Xavier Becerra, a former U.S. congressman and Health and Human Services secretary, is running for California governor against Republican Steve Hilton. Becerra’s career has been marked by efforts to expand health insurance coverage through the Affordable Care Act, which he helped pass in 2010 and subsequently defended as California’s attorney general. During his tenure as Biden’s health secretary, the national uninsured rate reached a historic low of 8%, with 310 million Americans covered in 2024.
However, Becerra faces a significant healthcare challenge should he win the November election. According to a May analysis by the UC Berkeley Labor Center, the number of uninsured Californians under 65 is projected to nearly double from 2.4 million to 4.6 million by 2030. This decline stems from recently enacted state and federal cuts to Medicaid and ACA marketplace programs. The labor center warned legislators that these changes could cost California approximately 200,000 jobs, predominantly in the healthcare sector, and could result in California losing as much as $30 billion in annual federal funding.
The anticipated increase in uninsured individuals poses challenges for hospitals, insurers, and the broader economy. Hospital systems have already begun reporting higher levels of unpaid medical bills, and health insurance premiums are expected to rise as plans face costlier patient populations. Becerra has promised an executive order to maintain coverage for those affected by federal cuts and suggested redirecting administrative inefficiencies in the healthcare industry to offset costs, though he has not detailed a comprehensive funding strategy.
Becerra’s opponent, Hilton, is running on a platform that includes eliminating state-funded coverage for undocumented immigrants and redirecting those savings toward income tax reductions. The second Trump administration has tightened ACA enrollment requirements and reduced enhanced premium tax credits, contributing to the projected coverage losses. This policy environment presents Becerra with the task of managing what healthcare officials describe as a critical challenge during his potential tenure.
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