Health care affordability has emerged as a top concern in California’s 2026 gubernatorial race, with candidates addressing how they would respond to anticipated federal cuts to safety net programs and improve access to mental health services.At a November forum at UC Riverside, four Democratic candidates; former HHS Secretary Xavier Becerra, State Superintendent Tony Thurmond, former LA Mayor Antonio Villaraigosa, and former State Controller Betty Yee all agreed the state would need to push for efficiency in the health care system and find new revenue sources to counter expected federal cuts, though they disagreed on funding approaches.Becerra positioned himself as a potential “health care governor” who would resist Trump administration policies, while Thurmond pledged to pursue a single-payer system, though candidates provided limited specifics on how they would actually reduce health care costs.The focus on health care comes as California faces significant challenges: the state recently froze Medi-Cal enrollment for adults without legal status starting in 2026 and implemented premiums due to budget deficits, while family premiums for employer-based coverage averaged nearly $27,000 this year—a 6% increase from 2024. Meanwhile, Governor Newsom’s earlier promises of single-payer health care remain unfulfilled, with previous legislative attempts failing amid cost concerns, including one 2017 estimate of $400 billion annually.
Implications for Hospitals and Health SystemsThe next governor will likely need to balance defending California’s health care safety net against federal funding cuts while also addressing persistent affordability and access problems. For hospitals and health systems, this means potential uncertainty around Medi-Cal reimbursement levels and enrollment, possible changes to state health care financing, and continued pressure to improve efficiency and reduce costs for patients, all while the political direction on whether California pursues single-payer or other systemic reforms remains unclear.