\u201cI knew it was going to be bad, but seeing that doubling was shocking to me,\u201d said Miranda Dietz, director of the labor center\u2019s healthcare program.<\/p>\n
An estimated 2.2 million people could lose insurance over the next four years from combined state and federal cuts, the researchers found. The losses will fall hardest on undocumented immigrants and low-income Californians, with the uninsured rate more than doubling among Black and Asian Californians. The southern part of the state will bear the brunt, driven by its larger share of low-income and immigrant residents.<\/p>\n
Many Californians remember how difficult it was to get healthcare before the state expanded and improved insurance options. <\/p>\n
In 2008, Kandi Hill had just given birth to her third child. When she started throwing up and experiencing irregular menstrual cycles with heavy bleeding, she struggled to find a doctor who would run any tests other than an STD panel. In a matter of months, she died from Stage 4 cervical cancer. She was 31.<\/p>\n
Cervical cancer has a 91% five-year survival rate<\/a> if caught and treated early, according to the National Cancer Institute, but back then the Medi-Cal system was bare bones, and doctors didn\u2019t seem to take poor Black patients seriously, said her husband, Ramonte Means.<\/p>\n Means was left to raise two small children and an infant alone. He has been the sole provider for his family ever since, often working part-time and frequently without insurance, stitching together multiple jobs \u2014 janitorial work, customer service, job coaching Usually, Means said, his employers won\u2019t give him full-time hours so that they don\u2019t have to provide benefits. With multiple part-time jobs, he tries to keep his income low enough to qualify for Medi-Cal and ensure his kids stay covered too. He\u2019d rather get insurance through an employer, but he can\u2019t afford a plan out-of-pocket.<\/p>\n \u201cNone of us want anything for free. I work two jobs. My kids go to school,\u201d Means said. \u201cWe\u2019re just asking for some dignity.\u201d<\/p>\n Today\u2019s Medi-Cal isn\u2019t perfect, Means says, but it\u2019s much better than when his wife died \u2014 patients have more benefits and can see specialists. <\/p>\n \u201cI truly believe if all this happened now, she\u2019d have been fine,\u201d Means said. \u201cThe system failed my kids more than anything \u2014 failed the whole family.\u201d<\/p>\n Millions gain coverage<\/p>\n When the Affordable Care Act passed in 2010, California quickly expanded its Medicaid program. Previously, the program was reserved for women and children, seniors and people with disabilities. Low-income adults were excluded unless they had dependent children. The law allowed California to extend open enrollment to childless adults and raised the income limit to 138% of the federal poverty level \u2014 about $22,000 for an individual today. <\/p>\n More than 5 million Californians gained coverage, including Means, who had occasionally earned too much money before the change to qualify.<\/p>\n \u201cSo 138% poverty is not a lot of money in terms of increasing income, but when you talk about how many people actually become eligible it has a significant impact,\u201d said Nadereh Pourat, associate director at the UCLA Center for Health Policy Research.<\/p>\n An additional 1.7 million middle-income Californians bought insurance through the commercial Affordable Care Act marketplace known as Covered California. <\/p>\n \u201cThat\u2019s a huge policy change,\u201d said Rachel Linn Gish, spokesperson for Health Access California, a consumer advocacy group. \u201cMillions and millions and millions of Californians covered in 10 years. No other state can say that.\u201d<\/p>\n Still, one major group remained uninsured: undocumented immigrants. They account for about 2.3 million residents, according to the Public Policy Institute of California<\/a>. <\/p>\n Newsom\u2019s healthcare pledges<\/p>\n Gov. Gavin Newsom campaigned on a promise to bring single-payer healthcare to the state. He pivoted to expanding access within the existing system \u2014 transforming Medi-Cal with new benefits and a focus on high-quality primary care. His administration also launched the state\u2019s second-largest coverage expansion, phasing in Medi-Cal eligibility for low-income undocumented adults until all adults and children qualified in 2024. <\/p>\n \u201cWe\u2019re making sure that universal access to healthcare coverage becomes a reality here in California,\u201d Newsom said in 2022 when the state allowed undocumented seniors to enroll in Medi-Cal.<\/p>\n Gov. Gavin Newsom listens as then-state Sen. Richard Pan speaks on a healthcare issue in Downey in March 2023. <\/p>\n (Keith Birmingham \/ Pasadena Star-News \/ Getty Images)<\/p>\n At its peak, the state-funded expansion covered 1.4 million adults and 217,000 children and cost more than $10 billion a year.<\/p>\n Republican lawmakers have sharply criticized that price tag, and increasingly, so have some moderate Democrats.<\/p>\n \u201cWe need to have cost containment,\u201d said Sen. Catherine Blakespear<\/a>, a Democrat from Encinitas, when the state passed last year\u2019s budget<\/a>.<\/p>\n Total Medi-Cal spending has more than doubled since Newsom took office in 2019, growing from about $96 billion to $217 billion this year. The nonpartisan Legislative Analyst\u2019s Office attributes most of that growth to higher spending per recipient<\/a> \u2014 added benefits, higher drug prices and some demographic changes \u2014 rather than enrollment alone. People are seeing doctors more, and each visit is more expensive.<\/p>\n Medi-Cal cuts loom<\/p>\n Orlando and Lourdes are immigrants from El Salvador. They asked to be identified by only their middle names because they fear being identified by immigration officials. Orlando has lived in Los Angeles for more than 20 years and works in construction with a work permit. Lourdes manages a store and is undocumented.<\/p>\n Recent federal immigration raids have already upended their lives. They\u2019ve counseled their 6-year-old daughter that there are \u201cgood police\u201d and \u201cbad police.\u201d Now Lourdes, who needs radiation therapy for cancer, worries about losing her Medi-Cal insurance. <\/p>\n To slow Medi-Cal\u2019s growth, the state froze enrollment for undocumented adults starting in January; roughly 86,000 fewer undocumented immigrants are covered. <\/p>\n Starting next summer, immigrants without legal status will lose dental benefits and face new monthly premiums. These and cuts to coverage for some legal immigrants are expected to push about 800,000 people off insurance, according to the UC Berkeley Labor Center.<\/p>\n \u201cWe pay taxes every year. We deserve to have health insurance,\u201d Orlando said.<\/p>\n Services have also been curtailed more broadly. Last year, the state dropped coverage of weight-loss drugs like Ozempic<\/a> for people who are simply overweight, keeping it only for more serious diagnoses like diabetes. This year, lawmakers scaled back wraparound services, including case management and medical meal-delivery services for low-income patients. They also reinstated a wealth test that caps how much savings an enrollee can have, regardless of their income, which advocates say punishes people for building a financial cushion. <\/p>\n The cuts have stirred criticism of Newsom from lawmakers on the left, some of whom want the state to raise revenue through corporate taxes or other means rather than shrink Medi-Cal. <\/p>\n Vanesa Duran, top left, lead care manager at St. John\u2019s Community Health, talks with patient Maria Gomez. Grace Calderon, middle, HIV testing counselor and community health worker for St. John\u2019s, takes a blood sample. Above, Bukola Olusanya, St. John\u2019s regional medical director, inside a mobile clinic van. <\/p>\n (Photographs by Jules Hotz \/ CalMatters)<\/p>\n Sen. Lena Gonzalez<\/a>, a Democrat from Long Beach and chair of the Latino Caucus, said she pressed Newsom and his team twice to save benefits for undocumented people. <\/p>\n \u201cI said this is legacy work for you, and I don\u2019t want you to ever forget that,\u201d Gonzalez said. \u201cFor this to happen was just really surprising.\u201d<\/p>\n Linn Gish, the Health Access California spokesperson, credited Newsom with supporting healthcare access \u201cfrom Day One\u201d but called the recent rollbacks disappointing: \u201cWe hoped he would be a champion until the end.\u201d <\/p>\n Newsom\u2019s office declined an interview request. In a statement, the Department of Health Care Services emphasized that the Legislature voted to approve the budget that included the cuts and said Newsom remains committed to \u201cresponsibly\u201d supporting universal coverage. <\/p>\n \u201cGov. Newsom has consistently highlighted California\u2019s coverage gains as central to his broader commitment to universal healthcare coverage and a more inclusive safety net,\u201d the statement said. <\/p>\n Federal challenges<\/p>\n Many Democrats, Newsom chief among them, blame President Trump, whose One Big Beautiful Bill Act tax reform law rewrote Medi-Cal rules and cut federal funding to California. The law also let enhanced Affordable Care Act subsidies expire, contributing to a 140,000-person drop in Covered California enrollment. State officials estimate the Medi-Cal program could lose more than $30 billion annually once federal changes fully take effect in 2027.<\/p>\n The biggest change: Many adults must now prove they\u2019re working or volunteering at least 80 hours each month. Research has shown most low-income adults already meet requirements<\/a> but lose coverage anyway because of bureaucratic errors<\/a>. <\/p>\n \u201cAll it takes is one piece of lost mail and all of a sudden you lose coverage \u2026 and things can snowball,\u201d said Dylan Roby, a health policy researcher and professor at UC Irvine. <\/p>\n![\"Gov.](\"https:\/\/www.europesays.com\/ie\/wp-content\/uploads\/2026\/08\/1787349373_229_.jpeg\")
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