Gov. Gavin Newsom signed a bill Saturday that sets the stage for California to work toward universal health care, like a single-payer system that progressive activists have sought for years.

The law could help California obtain a waiver that would allocate federal Medicaid and Medicare funds to what could eventually become a single-payer system that would cover every California resident and be financed entirely by state and federal funds.

The California Secretary of Health will be required to make recommendations on drafting the federal waiver by June 1, 2024, under

Senate Bill 770.

With this signature, California takes a historic step toward universal health care, said a statement from the bill’s author, Senator Scott Wiener (D-San Francisco). The state will now begin to answer the complex question of how we can access federal funding to finance a universal health care system such as single payer.”

For decades, Californians have tried, failed, and tried again to reform the state’s health care system, but attempts at a major overhaul have been stymied by enormous costs, legal and bureaucratic hurdles, and disagreement among groups within the health care industry.

Wiener’s legislation represents a step-by-step approach that will begin the process of solving one piece of a complicated puzzle, rather than attempting to overhaul the health care system on a wholesale scale.

Proponents of the single-payer model find fault with the existing health care system, leaving many patients with astronomical co-pays and leaving some tormented by fear of the debt they will incur as a result of medical procedures.

Although the bill received support from many health care reform advocates, it faced opposition from both sides of the political spectrum. Critics on the left said it doesn’t go far enough to move California toward single-payer health care, while critics on the right said it’s an ultimate goal of eliminating private health insurance and raising taxes.

The California Nurses Assn., which has advocated for single-payer health care for decades, opposed the measure, arguing that the work the bill requires at the California Health and Human Services Agency has already been done.

Carmen Comsti, a leading regulatory policy specialist for the nurses union, said the bill would be an unnecessary waste of state resources.

Michael Lighty, president of Healthy California Now, the sponsor of Wiener’s bill, countered that the legislation promises a universal system, which could include a single-payer system.

“What we have made clear is that there is no predicted outcome,” Lighty said.

Cindy Young, board member of the California Alliance for Retired Americans, which supports Wiener’s bill, emphasized that time is of the essence, especially for California’s aging population.

“There are things that seniors can’t get, or it costs our retirement money to be able to afford those things,” said Young, 68. “Long-term care is an absolute necessity. What will happen to us if we can do that? ‘Take care of yourself?’

The nurses union is urging lawmakers to consider a more ambitious single-payer bill next year.