By Mina Kim
Originally published on KQED (NPR)

The Republican spending bill signed into law by President Trump last month slashes an estimated $150 billion in federal Medicaid funding to California over the next 10 years. Nearly 40% percent of Californians rely on Medi-Cal for health coverage, and now millions are expected to fall off the rolls. That’s leaving medical providers bracing for impacts, especially in places already struggling to serve all who need care. We talk to heads of clinics in the Central Valley, Shasta County and Los Angeles to hear how they’re coping.

Transcript of recorded conversation with:

Mitesh Popat, chief executive officer, Venice Family Clinic
David Quackenbush, president and chief executive officer, Golden Valley Health Centers
Jo Campbell, chief executive officer, Hill Country Community Clinic
Miranda Dietz, interim director, Health Care Program, UC Berkeley Labor Center

Mina Kim: Welcome to Forum. I’m Mina Kim. Hospitals and clinics that serve California’s Medicaid patients — called Medi-Cal here — are preparing for impacts from President Trump’s spending bill, implementing hiring freezes, and weighing the services they may need to cut first.

Some 40% of Californians rely on Medi-Cal, and more than three million are expected to — or are at risk of — losing that coverage. Joining me are health clinic leaders in the Central Valley, Shasta County, and Los Angeles who serve large Medi-Cal populations to share what they’re facing.

And listeners, are you or someone you know on Medi-Cal? What questions do you have about the impact of the cuts?

Joining me, Mitesh Popat, chief executive officer of the Venice Family Clinic in Los Angeles. Mitesh, glad to have you with us.

Mitesh Popat: Thanks for having me, Mina.

Mina Kim: Also with us is David Quackenbush, president and CEO of Golden Valley Health Centers in the Central Valley. David, glad to have you too.

David Quackenbush: Thank you. Good morning.

Mina Kim: Good morning. And Jo Campbell is also with us, chief executive officer of Hill Country Community Clinic in Shasta County. Jo, thanks for being on with us.

Jo Campbell: Thanks for having me, Mina.

Mina Kim: I’ll start with you, Jo, because you’ve described your region in Shasta County as one of the sickest in California. Tell us about where you are and why you characterize it that way.

Jo Campbell: Well, if you look at the data for the North Region — I affectionately refer to California as the “true north” — most people, when they think of Northern California, they think of where you are, Mina. They think of San Francisco or Sacramento.

Mina Kim: Yeah.

Jo Campbell: Our clinic is three and a half hours north of San Francisco and actually closer to the Oregon border than to Sacramento or San Francisco. We are disproportionately poorer than most counties, and rural. About 189,000 people live in Shasta County, spread over roughly 3,500 square miles — so a very rural community.

When you don’t have consistent access to some of the basic things you get in a metropolitan community — like reliable transportation to get you to a health center, access to food or food banks — all of those things affect our ability to be healthy.

Mina Kim: You’ve described the population as facing poverty, trauma, lack of opportunity, and a low vaccination rate.

Jo Campbell: Yep. All of those things. Forty percent of the people in Shasta County are at or below poverty. The Adverse Childhood Experiences scores — which measure childhood trauma — average about two out of ten statewide. In Shasta County, the average score is five out of ten.

Mina Kim: And some 80% of your patients rely on Medi-Cal?

Jo Campbell: That’s correct.

Mina Kim: What does that work out to in terms of numbers for you, Jo?

Jo Campbell: Just over 5,500 patients.

Mina Kim: So what are you anticipating as the impacts from Trump’s spending bill?

Jo Campbell: I think fewer people will come in and get health care. If I think about my own situation — I have private insurance, and every year when we have to re-sign up, I invariably have to get someone to help me with some part of the process. If I had to do that twice a year, depending on what’s going on in my life, it might be easy for that to fall off — especially if I didn’t have any imminent health concerns.

So I think it’s going to make it really challenging for people to feel like they have access to health care, because they won’t have insurance.

Mina Kim: You’re talking about the new rules to reenroll twice a year. Have you put some figures around what you anticipate in terms of just the loss of patients you can bill Medi-Cal for?

Jo Campbell: My guess is about 30%. I won’t really know until we get there, but that’s what I’m planning for.

Mina Kim: David, like Jo, your clinics are in a rural area in the Central Valley with some of the highest Medi-Cal enrollment rates in the state. Tell us about your community.

David Quackenbush: Golden Valley has been around 53 years. We are the Medi-Cal health system in our three-county area of San Joaquin, Stanislaus, and Merced counties. We provide as many medical services as some of the larger systems with popular name brands that provide commercial coverage.

We have about 175,000 lives assigned to us — roughly 165,000 of those are Medi-Cal lives. Similar to Jo, about 80% of our patients are on Medi-Cal, which also means 80% of our revenue is Medi-Cal — a number that’s very important to connect.

We’re a mix of urban and rural. Jo’s rural is different from ours — hers is more isolated, ours is more farmworker, agricultural land. Most of those folks come to work in the ag industry. Our challenges are similar, but the context is different.

Mina Kim: How so?

David Quackenbush: Number-wise and historically. The Central Valley has been the main area for agriculture forever, and it still is. Our communities are all immigrants — either new immigrants or generations of immigrants. Many came for agriculture and stayed.

Medi-Cal patients are low-income and often have multiple comorbidities when they come to us. We try to do the best we can to serve them.

Mina Kim: And so what are you expecting as the impacts of these Medicaid cuts on the families you’ve been serving for such a long time?

David Quackenbush: In communities like ours, where our health center has been here for 50 years, we’ve served generations of families. We serve them when they’re uninsured, when they’re commercially insured, and when they’re on Medi-Cal.

Undocumented folks were just covered starting in 2024, but they were coming to us before that — and when they fall off Medi-Cal, they’ll keep coming. That’s the beauty and the difficulty of community health centers: our patients know we’ll take care of them regardless of insurance status.

But when they don’t have insurance, it’s much more complicated for us to provide services because we’re not generating revenue for those services.

Mina Kim: Mitesh, you’re in the city, with a very high Medi-Cal enrollment rate. Tell us about your region and your patients.

Mitesh Popat: Thank you again. At Venice Family Clinic, we serve 45,000 people across Los Angeles — mostly coastal LA, but also inland communities like Inglewood and Hawthorne. LA County has about ten million people, and roughly 40% are on Medi-Cal.

At the clinic, we serve varied sub-communities with very different needs — from West LA to the South Bay to Inglewood. Like my colleagues mentioned, 80% of our patients are on Medi-Cal.

We believe health care is a human right. We’re here to serve people regardless of ability to pay or insurance status. That said, coverage is care, and coverage saves lives. We learned that through the Affordable Care Act — numerous studies have shown how many lives were saved as a result.

We know that when people delay treatment, they may wait until they’re in crisis, ending up in the emergency department — which has a tremendous personal cost and a financial cost to the system and taxpayers.

Mina Kim: What are some of the complicated health issues that the people you serve tend to come to you with?

Mitesh Popat: Everything from routine well-child visits — which identify developmental concerns and social barriers like food insecurity — to chronic illnesses like diabetes and high blood pressure.

We know controlling chronic illnesses can prevent bad outcomes like heart attacks and strokes. For pennies a day, someone can control their blood pressure and avoid a catastrophic stroke.

What’s being missed in these discussions is that emergency Medi-Cal will continue — funding care in emergency settings. But what is planned to be defunded is care in office-based, clinic settings. That makes no sense.

Mina Kim: That would cost far less. We’re talking about how Medicaid cuts in Trump’s spending bill will affect Californians and the health care providers who serve them. We’ll have more after the break.

This is Forum. I’m Mina Kim.