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Across California and the nation, health providers, advocates, local officials, and state legislators are eyeing tax increases to offset a loss of more than $900 billion in federal Medicaid dollars as a result of the GOP’s One Big Beautiful Bill Act. In Los Angeles County, community clinics have banded together in support of a half-cent sales tax.
Martha Santana-Chin, a daughter of Mexican immigrants, last year took the helm of L.A. Care, the nation’s largest publicly operated health plan. She warns that looming federal cuts will push up to 650,000 people off L.A. Care’s Medicaid rolls by the end of 2028.
The federal budget bill President Donald Trump signed into law in July is creating uncertainty for states trying to rein in health care spending. In California, a lawsuit by the hospital industry challenging state spending caps cites the law, which will slash Medicaid spending, as one of many financial pressures.
Health care professionals fear that new caps on federal student lending, set to start in July, will put medical school out of reach for many who want to become doctors and exacerbate physician shortages. Others say unlimited federal lending has fed a rise in academic costs, saddling families and, ultimately, taxpayers with debt.
Jessica Altman, the head of California’s Affordable Care Act health insurance marketplace, warns letters will be sent out this week with sky-high premiums unless Washington extends covid-era enhanced tax credits by then. Even if Congress acts later and rates are lower than feared, she says, shoppers could be scared off.
In a rural, largely Republican region of California, homegrown efforts to bolster the medical workforce face an uphill battle, in part because of federal health care cuts approved by the GOP Congress and signed by President Donald Trump in July, as well as a state budget deficit.
The GOP’s tax and spending law and a new rule by the Centers for Medicare & Medicaid Services will make it harder to enroll in Affordable Care Act health plans, will raise consumers’ out-of-pocket costs, and could prompt younger, healthier people, including lawfully present immigrants who will lose financial aid, to drop coverage.
Spending cuts hitting medical providers, Medicaid and Affordable Care Act enrollees, and lawfully present immigrants are just some of the biggest changes the GOP has in store for health care — with ramifications that could touch all Americans.
Republican proposals to tighten the use of special taxes to fund Medicaid programs could deprive states of billions of dollars for safety net health care. In California, any such limit would come on top of Medicaid cuts proposed by California Democrats in response to a $12 billion state deficit.
Monica Soni, Covered California’s chief medical officer, oversees an effort to hold health plans financially accountable for the quality of care they provide, including childhood vaccination rates, which have fallen in California and nationwide. She worries federal spending cuts could soon bring turbulence to the state’s Affordable Care Act marketplace.
The state has in recent years embraced several initiatives recommended in an influential health care workforce report, including alternative payment arrangements for primary care doctors to earn more. Despite increasing residency programs, student debt forgiveness, and tuition-free medical school, California is unlikely to meet patient demand, observers say.
At a town hall in Orange County, California, angry residents said Congress should keep its hands off Medicaid. The cuts contemplated in a House budget blueprint would bore a giant hole in California’s version of the safety net health insurance program, Medi-Cal, which covers nearly 15 million residents.
Mental health workers on strike in Southern California say Kaiser Permanente is woefully understaffed, its therapists are burned out, and patients are often denied timely access to care. The insurer says it has largely fixed the problem. But across California and the nation, mental health parity is still not a reality.
A primary care clinic burned, medical offices closed, and hospitals struggled with possible evacuations. The wildfires that have incinerated large swaths of Los Angeles County are stressing the region’s health care infrastructure. Still, providers continue to find ways to deliver vital care.
The growing toll of climate-related disasters is a risk to the emotional well-being of young people. An Orange County, California, pediatric emergency doctor wants to add questions about climate change to standard mental health screenings conducted in pediatricians’ offices and other settings where kids seek care.
As Donald Trump prepares to reenter the White House with a Republican-controlled Congress, health officials and community advocates in California worry that large-scale Medicaid cuts could be enacted as soon as next year. More than 60% of California’s $161 billion Medi-Cal budget comes from Washington.
Proposition 35, which would use revenue from a tax on managed-care plans to raise the pay of health care providers who serve Medi-Cal patients, has united a broad swath of California’s health care, business, and political establishments. But a newly formed, smaller group of opponents says it will do more harm than good.
John Baackes, who steered Medi-Cal’s largest health plan following the Affordable Care Act expansion, and later prepared it for a state overhaul of Medi-Cal, will retire after this year. Baackes believes low payments to doctors and other providers, along with an acute labor shortage, hamper Medi-Cal’s success.
Proposed legislation would require the state attorney general’s consent for a wide range of private equity acquisitions in health care. The hospital lobby negotiated an exemption for for-profit hospitals.
Kamala Harris fought health care consolidation during her tenure as California’s attorney general, and she could escalate the fight nationally if she wins in November. Still, the pace of mergers has accelerated.
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