Health care is front and center as Desantis and Newsom go mano a mano

KFF Health NewsNov 27 2023

Republican presidential candidate Ron DeSantis and Democratic Gov. Gavin Newsom — political rivals from opposite coasts and proxies for red and blue America — are set to square off for a first-of-its-kind debate Nov. 30 in Georgia.

Newsom, a liberal firebrand in his second term as governor of California, isn't running for president in 2024. But he goaded DeSantis, in his second term as governor of Florida, to go mano a mano. "I'll bring my hair gel. You bring your hairspray," he taunted on social media.

The matchup promises to be a heated brawl between rising political stars who lead two of the nation's most populous and diverse states. And it will mark the first time the politicians meet in person even as they have very publicly traded barbs and insults, in recent weeks attacking each other in fundraising videos and campaign ads.

Front and center will be homelessness and health care, top priorities for voters — and issues that have largely defined the governors' policies and leadership styles. From abortion to covid-19 vaccines, Newsom and DeSantis could not be further apart.

Earlier this year, DeSantis blasted California for being too generous with public benefit programs, such as Medicaid, which the Golden State has expanded to all eligible residents regardless of immigration status. That sweeping policy takes effect in January and goes well beyond the optional expansion of Medicaid that the Affordable Care Act offered states. In Florida, one of 10 states that have refused to expand Medicaid under Obamacare, DeSantis wears the state's 11% rate of uninsured residents as a badge of honor.

"We're not going to be like California and have massive numbers of people on government programs without work requirements," DeSantis said at a presidential primary debate in Southern California earlier this year.

DeSantis has led his state to restrict abortion and gender-affirming care and to ban covid-related mask and vaccine mandates.

Newsom, a slick and brash surrogate for Democratic President Joe Biden, has slammed DeSantis for putting Floridians in danger and stripping them of their rights.

"Join us in California, where we still believe in freedom," Newsom said in a political ad earlier this year.

Newsom has earned the moniker of "health care governor" by catapulting the issue to the top of his policy priorities. He made California an abortion sanctuary and is dramatically expanding health care benefits. He had promised to bring single-payer health care to the nation's most populous state while campaigning for his first term, but that idea hit stiff political opposition early in his tenure. And now Newsom boasts about bringing the state's uninsured rate to an all-time low of 6.5% by expanding coverage in other ways.

These issues are expected to take center stage during the nationally televised 90-minute debate on Fox News, which could have major reverberations for the presidential contest next year and could even help shape the 2028 field of White House contenders.

In advance of the showdown, KFF Health News analyzed 10 of the governors' top health care positions and how their policies have improved — or hindered — the health of the residents they represent.

Obamacare

Florida

DeSantis has refused to expand Medicaid eligibility to more people under the Affordable Care Act. Partly as a result, more than 3 million Floridians had coverage through the federal Obamacare exchange as of February, more than any other state. Florida does not have a state-based exchange or offer state-sponsored subsidies.

California

The state has enthusiastically embraced the Affordable Care Act, expanding Medicaid while setting up its own insurance exchange, Covered California. Under Newsom, it has also gone well beyond the provisions of Obamacare and created a state requirement for Californians to have health insurance after the federal mandate was eliminated.

Abortion

Florida

DeSantis approved legislation in April banning abortions after six weeks of pregnancy. However, the Florida Supreme Court has taken up a challenge to the 15-week ban introduced in 2022, which will determine if the six-week ban can take effect.

California

Newsom spearheaded the effort in 2022 to amend the state constitution to enshrine the right to abortion and birth control. He also approved $60 million to help uninsured patients and people from out of state pay for abortions in California, and signed reproductive health care laws, including one protecting doctors who mail abortion pills to other states.

Transgender care

Florida

Under DeSantis, Florida passed a law this year banning gender-affirming health care for trans minors and mandating that adult patients sign informed consent forms before starting or continuing hormone treatment. The law also restricts who can order hormone therapy to physicians and prohibits the use of telehealth for new prescriptions. A federal lawsuit challenging the law is set to go to trial in mid-December.

California

Newsom and other state leaders have amended state law to ensure all California adults and children are entitled to gender-affirming health care services. And insurance companies doing business in California must include information on in-network providers for gender-affirming services by 2025. State health care agencies are designing "enforceable quality standards" to ensure trans patients have access to comprehensive care.

Homelessness

Florida

DeSantis has not declared homelessness a priority. In a video filmed on the streets of San Francisco and posted to social media in June, DeSantis used the topic as a campaign cudgel to criticize what he called "leftist policies" in California. Florida is experimenting with using Medicaid funds to address homelessness, but the program is limited. Nearly 26,000 people are homeless in Florida, or 12 of every 10,000 residents.

California

Newsom has plowed more than $20 billion into the homelessness crisis, with billions more for health and social services. For example, some homeless Californians can get social services through the state's Medicaid program, such as money for rental security deposits, utility payments, and first and last month's rent. Newsom also led a new state initiative that could force some homeless people into mental health or addiction treatment. More than 171,000 people are homeless in California, or 44 of every 10,000 residents.

Mental health

Florida

DeSantis has kept his pledge to advocate for mental health treatment programs as governor, although Florida still ranks 43rd nationally in access to mental health care and has the fourth-highest rate of adults with mental illness who are uninsured, according to the Miami Center for Mental Health and Recovery. Under DeSantis, Florida has increased state funding for mental health programs in schools and peer-to-peer mental health services for first responders, and directed funding to suicide prevention.

California

Newsom in 2020 signed one of the nation's strongest mental health parity laws, which requires insurance companies to cover mental health and substance use disorders just as they would physical health conditions. He is funding a $4.7 billion initiative to provide mental health treatment in schools. Newsom is also leading the campaign for a statewide, $6.4 billion bond measure in 2024 to revamp and expand community-based behavioral health programs, including thousands of new treatment beds.

Addiction

Florida

Florida's drug overdose death rate was 37.5 per 100,000 people in 2021. In August, DeSantis announced a new statewide addiction recovery program billed as a "first of its kind" in the United States, using peer counselors, medication-assisted treatment, and a coordinated network of support services. DeSantis also authorized Florida counties to adopt needle exchange programs in 2019 to reduce the spread of blood-borne diseases and encourage addiction treatment.

California

California's drug overdose rate was 26.6 per 100,000 people in 2021. Newsom is sending the state Highway Patrol and National Guard into San Francisco to combat the open-air fentanyl trade and is boosting addiction recovery programs statewide. But he vetoed legislation last year that would have allowed Los Angeles, San Francisco, and Oakland to establish safe injection sites.

Prescription drugs

Florida

A DeSantis proposal submitted to the FDA in 2020 includes allowing imported medications from Canada. A new state law also sets price limits for pharmacy benefit managers — intermediaries between insurers, pharmacies, and manufacturers — and creates new rules for them around pricing transparency. The law also requires pharmaceutical companies to disclose significant price hikes.

California

Newsom is spearheading a $100 million, first-in-the-nation initiative that puts California in the generic drugmaking business, beginning with insulin and the opioid reversal drug naloxone. California already had a pricing transparency law when Newsom took office. This year, he signed a law that tightens state regulations for pharmacy benefit managers.

Health care affordability

Florida

In 2019, DeSantis signed the Patient Savings Act, which allows health insurers to share cost savings with enrollees who shop for health care services, such as imaging and diagnostic tests. Under his leadership, Florida lawmakers have also allowed short-term health plans lasting less than a year and direct health care agreements between a patient and a health care provider that are not considered insurance and are not subject to Florida's insurance code.

California

One of Newsom's first health care initiatives was to fund state-financed health insurance subsidies for low- and middle-income residents who purchase insurance through Covered California. Newsom this year also agreed to lower copays and get rid of some deductibles for plans sold through the exchange. California's newly created Office of Health Care Affordability is capping industry cost increases and could potentially regulate health industry consolidation. California bans short-term health plans.

Public health

Florida

DeSantis signed legislation in 2021 banning government, schools, and private employers from requiring covid vaccinations. In 2023, he pushed legislators to adopt laws prohibiting certain vaccine and mask requirements. He also formed a Public Health Integrity Committee led by his hand-picked surgeon general, Joseph Ladapo, whose official guidance on covid vaccines contradicts the CDC's recommendations. The Sunshine State's covid-19 vaccine booster rate for residents age 5 and older is 12.4%.

California

Newsom became the first U.S. governor to issue a statewide stay-at-home order at the start of the covid-19 pandemic. He pushed strong vaccination and mask mandates and accused DeSantis of being weak on public health. Newsom has also signed laws strengthening childhood vaccination mandates, including a measure that cracks down on bogus medical exemptions granted by doctors. The Golden State's covid-19 vaccine booster rate for residents ages 5 and older is 21.9%.

Immigrant health care

Florida

With DeSantis making immigration a priority, legislators passed a state law requiring all Florida hospitals to ask on their admission forms whether a patient is a U.S. citizen or lawfully present in the country. Doctors, nurses, and health policy experts say the law targets marginalized people who already have difficulty navigating the health care system and will further deter them from seeking care.

California

Beginning in January, all immigrants who meet income qualifications will be eligible for the state's Medicaid program. Before Newsom took office, California had already expanded eligibility to unauthorized immigrant children through age 18. Newsom then signed laws expanding the program to young adults up to age 26, adults 50 and older, and, later, immigrants of any age who otherwise meet eligibility requirements.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.