal residents and those without authorization — will lose access to state dental coverage. Next year, they'll have to start paying monthly premiums.
Last month, Newsom proposed letting roughly 200,000 legal immigrants — asylees, refugees, and others — get cut off from Medi-Cal after Sept. 30, when the federal government will stop paying for them.
Advocates are livid.
Progressives say Newsom's political ambitions — and perceived need to distance himself from the polarized topic of immigrant health care — go against his early pledges.
"You're clouded by what Arkansas is going to think, or Tennessee is going to think, when what California thinks is something completely different," said California state Sen. Caroline Menjivar, chair of the budget subcommittee on health and human services.
Meanwhile, Republicans and fiscal hawks have painted Newsom as a tax-and-spend Democrat prioritizing use of limited state funds on free health care for noncitizens. And Newsom has taken hits from the Trump administration accusing California of "gaming the system" to use federal funds for immigrant health services.
He's not the only governor grappling with this dilemma. And all 50 states, which are currently required to provide health coverage to refugees, asylees, and others, will have to decide whether to backfill that coverage for some 1.4 million legal immigrants starting Oct. 1, when a provision of the One Big Beautiful Bill Act kicks in and leaves states without federal reimbursement for their care.
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