In a conference organized by American Community Media, health specialists warned about the risk posed by cutting subsidies to the Medi-Cal program, California’s version of Medicaid. The event addressed how California’s experience could serve as a model of resistance for the rest of the country.

It took a long 60 years for Medi-Cal—a social health program aimed at low-income individuals—to reach large numbers of people in the United States. Today, the outlook is grim and uncertain: the country is facing the largest social health subsidy crisis in its history.

“It’s not just a health issue, but a community issue”

“I’m concerned as a father and as a doctor. Costs will start to rise. There will be a real effect on hospitals and community clinics. We will have fewer doctors, fewer nurses, and therefore less health care. That will have a direct impact on our community,” said Dr. Ilan Shapiro Strygler, SVP, Chief Health Correspondent and Medical Affairs Officer at AltaMed Health Services.

Shapiro stressed that community clinics manage the health of our population and that the entire community will be affected. He also warned that the economic base will suffer consequences: “As we invest in health systems, it’s a promise to our children. We all share the same promise: we want to strengthen ourselves as a community and move forward; Medi-Cal is that path.”

According to Shapiro, nearly 2 million people, including children, are expected to lose their coverage. He emphasized that children with different abilities will be among the most affected: “Many of the children I work with are neurodivergent and have chronic illnesses. We need Medi-Cal resources to ensure their health and continued improvement.”

To illustrate the future problems that cuts to Medi-Cal could cause—not only in personal health but also socially and communally—the doctor said: “Imagine a father who works two jobs, but if he doesn’t have access to health insurance, he won’t be able to keep them. That indirectly harms his family.”

He also warned about the fear and mistrust that lead many people to avoid treating chronic illnesses, such as diabetes, prioritizing daily survival: “People are choosing a way to survive instead of addressing their health problems.” He added that he is worried about short-term effects, especially during chronic disease seasons. “I’m afraid of what could happen with the flu.”

Medi-Cal as a Tool to Fight Poverty

Cary Sanders, Senior Policy Director at the California Pan-Ethnic Health Network and another expert in the discussion, emphasized the importance of Medi-Cal as a program that has historically fought poverty not only in California but also across the United States: “Medicaid is a civil rights program and it still is. It has survived regardless of federal attacks. It’s a crucial anti-poverty program for continuing to advance racial equity.”

Sanders also stressed that health care in California is quite expensive and that thanks to Medi-Cal, many families have managed to survive despite poverty. However, the OBBB law—passed as a bill on July 4—could roll back progress achieved through the Affordable Care Act (ACA), which reduced the uninsured rate in the state to 6%.

She also stated that it’s important to hold accountable those who voted to approve this bill, which is harmful to the country’s health: “People have the right to know what’s happening. We have to keep educating people about what this bill means and who voted for it.”

In that context, states are analyzing how to cope with the loss of federal subsidies, which could worsen medical debt. Sanders explained that “state marketplaces are exploring options to offset, at least in part, the potential loss of premium tax credit subsidies that might not be renewed.” However, she clarified that changes “are not going to happen overnight,” but insisted on the need to keep the debate alive and disseminate information about available financial assistance.

“Part of our job is to make sure people are aware of financial assistance. Many people don’t know how to access health services. We need to keep insisting on this,” she reaffirmed.

A Risk for Rural Hospitals and Health Care

Anthony Wright, Executive Director at Families USA, was clear in calling the OBBB law “a disaster.” “More than 17 million people will lose coverage, either because it’s taken away or because they face bureaucratic obstacles and rising costs that, to a large extent, prevent them from accessing it,” he said.

Wright warned that rural hospitals will be among the most affected, facing the risk of reducing services or even closing. For him, there are three key points: hold those who approved the law accountable, alert the public about what’s happening, and resist further cuts.

Currently, costs are high in both public and private plans, and an increase in cost-sharing and market premiums is expected, driven by the expiration of key tax credits and the reduction in the number of insured individuals. This will leave a smaller, sicker risk pool, pushing premiums even higher.

As a consequence, cuts could occur that would directly affect hospitals, clinics, and other providers. State governments, Wright concluded, will face the difficult decision of cutting benefits or reducing rates to health care providers.