Gov. Gavin Newsom announced sweeping proposals to tackle the state’s healthcare needs shortly after taking office on Monday, outlining a dramatic Medi-Cal expansion that would cover young immigrant adults who are in the U.S. illegally, require that all consumers in the state carry health insurance and increase subsidies for middle-class families to help those who need it.

The Day 1 announcement was as much a rebuke to the Trump administration as it was an attempt by Newsom to make good on his campaign promise to fix a fragmented healthcare system that leaves many priced out or underinsured. The governor also signed executive orders to consolidate the state’s prescription drug purchases into a state-run program and to create a new surgeon general position to look at health disparities before they manifest, as Newsom put it.