County health care leaders decry ‘backward’ Medicaid cuts

Santa Cruz County health care providers are bracing for what they say could be a potentially devastating blow to local medical services following President Donald Trump’s signing of sweeping federal spending cuts that will slash Medicaid funding.

“For those of us working on the front lines of health care, especially serving low-income communities, there is nothing beautiful about it,” Dr. Sepi Taghvaei, executive vice president of Dientes Community Dental, said Tuesday of what’s known as Trump’s “big, beautiful bill.” Dientes provides affordable dental care to those without insurance or who cannot afford it. The bill’s “impact on our ability to serve our patients will be big, yes, but in all the wrong ways,” Taghvaei said.

Trump signed the bill on July 4. It is expected to cut more than $1 trillion in Medicare and food assistance spending over the next decade and leave at least 11 million people uninsured nationwide, according to the Congressional Budget Office. 

In California, 1.2 to 1.3 million people are expected to lose their access to Medi-Cal — the state Medicaid program — mostly because of its work requirements, according to a study by the Urban Institute. Some adults on Medicare up to age 64 will have to prove they work, volunteer or go to school for 80 hours a month to receive benefits.

Some of the money goes to hospitals and clinics that provide health care for low-income individuals, families, people with disabilities and pregnant women. About 40% of women who give birth in California do so under Medi-Cal, according to the Department of Health Care Services.

The cuts threaten public health in Santa Cruz County, where more than 30% of residents are enrolled in Medi-Cal and with about $1 billion of Medi-Cal money spent in the area, according to research done by UC Berkeley.

People won’t go to the doctor when they need it, diseases could proliferate if vaccines are not taken and unchecked comorbidities could rise, according to some of the doctors who spoke Tuesday at Santa Cruz Community Health Center’s Live Oak campus.

Dr. Lisa Hernandez, health officer for Santa Cruz County, said it is now a waiting game, until a special session of the California Legislature in the fall to possibly allocate more funding in response to the federal cuts.

The county is setting up a team to analyze the long-term effects of the bill and, more important, how the state will respond to the Medicaid cuts, which will trickle down to all aspects of the community health care system, said Nicole Coburn, assistant county executive officer. 

Dr. Casey KirkHart, chief medical officer of Santa Cruz Community Health, said the “backward-facing bill” will destroy the local community health system the organizations assembled had worked to build since the 2010 Affordable Care Act boosted enrollment in Medi-Cal. 

At Salud Para La Gente, a health center with 13 service sites in Santa Cruz and north Monterey counties, a majority of the patients are on Medi-Cal, according to Dr. Devon Francis, the organization’s chief medical officer. She said the program is a “critical safety net” for the community.

The number of visits from uninsured patients at Salud Para La Gente has fallen from 30% in 2012 to 8% in 2024 because of higher Medi-Cal eligibility, which has allowed the nonprofit to reinvest in the community over the past 13 years, said Francis. Medi-Cal money has paid for more clinics, equipment and the salaries of its doctors and staff.

Now that the funding is under threat, Salud Para La Gente will have to go back to more “uncompensated care.” Anyone who needs health care will be treated as duty calls.

But this will not be without consequence for patients, Francis said: Overcrowding in medical facilities, fewer staff members, higher premiums for people with private insurance and possibly the elimination of entire departments will have to be considered in the coming years.

“We have to find other ways to cover costs,” Francis said. “Everyone is going to feel the impact of these cuts, regardless of if you are covered by Medi-Cal or have private commercial insurance.”

Speaking in front of the offices of Santa Cruz Community Health and Dientes Community Dental, Rep. Jimmy Panetta decried the bill as a “tax break for billionaires” at the expense of the middle class and millions of people with disabilities who could struggle to navigate complex new enrollment rules or work 80 hours a week.

“It literally is a barfed up bill that’s as serious as its name,” he said. “It’s similar to using ChatGPT when it comes to legislating, in that you don’t care about self-improvement, you don’t care about kicking people off health care, nutrition programs, you don’t care about the debt and deficit and the drag on the economy that it’s going to cause. All that you care about is living in the moment.”

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FOR THE RECORD: This story has been updated to correct the number of Salud Para La Gente health sites.

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