Health policy experts now warn that Southern California could see similar chain reactions play out again, and on a larger scale, as hospitals brace for a wave of newly uninsured patients. Recent federal and state cuts to Medicaid are expected to roughly double California’s uninsured rate, leaving an estimated 2.2 million residents without coverage by 2030. Low-income patients who rely on Medi-Cal will bear the brunt of the fallout, but those with private insurance won’t be immune either.

“The feeling that everyone experiences is the inability to access the health care they need when they need it,” said Carmela Coyle, president and CEO of the California Hospital Association.

Because the health care system is so tightly interconnected, researchers say nearly everyone could feel some version of the squeeze — fewer services, lower quality of care, and potentially higher premiums.

What triggered the crisis

President Trump’s tax legislation last year slashed nearly $1 trillion from Medicaid, the federal insurance program for low-income Americans, over the next decade. California officials estimate Medi-Cal alone could lose roughly $30 billion a year as a result.

Many low-income adults will now face new work requirements and shorter eligibility windows — rules that research shows tend to knock people off public assistance programs not because they’re ineligible, but because of bureaucratic paperwork errors. State lawmakers also trimmed benefits for undocumented immigrants and refugees enrolled in California’s programs.

Bukola Olusanya, who provides street medicine through St. John’s Community Health in South Los Angeles, said most homeless patients won’t be able to meet work requirements even when they qualify for an exemption, such as a disability. The result, she said, will be massive coverage losses among some of the most vulnerable residents.

“We’re talking about people who don’t have access to a cellphone,” Olusanya said. “They don’t have access to the internet. They don’t have access to a printer, paper or anything to complete the eligibility process.”

Taken together, these changes threaten to unravel much of the progress California made expanding health coverage over the past decade, said Anthony Wright, executive director of Families USA, a health care consumer advocacy group.

“From a purely economic standpoint, this is the largest cut to coverage in history,” Wright said.

Hospitals caught in the middle

Hospitals are where the financial strain lands hardest. By law, emergency rooms cannot turn anyone away, so when more patients arrive without insurance, someone still has to cover the cost of their care. The California Hospital Association projects that uncompensated care statewide will climb from roughly $2 billion to $4 billion a year because of the cuts — a serious concern, Coyle said, given that more than half of California’s hospitals are already operating in the red.

When hospitals are forced to cut costs, those cuts tend to affect everyone, regardless of insurance status. Facilities may reduce staff, cut wages, or eliminate costly services such as labor and delivery units. Some may shutter emergency departments rather than continue absorbing losses from uninsured patients. Quality of care can suffer, and hospitals already struggling financially become more likely to close for good.

“If you don’t have as many paying patients, your revenue as an organization goes down,” said Nadereh Pourat, associate director of the UCLA Center for Health Policy Research. “These are nonprofit institutions, so that revenue is what funds the delivery of care.”

Coyle noted that the Affordable Care Act had served as a financial lifeline for hospitals by extending Medi-Cal to millions of low-income Californians who previously lacked coverage, while also creating an insurance marketplace for middle-income residents. In the decade before that expansion, 26 California hospitals closed entirely, and another 22 shut down their emergency rooms.

Anticipating the federal and state cuts, California hospitals have already laid off more than 3,000 workers.

Covered California already feeling the pinch

Nearly 2 million Californians with private insurance have already felt some of these effects. Last year, Congress declined to renew roughly $3 billion in subsidies that helped middle-income families afford coverage through Covered California, the state’s Affordable Care Act marketplace. Without those subsidies, prices jumped sharply in January, pushing many enrollees into cheaper, less comprehensive plans.

About 140,000 people have already dropped their Covered California coverage since the start of the year, and researchers at UC Berkeley and UCLA project another 176,000 will follow. State officials have also announced that premiums will rise by nearly 10% next year.

When costs spike, healthier people are often the first to walk away from coverage, said Charles Bacchi, president and CEO of the California Association of Health Plans.

“They’re the first to drop coverage because they start questioning whether it’s worth it financially. Why am I buying this? The price keeps going up and I don’t use it much, so I cancel,” Bacchi said.

That exodus drives prices even higher, since the people who remain insured tend to have more expensive medical needs. Without healthier enrollees helping spread out the cost, insurers struggle to keep premiums from climbing further.

Will your own premium actually rise?

For people who get insurance through their employer, economists and insurers disagree on how directly these added costs will translate into higher premiums. Some studies suggest hospitals absorb roughly 80% of increased costs tied to uninsured patients rather than passing them along.

“I don’t know if patients with private insurance really end up worse off, and I think that’s part of why Americans seem comfortable with the pretty unequal system we have,” said Tal Gross, a health economist at Boston University.

His reasoning: hospitals are typically already charging insurers close to the maximum they can, leaving little room to shift costs further. In some cases, a rise in unpaid care can even push hospitals to lower prices for private insurers in order to attract more paying patients.

Bacchi dismissed that theory. In many parts of California, he said, there’s so little competition among hospitals that they can charge insurers almost whatever they want, since insurers are legally required to keep certain facilities in their network.

“Any facility that does burn treatment, transplants, or any of those high-cost services has all the leverage,” Bacchi said.

Broad estimates suggest premiums could rise by 1% to 2% — roughly $500 a year for the average family — from the federal cuts alone, according to Kenneth Thorpe, a health policy professor at Emory University. Separately, state lawmakers approved a new tax on health plans meant to help offset Medi-Cal’s federal funding losses, which commercial insurers say will add another $100 per person annually.

“All of that hurts compared to what’s happening with wages, which are pretty stagnant,” Thorpe said. “It’s a bad time.”

The bigger picture

Wright, of Families USA, said losing health coverage is painful for individuals and damaging for entire communities. The same dynamic that turned King-Harbor’s 2007 closure into a regional crisis — a sudden spike in uninsured patients overwhelming emergency rooms — could resurface, only this time affecting far more hospitals across the state.

“It means people live with worse illnesses, die younger, and are one medical emergency away from financial ruin,” he said.

Original source: CalMatters

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A closer look, however, shows that Californians are making concessions to afford staying insured. 

More enrollees are opting for “bronze-level” plans. These plans have lower monthly premium costs but higher deductibles and copays; they cover 60% of medical expenses — leaving enrollees to pay the rest. One in three new enrollees chose bronze plans for 2026, compared to one in four last year, according to Covered California. And 130,000 Californians renewing their coverage switched from a silver or higher-metal tier plan to bronze.

“Many Californians see the value in remaining covered, but they had to make sacrifices and shift to lower-tier plans. We see it as a commitment to health and the value that Covered California provides,” Jessica Altman, Covered California’s executive director said in a statement. 

While bronze-level plans may offer people some peace of mind, the high deductibles and copays tend to discourage people from seeking care, said Miranda Dietz, director of the Health Care Program at the UC Berkeley Labor Center.

“Those out-of-pocket costs do impact people’s decisions to get care, so that’s worrisome as well,” Dietz said. 

People earning above 400% of the federal poverty level — $62,600 for an individual and $128,600 for a family of 4 — no longer qualify for premium assistance after Congress chose not to extend the enhanced subsidies at the end of last year, pushing many to opt for plans with cheaper premiums or drop their marketplace plans entirely. 

Of the 224,000 middle-income enrollees set to renew, 22% cancelled their plans, according to Covered California. New sign ups for people in this income bracket decreased by 59% compared to last year.

Whether those who renewed coverage or newly signed up continue to pay their premiums is another question. A clearer picture of who stays enrolled will emerge around April, Covered California said. 

“Once you actually face the prospect of paying that premium and the stress that puts on your budget, it’s entirely possible that some of those folks may fall off, and the (enrollment) numbers might go down,” Dietz said.

Affording care: a growing stress point 

It’s unknown whether people who cancelled their marketplace health plans are enrolling in other types of insurance. Covered California data from the last five years show that when people terminate their marketplace plan, 10% to 14% of them report becoming uninsured. 

The Affordable Care Act’s enhanced premium subsidies, first enacted in 2021 as part of federal COVID-19 response, helped lower the insurance costs for millions of Americans. They especially helped middle-income earners by allowing them to qualify for financial assistance for the first time, capping premiums at 8.5% of income. That help is now gone, and premiums are up an average of 10%.

Lower-income enrollees remain eligible for standard federal premium aid available since ACA marketplaces launched. They also benefit from state help. California allocated $190 million in 2026 to provide state-funded tax credits for people who earn up to 165% of the federal poverty level — $25,823 for an individual or $53,048 for a family of four — averaging about $45 a month per enrollee.The end of the enhanced federal subsidies also come at a time when poll after poll shows health care costs are a growing stress point for people. Seven in 10 Californians say health care expenses place a financial strain on their household, according to a recent survey by the California Health Care Foundation. Four in 10 have medical debt and six in 10 report skipping care. Meanwhile, eight in 10 Californians say making health care affordable is an “extremely” or “very” important priority for state officials and lawmakers in 2026.

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Trump and the GOP promise the legislation will be great for Americans.

Not everyone is celebrating.

Lost in the fiery debate over the bill’s Medicaid funding for the poor is what happens to the millions of working Americans who make too much money to qualify for the federal health insurance program.

Not everyone has employer-sponsored health insurance. Small business owners and their families, gig workers, part-time employees, and full-time workers must purchase plans on the open market if their employers don’t offer health insurance. (Companies with fewer than 50 full-time employees are not required to offer health care benefits.)

Currently, many of these residents rely on Covered California, the state’s Affordable Care Act health insurance marketplace. The program allows qualifying residents to purchase private health insurance coverage at federally subsidized rates. The program (referred to as ObamaCare) serves residents whose incomes are too high for Medi-Cal (as Medicaid is known in California).

Roughly 2 million Californians rely on Covered California for health insurance. In the Inland Empire, approximately 22,273 people were enrolled in the program during the first quarter of 2025, according to state figures.

In 2026, however, some Covered California enrollees could see their monthly premiums skyrocket.

Why?

In 2021, Congress expanded financial assistance for the Affordable Care Act. That dramatically reduced monthly health insurance premiums for Covered California enrollees by offering tax credits that can be used to offset the high costs of coverage.

However, those enhanced tax credits are set to expire at the end of 2025. The One Big Beautiful Bill did not address enhanced ACA tax credits, and it appears that Trump and the GOP do not intend to extend them.

Nationally, it’s estimated that 5.1 million people currently insured through the Affordable Care Act could lose their health coverage next year, primarily because they will be unable to afford it.

Here’s an example of how that impending expiration affects a Riverside County couple in their early 60s who own a small business and have an annual household income of $176,000.

In 2025, the couple can find health insurance plans on Covered California with premiums starting at approximately $987 per month (covers both of them). However, depending on the plan type they seek (carrier, PPO vs. HMO, low out-of-pocket costs for services, etc.), their monthly premium could be as high $4,177.

Without the enhanced tax credits, the same couple would find health insurance premiums on the Covered California marketplace to be more expensive. Based on 2025 numbers, the costs would start at $1,631 per month for a plan with a high deductible. If they want a plan with low out-of-pocket costs, they can expect to pay as much as $4,822 per month. These figures do not include the anticipated health insurance hikes expected for 2026.

For individuals with significantly lower incomes than the example above, the expected increase in health insurance costs through Covered California will be substantially greater. For example, a couple who currently earn $85,000 between them and who don’t have children or employer-sponsored health coverage are unlikely to receive any break on health insurance starting next year.

For now, they can pay as little as $342 per month for the least expensive insurance plan offered via Covered California, which features a hefty $13,000 annual deductible. Next year, that same plan could cost approximately $1,631 per month — more than a 400% increase. That’s the low end. If they want a plan that offers a lower annual deductible, they can expect to spend around $2,000 per month for the most affordable plans.

In theory, the Republican-led Congress could remedy the impending tax credit expiration before the end of the year. Given that Trump spent most of his first term in office trying to repeal the Affordable Care Act, however, the odds of that appear slim.

Stay tuned.

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