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Don’t ask Gov. Gavin Newsom about Democratic lawmakers’ proposal to create a state-funded single-payer health care system — he hasn’t read it.

“I have not had the opportunity to review that plan, and no one has presented it to me,” Newsom said Monday while unveiling his record-high $286.4 billion budget proposal — which includes an estimated $45.7 billion surplus — for the fiscal year that begins July 1. (For more details, check out this comprehensive budget breakdown from CalMatters’ Alexei Koseff.)

Newsom pivoted back to his own “first in the nation” plan, which would expand access to Medi-Cal, the state’s health care program for low-income Californians, to all eligible residents regardless of immigration status starting in January 2024.

But the proposal still falls short of Newsom’s own promise — announced on the campaign trail in 2018 — to replace a complex patchwork of insurance programs with a single state-funded plan. And it puts him in the awkward position of running for reelection without clearly signaling to Californians that single-payer health care remains one of his top priorities.

Contrast that with the Legislature, where a key committee today is set to consider a bill that would create a universal health care program called CalCare. The committee’s leader, Democratic Assemblymember Jim Wood of Santa Rosa, has already vowed to move the bill forward.

But Newsom, long a proponent of setting “big, hairy, audacious goals,” seemed to strike a more cautious and incremental approach on Monday, emphasizing the importance of “dealing with reality” and “pragmatism” amid another COVID surge.

  • Newsom: “I think that the ideal system is a single-payer system, I’ve been consistent with that for well over a decade. … The difference here is when you are in a position of responsibility, you’ve gotta apply, you’ve gotta manifest, the ideal. This is hard work. It’s one thing to say, it’s another to do. And with respect, there are many different pathways to achieve the goal.”

Other interesting tidbits from Newsom’s budget press conference:

  • He said California has plans to “contract and manufacture its own insulin at a profoundly reduced cost,” but declined to provide more details.
  • He wants to postpone California’s mandated gas tax increase — “a $523 million gas tax holiday of sorts” — expand business tax credits and pay off $3 billion in unemployment insurance debt, ideas that GOP lawmakers said they had originally proposed.
  • He said “changes need to be made” to state regulators’ controversial proposal to reform a wildly successful rooftop solar incentive program.
  • He noted that although the budget plan invests in reproductive rights, it doesn’t call for a “mass expansion” in funding to help out-of-state women seek abortions in California.
  • And he said taxpayers will likely see “substantial” rebates due to a law forbidding the state from spending more tax dollars per Californian than it did in 1978, once adjusted for inflation, though the exact amount won’t become clear for months.

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The coronavirus bottom line: As of Sunday, California had 5,943,177 confirmed cases (+5.5% from previous day) and 76,550 deaths (+0.3% from previous day), according to state data. CalMatters is also tracking coronavirus hospitalizations by county.

California has administered 66,364,468 vaccine doses, and 71.7% of eligible Californians are fully vaccinated.

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1. What’s in Newsom’s homeless plan?

Homeless tents at an encampment in Los Angeles on Nov. 17, 2021. Photo by Miguel Gutierrez Jr., CalMatters

Newsom hinted at another big policy shift Monday: He said his administration wants “to tackle something that requires us to be a little bit uncomfortable, and that’s conservatorship reform.” The governor went on, “We, with respect, need a few more tools to help those who truly can’t help themselves” due to severe mental illness.

California’s conservatorship laws came under a national spotlight last summer, first when pop star Britney Spears sought to overturn her conservatorship, then when some Republican recall candidates said homeless Californians should be forced into mental health treatment. Newsom dismissed the idea that his focus on conservatorships was a political response to the recall, arguing that “the issue of encampments is not directly tied to the issue of conservatorships.” He also managed to work in a dig at Larry Elder, the top vote-getter among the recall challengers: “I’m surprised to even hear that there was a (conservatorship) proposal from a current radio talk show host who was one of the principal candidates … his name now escapes me, forgive me.”

Nevertheless, Newsom’s budget blueprint heavily emphasizes encampment clearings — to the tune of $500 million, a ten-fold increase from the funding approved last year. CalMatters’ Manuela Tobias takes a closer look at Newsom’s multibillion-dollar plan to address California’s housing and homelessness crises.

2. Hospitals under increasing pressure

Registered nurse Kyanna Barboza tends to her COVID-19 patient at St. Joseph Hospital in Orange on Jan. 7, 2021. AP Photo/Jae C. Hong
Registered nurse Kyanna Barboza tends to a COVID-19 patient at St. Joseph Hospital in Orange County on Jan. 7, 2021. Photo by Jae C. Hong, AP Photo

California’s COVID situation also came into clearer focus on Monday, when Newsom presented statistics comparing conditions on Jan. 9 to one year ago. The topline takeaway: Although the state has close to twice as many confirmed COVID cases as it did at this time in 2021, it has half as many patients hospitalized with the virus. But the total amount of hospitalized patients — including those that don’t have COVID — is quickly approaching the record set last winter, and Newsom predicted the state could surpass that peak by Feb. 2. He noted that California is currently employing 2,250 contract workers to help overburdened and understaffed hospitals, and is trying to hire another 1,250.

Newsom also reiterated that California is “100%” committed to not reinstating lockdowns due to omicron. But the quickly spreading variant is testing that resolve: Sonoma County on Monday asked residents to stay home as much as possible for the next 30 days, while also banning indoor gatherings of more than 50 people and outdoor gatherings of more than 100 people. Some Los Angeles County schools are delaying plans to reopen campuses and hold sports competitions this week, joining some in the Bay Area that already took that step. And Palo Alto Unified is so desperate for staff that it issued a Sunday bulletin begging for parent volunteers to help keep schools open.

3. Mayes bids Legislature adieu

Assemblymember Chad Mayes speaks before a vote on Sept. 11, 2019. Photo by Anne Wernikoff for CalMatters

From CalMatters political reporter Ben Christopher: The state Legislature will soon be losing its only registered independent. Assemblymember Chad Mayes of Rancho Mirage announced Monday that he won’t run again in 2022, making him the 15th legislator so far to either rule out a reelection campaign or to quit mid-term. But Mayes isn’t dismissing a possible run for Congress against GOP Rep. Ken Calvert, whose district was made considerably more competitive by the state’s redistricting commission. “I’m not ruling it out, but I’m not ruling it in either,” he told Ben, adding that he’s still adjusting to life as the sleep-deprived father of a two-week-old. “I’m just trying to get out of the fog of not sleeping well at night. Once I hopefully get through some of that, I will try to think through what’s next.” Meanwhile, Democratic Palm Springs City Councilmember Christy Holstege has already announced plans to run for Mayes’ seat. 

A quick look back at Mayes’ rollercoaster journey from the GOP to no party preference:

  • Elected in 2014, Mayes served as Assembly Republican leader, where he tried to guide his caucus toward the political center while former President Donald Trump pushed the GOP base to the nativist right. 
  • Mayes was booted from that job in 2017 after helping Democrats reauthorize one of the state’s landmark programs to combat climate change. 
  • He left the GOP for good in 2019 and ran for reelection the following year as an independent — and won.

Mayes told Ben he wanted “to prove the concept” that you can break from the two-party system in California and succeed. “Someone else can take it up now. I don’t feel like I have to prove it again,” he said.

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CalMatters commentary

CalMatters columnist Dan Walters: Should California create a single-payer, state-managed health care system for 40 million residents?

Ending health care insecurity: California legislators have studied proposals for universal health care at length. Now, it’s time to pass a bill that would actually create such a system, argues Cathy Kennedy, president of the California Nurses Association.

Restaurants need consistent regulations: California lawmakers should adopt statewide rules for outdoor dining and abandon legislation that would harm the restaurant community, writes Jot Condie, president and CEO of the California Restaurant Association.

Other things worth your time

A California prison town weighs a future without a prison. // New York Times

Bay Area freeway shootings have nearly quadrupled in 4 years. // San Francisco Chronicle

Editorial: California has to stop bungling affordable housing. // Los Angeles Times

San Francisco ADUs are being built mostly in the richest parts of the city. // San Francisco Chronicle

As new housing law hits Bay Area, developers wade in. // Mercury News

Bay Area mayors warn of ‘catastrophic’ impact on local restaurants without more federal aid. // San Francisco Chronicle

New California law on mental health curriculum goes into effect. // EdSource

California farmworkers eligible for more overtime pay, but some growers say it’s a problem. // Sacramento Bee

Sanger mayor told to quit after domestic violence arrest. // Fresno Bee

Biden is watching this California city’s electric car program. // Los Angeles Times

Santa Cruz’s notorious lagoon about to get an upgrade. // Mercury News

Rancho Guejito tapped groundwater deep in San Pasqual Valley. Some farmers aren’t happy about it. // San Diego Union-Tribune

Winter storms deal death blow to iconic California rock formation. // AccuWeather

San Jose is losing hundreds of acres of trees a year, study says. // Mercury News

See you tomorrow.

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Emily Hoeven wrote the daily WhatMatters newsletter for three years at CalMatters . Her reporting, essays, and opinion columns have been published in San Francisco Weekly, the Deseret News, the San Francisco...