Gavin Newsom might not be able to accomplish his ambitious campaign goal of bringing government-funded universal health care to California, but his first hires suggest he’s planning something big.

Incoming chief of staff Ann O’Leary helped develop the Children’s Health Insurance Program when she worked in the Bill Clinton White House.

His cabinet secretary — typically the second-highest-ranking cabinet member — Ana Matosantos helped lead negotiations to expand health insurance access under former Gov. Arnold Schwarzenegger.

And several other key appointees in the new administration have spent years advocating to make health care more affordable and expand immigrants’ access to insurance.

“These are the appointments of a governor who is serious about doing something big on health care,” said Anthony Wright, executive director of Health Access California. “You have folks who have engaged the issue very seriously and have the scars to prove it.”

Newsom campaigned on expanding health care access through a government-funded system often referred to as “single-payer.” That could cost $400 billion — more than double the state budget — and would need federal approval.

Newsom’s hires and the impracticality of federal cooperation indicate his plans aren’t quite that ambitious, said Chad Mayes, the top Republican on the Assembly Health Committee.

“It looks to me like he will be working toward universal coverage as opposed to a single payer health care system,” the Yucca Valley assemblyman said in a statement.

Although vocally supportive of single-payer, Newsom has also acknowledged the obstacles and suggested that reducing health care costs and expanding insurance coverage could lay the groundwork for such a system.

Whether or not Newsom pursues a single-payer plan, he’ll still need to work with the federal government, which funds the bulk of the state’s health programs. O’Leary brings substantial experience at that level, having served as a top aide to Hillary Clinton.

Matosantos, meanwhile, has an extensive state-level resume.

The former California finance director helped lead health care negotiations among Republican Gov. Schwarzenegger, legislative Democrats and competing interest groups. That required both political savvy and policy expertise, Wright said.

“Not everyone can do that,” he said.

Matosantos, who once worked for the Senate Health Committee, will serve as liaison between Newsom and the state agencies and departments he oversees.

Her background at the Department of Finance during the recession might make her more hesitant to increase state spending, said Jen Flory, a policy advocate at the Western Center on Law and Poverty.

“She was in charge of Finance during some really challenging times,” Flory said. “I don’t think that anyone has any blinders that she’s just going to throw money around.”

Lawmakers, who killed a single-payer bill in 2017, haven’t introduced a new version this session. The Legislative Analyst’s Office at the time projected the last one had a budget-busting $400 billion annual price tag.

But there is broad legislative support for expanding access to health care. It’s a top issue on both sides of the aisle. Mayes, who has a history of collaborating with Democrats from his position in the minority party, said he hopes to work with Newsom toward universal health care that reduces costs while increasing quality.

So far, the biggest health proposal introduced this session would extend state coverage to people without legal status and cost about $3 billion annually. More than half of the more than 3 million California residents who lack health insurance aren’t eligible for state coverage because of immigration status.

Newsom’s pick to run his Office of Strategic Communications and Public Engagement, Daniel Zingale, was a key backer of previous versions of the proposal as senior vice president at the California Endowment health care foundation. Zingale’s extensive California health policy background also includes advising Schwarzenegger’s universal health care push.

Wright said he expects Angie Wei, whom Newsom hired as a top policy development aide, will be a “powerful voice for immigrant inclusion in health care.” Wei advocated for affordable health coverage in her most recent role at the California Labor Federation and for immigrant rights in her work with the California Immigrant Welfare Collaborative.

Newsom is also bringing on Maricela Rodriguez, who oversaw the California Endowment’s promotion of health insurance coverage, in a top communications role.

“This is a group of people that have been working on various health proposals for a very long time,” Flory said.