Health care in crisis: Capitol Weekly conference recap

On Wednesday Capitol Weekly and The University of California Student and Policy Center presented the Health Care in California Conference, which tackled President Donald Trump’s “big, beautiful bill,” and its impact on patients, medical research, hospitals and overall access to healthcare for Californians across the state. In addition to the recap below, you can access videos of each specific panel discussion and the keynote interview by Capitol Weekly editor Rich Ehisen with Dr. S. Monica Soni of Covered California here.

Panel 1: Clinics and Access
The first panel consisted of Susan Bonilla, CEO of California Pharmacists Association (CPA); Miranda Dietz, interim director of the healthcare program at the UC Berkeley Labor Center; Anna Marshall, associate director of federal affairs and policy at California Primary Care Association (CPCA); Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California (PPAC) and Amanda McAllister-Wallner executive director of Health Access.

Moderator and California Health Care Reporter for Politico, Rachel Bluth, kicked off the panel asking how H.R. 1 is affecting Planned Parenthood, which was a substantial target of the bill.

“As of three weeks ago we are completely defunded for any Medicaid funding and any federal matching funding,” PPAC’s Hicks said, noting that Planned Parenthood has 109 health centers throughout California that collectively “see over a million visits per year, and 80 percent of our patients depend on Medicaid.”

In those three weeks, Hicks said, Planned Parenthood has continued to see Medicaid patients, nut said they are not getting reimbursed for any of it.

“As you can imagine that is not sustainable in any way, and pretty quickly here if we don’t have a solution there is no choice but to make some really drastic decisions which will mean health center closures…,” she said.

Hicks referenced a letter from California Primary Care Association saying that Planned Parenthood’s footprint is so large in California that it cannot be absorbed by other clinics in the state.

According to Health Access’s McAllister-Wallner, prior to the Affordable Care Act it was extremely common for Californians to not have medical insurance if it wasn’t provided through their employer or “you weren’t a part of a pretty small and narrow definition of eligibility for Medi-Cal.”

In the debate over H.R. 1, Republicans tried to frame the bill as kicking off the 26-year-old living in their mother’s basement, but in reality, H.R. 1 is a “de facto repeal of the ACA expansion,” McAllister-Wallner said.

“We’ve been able to do incredible things, bring the uninsured rate in California down to 6 percent and we’re going to see that number, unfortunately, skyrocket over the next few years, depending on how the state responds,” McAllister-Wallner said.

According to Berkeley’s Dietz, several different minority groups in California will be impacted by this halt to ACA expansion and changes made by the state, including legal immigrants, undocumented people and senior citizens.

“We’ve been able to do incredible things, bring the uninsured rate in California down to 6 percent and we’re going to see that number, unfortunately, skyrocket over the next few years, depending on how the state responds.”

These changes, Dietz said, “is going to have a devastating impact on the great progress that California has made about bringing those folks into coverage.”

CPA’s Bonilla offered a potential bright side to this doom and gloom – pharmacies. Bonilla said that utilizing pharmacies is how the state can preserve access to healthcare throughout the implementation of H.R. 1.

Instead of solely using pharmacists and pharmacies as medicine-dispensing centers, patients can use them for vaccinations, early prevention care and medication management – essentially, non-urgent conditions.

Although there are barriers right now in the way of that, Bonilla said that if pharmacists are allowed to practice up to the level in which they have been trained, millions of dollars can be saved in the healthcare system.

This federal push to restrict healthcare access for Californians differs from the COVID-era Biden administration policy of “unwinding” in which people couldn’t be dropped from coverage even if their income changed or they didn’t submit the necessary paperwork.

However, CPCA’s Marshall said, this time around, California doesn’t have the benefit of a flexible presidential administration and a budget to do a mass media campaign and get people enrolled.

Panel 2: Medical Research
The second panel of the day centered on medical research and how federal actions will impact medical innovation in the country.

Panelists included Sam Chung; senior vice president of government relations for California Life Sciences (CLS); Dr. Harold Collard, vice chancellor of research and health policy and medicine professor at UCSF; Jimmy Jackson, senior vice president and chief policy officer for Biocom California; Asher Lisec, vice president of the western region for state advocacy for PhRMA, moderated by David Jensen, longtime Capitol Weekly contributor and the creator and publisher of the California Stem Cell Report.

While research funding was not targeted in H.R. 1, UCSF’s Collard noted the wide-ranging impact of the cuts imposed by H.R. 1, saying “From the biomedical research space, there is no way to separate biomedical research from healthcare.”

Collard said one of the biggest challenges we are facing now is the disruption in the social contract. In the 80 years after World War II, he said, a partnership was created between the federal government and the people of the United States to fund biomedical research.

“I think that social contract is being questioned…” he said.

With the National Institutes of Health – which is a federal agency – being the largest grantor of biomedical research funding in the United States, CLS’s Chung said it’s a “critical issue that can completely unravel the very foundations of biomedical research in California.”

With the United States dropping back on research funding, Chung said other countries such as China have stepped up and “already declared their intent to take over that leadership position when it comes to biomedical research.”

“That compromises our national security, our economic standing as well as our public health standing,” he said. “From our perspective we see this threat not as something that’s abstract, something that’s years out….we are already starting to see more Chinese-based products going through our FDA process than the United States.”

According to a Biocom economic impact report Biocom California’s Jackson cited, “the Life Sciences industry is responsible for $400 billion of direct economic impact to the state of California.”

“We are the second largest industry in the state, behind only tech,” he said. “If you take film, agriculture, the wine industry and tourism and combine them, they’re not as large as the economic impact of the Life Sciences industry.”

According to Jackson, most members of the Life Sciences industry are small businesses that rely on universities and academic institutions for their discoveries.

Earlier in the year when Trump partnered with Elon Musk’s Department of Government Efficiency (DOGE) looking to cut down on federal spending, PhRMA’s Lisec said the cuts imposed on the NIH were targeted at specific kinds of research.

“They went in and systemically started canceling grants that were already promised to academic researchers that were out there,” she said. “I will tell you, they purposefully went after certain types of science. They went and looked for words like ‘diversity’ when they were deciding what to cut.”

These cuts to medical research not only halt innovation, but are the basic building blocks needed to create new vaccines and clinical trials. If there is no research to pull from, then advancements cannot be made, Lisec said.

“If you take film, agriculture, the wine industry and tourism and combine them, they’re not as large as the economic impact of the Life Sciences industry.”

“When we as an organization are looking at what are the harms here, it’s ultimately to patients because now we have institutions that don’t have that certainty [in funding] about whether they can make those investments in the future for basic science and for clinical trials,” Lisec said.

Luncheon Keynote
The conference’s keynote address was given by Dr. S. Monica Soni, chief medical officer and a chief deputy executive director at Covered California, moderated by Capitol Weekly Editor-in-Chief, Rich Ehisen.

A little less than 2 million Californians get healthcare coverage through Covered California, and “90 percent of those folks actually get some form of financial assistance to be on a Covered California-supported plan,” Dr. Soni said.

The demographic that Covered California mostly serves are the “working poor,” Dr. Soni said. The group of people that make a little too much money to be on Medi-Cal, aren’t old enough to be on Medicare and aren’t receiving healthcare through their employer.

Because of that, financial subsidies as little as $5 matter and can determine if they will get health insurance this year.

“The fabric of California is represented in Covered California,” Dr. Soni said. “It’s extremely diverse, both from a socioeconomic perspective, a race/ethnicity perspective and languages spoken. We really are sort of this microcosm of our state.”

According to Covered California’s modeling, if federal financial subsidies aren’t renewed, 400,000 people are expected to be priced out of obtaining coverage through the Covered California exchange. For context, Ehisen added that number roughly equals the population of the state of Wyoming.

Dr. Soni said from December of this year to January of 2026, patients using Covered California will see a 92 percent increase in their premiums if the subsidies aren’t renewed.

“That number is worse for our communities of color,” she said. “Over a 120 percent increase in what an individual would see from one day to the next.”

While loss of coverage affects an individual’s health, it will almost certainly affect the greater public health of California.

When Dr. Soni was practicing medicine in Los Angeles County before the Affordable Care Act was passed in 2010, she said it was almost a daily occurrence in which a patient would come into the emergency room with metastatic cancer that could have been prevented.

In recent years, however, Dr. Soni said those kinds of experiences have become really infrequent as a result of all the advancements that have been made in the state of California.

“I actually feel like we will be in a worse position with the erosion across our program’s Medi-Cal California, then we were 10 years ago because at that point in time we had all these, what I would call collateral, a backend way to get someone to an ophthalmologist… those are gone,” she said.

“That’s the part that makes me feel really worried,” Dr. Soni said. “You have folks that will show up in the emergency room who had previously been getting care, now with no place to go and an inelastic system unable to absorb them and no back channels anymore.”

One of the ways in which Covered California is preparing for these looming federal changes is by publishing data reports using their own claims information to show who is really on their healthcare plans – a sort of rebuttal to what was being communicated nationally, Dr. Soni said.

Another way is through partnership. Dr. Soni said across several different state apparatuses, everyone is in constant communication on how best to support the California Department of Public Health and guide Californians through these tough decisions they will have to make relatively soon.

Panel 3: Hospitals
The third panel of the conference was moderated by Deputy California Editor of KFF Health News Samantha Young.

Panelists included Adam Dorsey, group vice president of California Hospital Association (CHA); Graham Knaus, CEO of California State Association of Counties (CSAC); Tam Ma, associate vice president for health policy and regulatory affairs at University of California Health and Kristoff Stremikis director of market analysis and insight at California Health Care Foundation (CHCF).

With Panel 3’s topic being hospitals, it was only fitting that, again, Trump’s “big beautiful bill” was the initial conversation starter.

In order to understand how unprecedented these cuts to healthcare are, CHA’s Dorsey said he estimates about 1.3-2 million people will lose healthcare coverage in California.

“It’s devastating for patients but it’s also devastating for the system because H.R. 1 really does go after the heart of financing for Medicaid programs across the country,” he said. “And we think that uncompensated care costs for hospitals will likely be around $9.5 billion over 10 years when H.R. 1 is fully implemented.”

CHCF’s Stremikis added on to Dorsey’s answer saying that California will probably spend about $200 billion on Medicaid programs this year and about $120 billion of that [60percent] comes from the federal government.

“And we think that uncompensated care costs for hospitals will likely be around $9.5 billion over 10 years when H.R. 1 is fully implemented.”

“At the end of the day… you’re looking at about a 15-25 percent reduction in federal revenue every year,” he said.

According to Stremikis, this impact on patients means that “fewer people will have coverage, the benefits they have access to will be skimpier and the providers that they want to go and see will be paid less.”

“There really is nothing else but those three bad things that will happen,” Stremikis said.

Rural counties are also extremely vulnerable to the effects of H.R. 1 when it is implemented. Since rural counties – on average – serve working populations of Medi-Cal patients, these hospitals are more susceptible to filing for bankruptcy since H.R. 1 would cap the federal reimbursements they can get with treating Medi-Cal patients.

“The one place you can give a hospital birth in Inyo County is very likely to close,” CSAC’s Knaus said. “Which means if you are in Inyo County and need to go to a hospital to give birth, you will need to drive at least 4 hours.”

Knaus explained that when care for Medi-Cal patients is affected, it also significantly impacts those with private insurance. Hospitals and clinics that serve Medi-Cal patients typically also treat privately insured patients, but revenue from private payers alone is usually insufficient to keep these facilities financially stable.

The University of California Health system is also facing broadband financial strain, Ma said.

“These cuts are coming at a time when many hospitals are already facing significant financial pressures. The cost of everything is going up – the cost of labor, of supplies, of pharmaceutical drugs, of construction, of materials, of technology is going up, for a number of reasons including the supply chain disruption caused by different changing federal policies,” Ma said.

Stremikis said “we’re not in a recession period, but we’re facing this crisis that’s really driven by policy.”

When the country’s economy collapsed in 2008, the state government partnered with hospitals to solve the budget crisis.

“And what they did was they came up with these financing arrangements that are now directly under attack in H.R. 1” Stremikis said. “And so the tools that were kind of at our disposal to help address a crisis in the past are the same things that are now under attack.”

This story was produced by Capitol Weekly intern Acsah Lemma as part of Capitol Weekly’s Public Policy Journalism Internship program. Additional editing by Rich Ehisen.