In 2013, Placer County in California offered limited healthcare to about 3,400 uninsured residents. Fast forward to today, and that number is now zero. This change came after the Affordable Care Act (ACA) made it easier for many to access health coverage. However, this progress could soon face a setback.
Experts predict that around 10 million people might lose their health insurance in the coming decade. This forecast follows the passage of the “One Big Beautiful Bill Act,” which will cut Medicaid spending by more than $900 billion. Nadereh Pourat from UCLA highlights the challenge: “Many individuals will lose coverage, and systems meant to support them are dwindling.”
In states like California and New Mexico, it’s a legal obligation to provide care for the poorest residents. Thanks to the ACA, both states expanded Medicaid, easing the burden on local programs. But now, Placer County expects that over 16,000 residents could lose their health coverage by 2028. Rob Oldham, the county’s health director, stated, “Most of our infrastructure to meet these needs has disappeared,” showing just how serious the issue has become.
Counties like Doña Ana in New Mexico are facing similar dilemmas. After expanding Medicaid, they added services like dental care for seniors. Jamie Michael, who oversees health services there, warned that potential federal cuts might lead to tough decisions about budget and benefits.
Budget Strain
Some states have made it easier for counties to drop their obligations to provide care for the uninsured. In places like Texas, communities are struggling to handle rising healthcare costs, especially for the uninsured. Windy Johnson from the Texas Indigent Health Care Association pointed out that as more people move in, funding becomes increasingly strained.
California itself is staring down an $18 billion budget deficit for the 2026-27 fiscal year. Governor Gavin Newsom is mulling over options but has resisted significant tax increases on the wealthy. The state could stand to lose $30 billion annually in federal funding for its Medi-Cal program due to policy changes. Scott Graves from the California Budget & Policy Center emphasizes that state leaders need to figure out where to find funds to support those losing coverage.
No Simple Solutions
The number of people using county indigent programs is unknown since the state doesn’t track those figures. However, enrollment in these programs dropped sharply right after the ACA was rolled out, from 858,000 in 2013 to roughly 176,000 in 2014, according to a Health Access California survey.
Health advocates worry that without significant investment from the state, California could see a return to a flawed network of county-run programs, leaving vulnerable populations without adequate care. Kiran Savage-Sangwan, leader of the California Pan-Ethnic Health Network, warned that before the ACA, many uninsured individuals avoided necessary care, often resulting in dire outcomes.
In affluent areas like Santa Clara County, voters recently approved a sales tax increase to backfill lost federal funds. But even this will only cover about one-third of the projected $1 billion annual loss.
Ultimately, the current landscape paints a troubling picture for healthcare in California and beyond. As the number of uninsured rises, the question remains: how will local and state governments respond to the growing challenge?
