“As California goes, so goes the nation,” said state Attorney General Rob Bonta — and in the face of federal funding cuts, that goes for health care too.
As President Trump realizes his campaign promises with a near-daily blitz of executive orders and funding cuts that put Medicaid and the Affordable Care Act (ACA) on the chopping block, California isn’t backing down — and other states are following suit.
“The chaos flooding us is their strategy, and as we see more, protecting the state’s decision to expand its Medicaid program to all low-income residents, regardless of immigration status, is a top priority,” said Bonta at a Tuesday, February 4 panel on health and politics held by Insure the Uninsured Project in Sacramento.
“We will vigorously defend against any new federal policies that interfere with state laws and state-funded Medicaid. Regardless of who’s in the White House, we’re going to keep moving forward,” he added.
Medicaid is the country’s largest health insurance program, covering nearly 80 million Americans.
Over 15 million Californians, nearly 40 percent of the state’s population, are covered through Medi-Cal, the state’s version of Medicaid.
In 2023, US Medicaid spending was $871.7 billion, with $591.4 billion, or nearly 68 percent of that, from federal funds.
Overall, Medicaid represents nearly $1 out of every $5 spent in the US.
Bonta said that California was poised to repeat and, if needed, surpass actions taken during the first Trump administration, including instigating a Supreme Court lawsuit upholding the ACA; defending state sanctuary and vaccine mandate laws; and obtaining court injunctions that put stops on public charge, “a cruel policy designed to force immigrant families to forego public programs like health care out of fear that it will jeopardize their immigration status.”
An executive order issued by Trump on Monday, January 27 — which attempted to disrupt health care spending and other federal programs like food, housing and child health, all totaling nearly $3 trillion — was sued the next day Tuesday by 22 Democratic state attorneys general, including Bonta.
On Friday, US district court judge John McConnell Jr. granted a temporary restraining order blocking the Trump administration from freezing those federal loans, grants and aid to 22 states, until McConnell can hear the states’ request for a longer-term block.
A hearing date is not yet set.
These attempted freezes also accompany Trump’s campaign promises to end enhanced ACA subsidies which, passed under Biden and set to expire at the end of 2025, cut premium payments nearly in half for millions of Americans and doubled enrollment, especially in red states.
“Health has become more politically determined than ever. We’re making sure that our patients know that they should vote, because it’s going to impact their health,” said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County (CCALAC), a coalition of 118 clinics serving two million patients annually and one in three Medi-Cal enrollees in LA County.
“Medi-Cal saved my own life,” she continued. “In 1996, I was in the hospital in Fairfield, California with a $22,000 bill. Pre-ACA, I narrowly qualified for emergency Medi-Cal, and it took the bill away. Without that, I wouldn’t be a homeowner, an employer or a taxpayer at my level. Healthcare transforms lives and so does voting to keep it.”
“Eight years ago, folks stopped coming in for visits. They were afraid to enroll in coverage, even to drop their kids off at school. And now, we’ve lost our sensitive location status, which makes it even more challenging,” she continued. “They gave us the plan in Project 2025, and now they’re executing it. Our challenge now is to support people who are rightfully afraid to leave their homes.”
On January 21, the Trump administration ended a 2011 policy that had protected sensitive locations — including hospitals, schools, churches, funerals, weddings and public demonstrations nationwide — from Immigration and Customs Enforcement (ICE) operations like undocumented immigrant arrests.
“We use the word ‘coup’ about other countries, never about ourselves, because we’re exceptional, it would never happen here. But it’s absolutely happening here,” said Manjusha Kulkarni, executive director of AAPI Equity Alliance, a coalition of 50 community-based organizations serving 1.6 million AAPI, or 16 percent of LA County.
“Misinformation is free, while reliable information is behind a paywall. If you know your rights, share that knowledge. We share it in our health clinics, we host ICE workshops, and it works,” she continued.
Kulkarni cited as an example ‘border czar’ Tom Homan’s comments on CNN that late January ICE raids in Chicago were not as successful as expected due to immigrant education.
“They’re attempting to weaponize the ways we protect ourselves, even the words we use to describe ourselves,” added McCarthy. “What happens after this depends on who controls the narrative, and that depends on who’s the most unified.”
