CalMatters
By Kristen Hwang, CalMatters
The last time Donald Trump was president, his health care policies chipped away at the Affordable Care Act and helped eliminate federal abortion rights, leaving states to fill the gaps. In his second term, experts predict Trump’s agenda to be similar and warn that health care will get more expensive and harder to access for millions of people.
Congressional Republicans, newly empowered by Trump’s victory and the Senate moving to GOP control, have made it clear that they intend to try to implement long-standing conservative goals that include decreasing government spending on health care and further dismantling abortion rights, which are currently protected in about half of the country, including California.
Newly nominated Health Secretary Robert F. Kennedy Jr. has also pushed erroneous claims about vaccine hazards and exaggerated the risks of water fluoridation that could have ripple effects across state public health efforts.
The Democratic supermajority in the California Capitol, however, has spent the past several years passing laws to stymie future conservative administrations on health care, said Mia Bonta, chairperson of the Assembly health committee and a Democrat from Oakland.
Legislators have protected insurance coverage of abortion and transgender care. They have expanded health insurance programs to low-income undocumented immigrants and paid for it with state funds. They have taken pieces of the Affordable Care Act and written it into state law, expanding the enrollment period and banning lifetime limits on coverage. And they’ve invested millions of dollars into public health after the system languished for a decade.
“We were able to be very deliberate in the past several years to Trump-proof our health system moving forward,” Bonta said.
Not all state lawmakers have been happy with California’s health care expansions. Senate Republican Minority Leader Brian Jones, for instance, said public insurance for undocumented immigrants, which as of this year is available to all income-eligible immigrants, is too expensive and should be “delayed or repealed entirely.”
But Democratic lawmakers and health care advocates say they are better prepared than the first time Trump took office — though they expect the new administration to put California’s new laws to the test.
“We have their playbook from 2017, and almost everything they tried to do, California helped stop through our advocacy … or through court cases,” said Rachel Linn Gish, communications director for Health Access California. “In that way we are in a much stronger position than before.”
Affordable health care at risk
During his first term, Trump tried and failed to repeal the Affordable Care Act. He has said for his second term that he has “concepts of a plan” for the program that insures more than 21 million Americans.
Republican lawmakers in general have shifted away from talking about eliminating the program entirely, but some leaders, including Vice President-elect J.D. Vance have suggested changes that would make insurance more expensive. Vance during the campaign said he wanted to increase choices for consumers and “make the health insurance marketplace function a little bit better.”
Eliminating the health insurance marketplace, which is also known as Obamacare, has grown deeply politically unpopular even among Republican constituents. Since Trump’s first term, the number of people enrolled has grown by more than 9 million nationally. That political leverage is something that California advocates believe will help protect the program.
“More people are enrolled in (Affordable Care Act) marketplaces than ever before,” Linn Gish said.
But in many ways the state’s Achilles heel is federal funding. Federal spending on California health care programs is more than three times greater than the state’s share. That’s more than $117 billion from the federal government to support Medi-Cal and the Affordable Care Act compared to $35 billion from California’s general fund for all state health spending, which includes public health, state hospitals and social services.
And much of California’s policies can only be fully realized with sufficient money in the bank.
With the state grappling with a third consecutive deficit next year, the most immediate and likely federal health care cut will be difficult to prevent: financial assistance for middle-class families.
Outgoing President Joe Biden approved two rounds of Affordable Care Act subsidies during his presidency, making assistance available to middle-class families for the first time. Those subsidies will expire at the end of 2025, and Trump and congressional Republicans have signaled that they don’t want to renew them.
Without them, premiums will increase by an average of $1,000 annually for residents with insurance through Covered California, the state’s Affordable Care Act program. Premiums are already set to increase by about 8% next year, and without federal assistance other out-of-pocket costs such as deductibles and copays will most likely spike as well.
Prior to Biden’s push to lower health care premiums, many Californians paid upwards of 18% of their income on health insurance, according to Covered California data. Federal assistance capped that expense at 8.5%.
“You’re talking about a world where we’re doubling how much people pay,” Linn Gish said.
In 2023, California lawmakers established a backstop of state funding to help more people afford health insurance, but those reserves can’t make up the gap if federal funding stops.
Health care for immigrants
Medi-Cal, the state Medicaid program, offers expansive benefits to all low-income individuals regardless of immigration status. The program could face uncomfortable cuts with a less-than-friendly federal administration.
Federal dollars cover about 70% of Medi-Cal’s program costs, while the state invests approximately $30 billion in general fund spending.
“The largest concern many of us have who have worked with our state budget is the resources we will be receiving from the federal government this upcoming year,” said Assemblymember Joaquin Arambula, a Democrat from Fresno who has focused on expansions for undocumented workers. “There are many who are struggling who need their government to help.”
About 7 million more Californians qualified for Medi-Cal after Affordable Care Act rules allowed the state to bump up income limits in 2014, and about 1.8 million undocumented immigrants have gotten Medi-Cal coverage after the state began expanding eligibility for them in 2015.
Some California Republicans have strayed from the party platform when it comes to health care for undocumented immigrants. The Central Valley relies heavily on immigrant labor, and a handful of state Republicans from those communities supported expanded access to health insurance for undocumented residents.
The state GOP, however, still officially opposes coverage for undocumented immigrants and several Republican lawmakers want the state to undo that health care expansion.
Gov. Gavin “Newsom and Democrat lawmakers insist on expanding free health care for illegal immigrants to the tune of $5 billion per year. In the midst of a multi-billion dollar budget deficit, hospitals and maternity wards shutting down, and a massive influx of migrants illegally crossing our open border, we should not be expanding this costly government program,” Jones, a Republican from San Diego said.
Immigrants who came to the United States in their youth and who are protected by the Obama-era program known as Deferred Action for Childhood Arrivals (DACA) for the first time can enroll in Covered California thanks to expanded eligibility under the Biden administration.
Liberal lawmakers and policy advocates hailed the expansions as a long-sought-after victory, but they remain controversial among California Republicans. Many lawmakers and advocates expect these expansions to be challenged over the next four years.
“Anything that has Biden’s fingerprints on it is going to be the first touched. The DACA expansion is going to be high on the list,” Linn Gish said.
This year a bill expanding Covered California to all undocumented immigrants, not just those who came to the U.S. as children, stalled in committee. That measure would have allowed immigrants who make too much money to qualify for Medi-Cal to purchase insurance.
Arambula, who authored the bill, said those populations are “unjustly excluded” from buying insurance at full price even if they want to. He plans on reintroducing the measure, which could be implemented without federal approval.
Family planning and abortion cuts
On the campaign trail Trump took credit for appointing the Supreme Court justices who ended the national right to abortion by overturning Roe vs. Wade, but he said he would not support a national law banning abortion.
Still, California Democrats aren’t taking any chances on abortion rights. They passed more than two dozen laws to protect access to abortion, contraceptives and gender-affirming services in the last three years.
In 2022, voters also protected abortion as a right in the state constitution.
Democratic lawmakers say they have more work to do.
Bonta said she plans on introducing bills to further protect reproductive rights on the first day of the legislative session. Those bills would require hospitals to provide emergency abortions, protect birth control for Medi-Cal recipients and ease the regulation of birth centers. Bonta said lawmakers are working quickly and she expects many of the bills introduced in December to have urgency clauses that allow immediate implementation.
“It’s going to be a huge change within the health care space,” she said.
This article was originally published by CalMatters.
Kakistocracy is coming for you.
Very true this is most likely coming our way. Let’s hope that the dire predictions don’t come true and things will work out in the end. If not, we can stop the nonsense or a lot of it by taking power away on Nov. 3, 2026. Maybe take back the Senate or House….both? One thing for sure is that we need to get all of those people we lost a few weeks back by changing our approach. Demonizing uneducated white people won’t get ’em back. It will be interesting to see how the DNC changes tactics to get those folks back….it WILL be a chore!
CA is a $6T economy and still needs the feds to give 3 dollars for every one dollar for healthcare
If the State budget was properly run in a fiscal sense, we could give Trump the middle finger, but its not and we can’t.
Instead the State of CA is cutting healthcare budget by 9% because they overestimated projected tax income and overspent based on projections that did not materialize. That is horrible management.
That’s like me thinking I should be making $500K next year and spending all $500K plus some before noticing I only actually made $450K.
$6T economy, some of the highest tax and fees schedules in the US, and they need to cut healthcare budget by 9%.
So, our money shouldn’t come back to us? Send *all* of it to red state welfare?
Send the money to wherever it is needed the most. If that’s “red” states, as you say, then that’s where the money should go. That would be the sensible thing to do, in my opinion.
Sure, send our hard earned money to people who literally hate us and root for forest fires when we have natural disasters and want to tell us how to live and take away our rights.
Nah, f*** that and f*** them.
Wow, now that’s a truly crazy statement.
BASIC – how on earth is that “crazy?” It’s like you’ve never seen or read the news or any social media at all. There’s a LOT of far right hate for liberals, Californians in particular. Heck, just look at all the reports for Trump’s former admin that said he didn’t want to send us funds for wildfires and only did once he was told the counties that were on fire had actually voted for him. His followers love that kind of hate.
sac – If your comment about Trump not wanting to send money for wildfires I doubt it was because people didn’t vote for him. Is this another post where Trumps words are taken out of context?
Doulie, you’re not going to believe anything from a non-cult member. Trump has threatened this more than once, if you care to know it’s easy to find. You don’t.
DOOLY – Facts.
“Mark Harvey, who was Trump’s senior director for resilience policy on the National Security Council staff, told E&E News on Wednesday that Trump initially refused to approve disaster aid for California after deadly wildfires in 2018 because of the state’s Democratic leanings. But Harvey said Trump changed his mind after Harvey pulled voting results to show him that heavily damaged Orange County, California, had more Trump supporters than the entire state of Iowa.’We went as far as looking up how many votes he got in those impacted areas … to show him these are people who voted for you,” said Harvey'” – https://www.politico.com/news/2024/10/03/helene-trump-politics-natural-disaster-00182419
“Aides Say Trump Resisted Sending Federal Funds After California Wildfires
He changed his mind after being shown data that his supporters in the state had been affected, the former officials said. One called his approach “red states vs. blue states.” – https://www.nytimes.com/2024/10/04/us/politics/trump-wildfire-aid-california.html
BASIC – only a fact denier (ie, a liar) would call well known facts “crazy conspiracy theories.”
“Take a walk” indeed, from the guy who’s been posting nonstop for the past 3 days. Heck you have 5 deleted comments just in the past hour, not to mention the others you’ve posted in the same amount of time.
LOL talk about nutty!
Which part? The part where fellow Americans hate us because we are from California?
Or the part where I don’t want to send my tax dollars to people who want to take away our rights?
Hey, if you want to send money to people who hate you be my guest.
Oh no, you don’t wanna get busted for tax evasion. They’ll take away your yacht!
LoL, look at you in full fantasy mode. Nah, I’m extremely clean tax wise. You really wishing I’d lose my yacht though. Sad.
I’m gonna go all in on “California First” and refuse to send funds to states that don’t offer the same rights we do.
Perhaps, Californian’s can no longer FUND medical costs, housing and EBT for folks here illegally? Did you know it’s ILLEGAL for anyone, including Police /Government employees to ask if you are here legally…? Can you name any other country that follows this insane thinking…? It would be nice if we could afford to give out free service to anyone who comes here. Unfortunately, those days are GONE. Especially when those who PAY the most taxes (middle class and industry) are LEAVING the State due to mismanagement, micromanagement regulations and forced mandates.
California First! If you don’t agree with our policies, kick rocks kid. Go to Texas and Mississippi you commie freeloader.
California First! Make California Great! MCG! No more supporting free-loading states with our economy and agricultural. Put tariffs on all the food we grow and send elsewhere. Californian dollars should be for Californians!
Calmatters has trump derangement syndrome.
“ Still, California Democrats aren’t taking any chances on abortion rights. They passed more than two dozen laws to protect access to abortion, contraceptives and gender-affirming services in the last three years.”
Californians are tired of paying for this. If they want it, let them pay for it themselves.
Calmatters is quite literally reporting on things Trump and his team say, their policies, and their plans. Facts are not deranged, only someone who doesn’t believe facts is. I’m a proud Californian that supports women choosing what to do with their bodies. If you don’t like it, move to Texas or Russia or Iraq.
You don’t like it? Leave.
DAVID – “Californians are tired of paying for this.” – No, we’re not. The majority of Californians hold these rights as important and will never stop.
Imagine crying non stop about living in a place that is already difficult (financially) to live in. Why stay somewhere that will always be contrary to your life values?
I can see where Alex and Sac are coming from as it’s a hard time for all of us. Many, many, many of us are still in shock and will continue to be in shock. Sometimes the only way to relieve the internal anger is by expressing it verbally, or in this case, the written word. My “nutty” aunt in Boise (Nampa) has a modified bumper sticker that reads, “STOP THE HATE”….and just below that she added her homemade sicker in smaller print that reads, “(..unless it’s justified!”). It’s the old “Eye for an Eye” and “Tit for Tat” attitude that propagates living in misery. It’s a sad place to be, but there is a way out….if you want “out.” Stressing out and lashing out make us ugly inside.
I don’t think internet comment boards are the place for your message. Most of us can’t have these debates with loved ones so we blow off steam on the ol’ computer.
ANON – Bingo.
BEES – I’ll never stop bashing and “hating on” people who discriminate and/or belittle/think less of people for being born differently. You should know this by now.
I have to keep my mouth shut to keep a cordial relationship with some family members who are fully cult members. This is where I get to say how I really feel about their cult.
Opposing hate with hate never makes sense. It’s like having a heated argument with the cook for adding too much salt to the soup while the ship is sinking. When critics stop voicing their opinion, it’s silly to think that the argument has been won. We each have an obligation to hear out the “other side.” Remaining calm is key to “winning” and showing anger or becoming unglued is a sure-fire way to continue in the losing column of life. Let’s keep the peace people.
It’s more like opposing hates with facts, research and a splash of disgust.
Exactly, ANON. Countering lies, bigotry and offensive conspiracy theories is not “hate,” it’s simply countering lies, bigotry and offensive conspiracy theories.
Calling demands for empathy, reason, logic, historical facts, tolerance of others “hate” is just as awful as the hateful comments that warrant our responses.
True. On a political note, Dems need to stop trying to rise above the craziness and start using the same tricks. I’m tired of us trying to be the bigger person. Maybe we should start saying “crazy” stuff too like “Free healthcare for all! Free college! Tax Bezos and Musk! Free childcare! Eat the rich!”
Also, hate is not “the other side.” We have zero obligation to remain calm and civil when people are espousing discriminatory and vile rhetoric. If we want to discuss economic policy differences from mathematical and historical perspectives that do not include racism or other isms, then I’ll remain cordial.
BEES – I don’t think this site is a good place for you. Sorry, but the constant complaining about what most people here do is just not very neighborly. This is how it’s been for years here.
Nah, they should stay. Every family needs a peacemaker haha
Not sure the constant whining about people countering hate is “peacemaking.”
You lecturing people about what they should do, what they should feel, bla, bla, bla, is not going to do s*** for anyone.
Beyond that, your philosophy of “be nice to the bad people cause they just need to be heard” is ridiculous. We’ve heard “the other side” over and over for the last eight years, there’s no mystery here.
Personally, I’m good, I have zero fear about what the next four years brings. As I have said many times, I will benefit financially from Trump’s tax policies. And at the same time these vengeful fucks want to use the government to destroy anything and anyone they don’t like so I’m not shaking hands with someone who is holding a knife behind their back to use on people just because they are trans, or gay, or immigrants, or whatever else triggers these fuckwads.