It also left a litany of unanswered questions: who came up with the narrow criteria, how many hospitals would qualify and whether the funding will be enough to prevent hospital closures in the near term.

Assembly Bill 108, signed into law last week, will provide grants to public and nonprofit hospitals that meet several criteria, including having less than 10 days of cash on hand and having more than half of their patients on government-funded insurance programs or uninsured. The goal is to tide eligible hospitals over until July 1, when the new fiscal year begins, said Sen. John Laird, a Santa Cruz Democrat who chairs the Senate Budget Committee and championed the funding bill.

The measure, put in print on May 4, flew through both legislative chambers in just three days before Gov. Gavin Newsom signed it within hours. By Monday, the program was up and running and hospitals had just a week to apply. The Department of Health Care Access and Information will announce recipients May 26.

“It is a rare occurrence for bills to go from the starting block to the finish line in just a few days,” said veteran lobbyist and Capitol watcher Chris Micheli, who said the speed reflects the urgent need of hospitals and a consensus among leaders.

Hospital leaders interested in applying said they were pleased the Legislature acted so quickly, though some are scrambling to meet the application deadline after learning about it just a week ago.

Laird told CalMatters that he knows of two to three hospitals that will likely qualify but declined to name them, arguing that doing so could scare off vendors and hospital staff.

When pressed, he acknowledged that potential recipients include Watsonville Community Hospital in his own district.

“This bill comes at a completely inopportune time in the budget process, and the time was not dictated by us,” Laird said during a budget hearing last Tuesday. “It was dictated by a few hospitals going under.”

The criteria are so narrow and the bill moved in such an “expedited fashion” that it seems tailored to the needs of a specific hospital, said Assembly Budget Committee Vice Chair David Tangipa, a Fresno Republican, who voted for the bill nonetheless.

“It says 10 days. Why not put it at 30 days?” he said. “They needed to make sure that even though it appears to be a general fund that all of these other hospitals could apply for, that probably only one hospital met all of those qualifications.”

Neither Laird nor the finance department staff was able to explain how they came up with the criteria, including why they picked 10 days — instead of any other number — of cash on hand to indicate a dire enough financial situation. Hospital administrators said the typical goal is at least 90 days of cash on hand.

The ambiguity frustrated some state lawmakers, who repeatedly pressed for clarity during the budget hearing. Sen. Chris Cabaldon, a Napa Democrat, called the lack of answers “profoundly disturbing.”

“It’s been one long ‘I said what I said’ hearing,” he said. Still, he voted for it.

Others lamented that the criteria, especially the 10-day threshold, should have been expanded to allow more hospitals to compete for the funding.

“Right now, it’s far too narrow, and really by this time the hospital has gone over the cliff,” Sen. Lola Smallwood-Cuevas, a Los Angeles Democrat, told CalMatters in an interview. She, too, voted for it. “We want to figure out who’s standing on the cliff, who’s a few feet from the cliffs, who’s a mile from the cliff.”

The $25 million grant comes as hospitals across California, particularly in rural areas, say they are at risk of dropping services or shutting their doors due to rising labor costs and federal Medi-Cal funding cuts.

The funding woes sparked calls for renewed funding for the state’s Distressed Hospital Loan Program, which in 2023 gave 16 financially distressed hospitals nearly $300 million. Of those, 15 have asked for more time to repay the debt, and nine of them have also applied for loan forgiveness, according to the California Health Facilities Financing Authority.

The California Hospital Association, which represents nearly 400 hospitals, is sponsoring a bill to put another $300 million into the loan program. Senate Democrats proposed $200 million in funding in mid-April but have not specified if the dollars would be a loan or a grant.

Newsom proposed up to $50 million toward hospitals in “immediate and significant financial distress” in 2026-27 in his budget revision Thursday.

A few hospitals plan to apply

Watsonville Community Hospital, which has publicly shared its financial struggles, reported having 8 days of cash on hand in the last quarter of 2025, according to the most recent financial records collected by the state. The hospital received an $8.3 million state loan in 2023 as part of the distressed hospital program lawmakers passed that year. When asked about the hospital, Laird said the hospital is “quite likely” to be eligible.

“This is critically important for the hospital as we navigate fiscal challenges brought on by funding delays and cutbacks at the federal level,” hospital spokesperson Jennifer Murray said in an email.

Hospitals in the Central Valley and rural Southern California also could benefit from the grant, according to Laird.

Madera Community Hospital told CalMatters it intends to apply for a slice of the grant money. The hospital reopened its doors in March 2025 after closing at the start of 2023. American Advanced Management, the company that took over the hospital, received $57 million from the state to reopen it. State data show the hospital ended 2025 with two days of cash on hand.

Delays in reimbursements and low patient volume in its outpatient clinics are contributing to Madera Community’s slower-than-expected recovery, said Matthew Beehler, a spokesperson for the hospital. He said Madera Community is still working on contracting with some insurers and is not yet receiving funds from the Hospital Quality Assurance Fee, a state-federal supplemental payment program for hospitals that serve a high number of Medi-Cal and uninsured patients. State data show that in 2022, before the hospital closed, it relied on more than $16 million in supplemental payments.

The $57 million from the state, Beehler said, helped cover the hospital’s first six months of operations. Beyond that, American Advanced Management has covered the shortfalls.

“I think that we are headed towards the path of real sustainability for the hospital,” Beehler said. “It just takes time to have all that sort of reach its state of equilibrium.”

In the Eastern Sierra, Dr. Kevin Flanigan, CEO of the Southern Inyo Healthcare District, said he, too, plans to apply for the state’s emergency grant. He said his hospital needs about $1 million to get through 2026. However, he does not know if his hospital will qualify given the 10 days of cash on hand criteria. He said Southern Inyo’s cash balance fluctuates anywhere between 18 to 20 days of cash to 8 to 10 days — grim in either case.

If his hospital doesn’t qualify for a grant? “Then God willing, we find money elsewhere. If not, we begin the process of closing certain things,” Flanigan said. Southern Inyo is a small hospital, with only four acute care beds, 30 skilled nursing beds and an outpatient clinic; there isn’t much to cut from, he said.

“We are clearly one of the most precarious hospitals in the state.”

Unanswered questions

Laird told CalMatters he is confident the $25 million will be enough to save hospitals facing the most imminent threat of closure.

But it’s unclear how he and the finance department arrived at the dollar amount. Department of Finance spokesperson H.D. Palmer said the figure represents the administration’s “best assessment of potential funding needs” and is partly based on the Distressed Hospital Loan Program, which gave 16 hospitals an average of $19 million each to keep them afloat for several years.

Laird said the amount was based on the number of hospitals legislators “informally” think would be eligible. Whatever is left untapped by June 30 would revert back to the state, he said, and legislators could add more funding if it runs out.

“It is what we think is necessary now,” Laird said.

The Department of Health Care Access and Information collects and publishes financial data from hospitals quarterly, but that data lags. Which hospitals qualify for the grant will depend largely on their self-reported finances as of April 15, the department said.

Many state lawmakers want more answers, too. Sen. Shannon Grove, a Bakersfield Republican, grilled finance department staff over the bill details.

“How long is this lifeline going to last? Is it even going to save the people who are in the 10-day timeframe?” she asked.

“That is the intent,” said Lupe Manriquez of the Department of Finance.

“I know it’s the intent. Is it going to save them?” Grove pressed.

“That’s the goal,” Manriquez answered.

Cabaldon told the staff he wouldn’t even bother asking about the criteria because “I already know what the answer is going to be.”

“It is incumbent on this committee to be able to have real answers to the questions that are posed about the why and the evidence,” Cabaldon said. “We are not having a conversation. We are asking questions of fulfilling our constitutional role in this process and getting zero answers.”

Palmer called the heat on his staff “undignified sniping and sarcasm,” noting that the bill originated from the same legislative chamber that’s now questioning it.

“They asked for our assistance in the expedited consideration of the bill outside of the regular budget process — and we complied and cooperated,” Palmer said in an email. “If members were either unable or unwilling to do some basic homework on their own bill that they wanted to be put on a fast track, then that’s a question that’s better posed to them — not us.”

How long a lifeline?

But throwing money at hospitals to keep them afloat is not the answer, some lawmakers argued.

“We can’t just keep giving $25 million handouts over 10 days where a hospital is looking to close,” Smallwood-Cuevas said, noting that President Donald Trump’s H.R. 1, which sharply reduces federal spending on Medicaid, could devastate hospitals.

“What is the state doing to identify and support vulnerable safety net hospitals before they reach the point of fiscal crisis? That is an answer I want to hear.”

Some hospital administrators also called for longer-term solutions. Katherine Burnworth, board president of the Imperial Valley Healthcare District, which oversees Imperial County’s two hospitals, told CalMatters that while she appreciates state action, $25 million statewide “is a drop in the bucket compared to the scale of the problem.”

“That may help a small number of hospitals avoid a near-term emergency, but it does not address the ongoing instability that communities like ours live with year after year,” Burnworth said.

While acknowledging the importance of emergency grants, Republicans on the committee argued that California has shortchanged hospitals’ Medi-Cal reimbursements. The California Hospital Association estimates that hospitals are reimbursed 74 cents for each dollar they spend on Medi-Cal patients. Hospitals that see a high share of Medi-Cal patients do get supplemental payments to help offset some of the gaps in reimbursement.

The GOP lawmakers also said that some state regulations, such as a minimum wage hike for health care workers and the requirement that all hospitals comply with new seismic safety requirements by 2030, will burden hospitals with high costs.

“We are throwing Band-Aids on everything, when really we need to just get together and fix the issues of what are the unfunded state mandates that are on our hospitals right now,” Tangipa said.

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“There are California taxpayers and American taxpayers who are being defrauded because California isn’t taking its program seriously. But also, you have people who’ve been prescribed medications that they don’t even need,” Vance said. “Sometimes they’ve had drugs put into their bodies that they don’t need because fraudsters have actually encouraged false prescriptions and false administration and medications.”

Vance, standing alongside Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, said the administration is also sending letters to all 50 states informing them that if they do not “effectively and aggressively prosecute Medicaid fraud in their states,” they will see federal funding cut off as well.

“We want California to get serious about this fraud,” said Vance, who President Trump named his “fraud czar” last month.

Oz called out what he said was widespread fraud in hospice services and similar in-home care programs nationally — and particularly in the Los Angeles region — and announced a six-month moratorium on new Medicare enrollment for hospices and home health agencies.

“A third of all these programs in the entire country are in Los Angeles. Ask yourself, how is that possible? It’s not,” Oz said. “They’re not that many people dying in Los Angeles. We’re not talking about California, just Los Angeles.”

He said he and others in the administration determined that “at least half of the hospices, in the entire area around Los Angeles, are fraudulent,” and had shut down 800 of them that last year had “charged the federal taxpayer $1.4 billion,” which “will no longer be paid.” That is a major increase from the 450 providers the administration said it had suspended as of last month.

The announcement was the latest attempt by the Trump administration to highlight and rein in fraud in federal healthcare benefits programs, particularly in blue states. The actions were met with immediate push back from California officials.

“We hate fraud. But that’s NOT what this is,” Gov. Gavin Newsom’s office posted on the social media site X. “Vance and Oz are attacking programs that keep seniors and people with disabilities OUT of nursing homes. Pretty sick.”

Newsom’s office said that the growth of In-Home Supportive Services placements in California was “simple,” and due to California “keeping more people OUT of far more expensive nursing homes!”

Such services cover assistants who help people with daily tasks such as bathing, laundry or cooking; provide needed care such as injections under the direction of a medical professional; and accompany them to and from doctor’s appointments. A 2020 report by the California state auditor found that nearly three-quarters of IHSS caregivers assist a family member.

Newsom’s office wrote IHSS care costs $30,000 a year, while nursing home care costs $137,000 a year. “SAVING TAXPAYERS: $107K per person,” it wrote.

California Atty. Gen. Rob Bonta also criticized the administration’s moves.

“Once again, California appears to be targeted solely for political reasons,” Bonta said. “The Trump administration is planning to defer over $1 billion in Medicaid funding for vital programs that helps seniors and people with disabilities remain safely in their homes.

“My team is carefully reviewing all available information. We have not hesitated to challenge unlawful actions by the Trump administration, and we will continue to act whenever Californians’ rights or access to critical services are threatened,” he said.

Democratic Sen. Alex Padilla also lashed out at the Trump administration.

“The Trump Administration is attacking California over claims that they can’t back up,” Padilla wrote on social media. “Let’s be real, this isn’t about fraud — it’s about punishing a state that didn’t vote for him. Political retribution plain and simple.”

Fraud in California’s hospice industry has been a problem for years.

Authorities in the state promised to crack down on the issue after a Times investigation in late 2020 revealed that unscrupulous providers were billing Medicare for hospice services and equipment for patients who were not actually dying — with the hospice industry in the state exploding in size.

California’s Medicaid program, known as Medi-Cal, is expected to cost about $222 billion for the budget year starting July 1, including both state and federal funding. Roughly 15 million Californians, more than a third of the state, are on Medi-Cal.

Vance, a potential 2028 presidential hopeful, has taken up his work as “fraud czar” with vigor, traveling around the country to drive home the idea that the Trump administration is working diligently to bring down healthcare costs by addressing waste, fraud and abuse that is rampant across the system.

He has said that waste and abuse is particularly prevalent in Democratic-led states such as California, New York and Minnesota.

“We have red states and blue states that go after fraud aggressively, but we also, unfortunately, have some states, mostly blue states, unfortunately, that do not take Medicaid fraud very seriously,” he said Wednesday.

Vance specifically threatened to cut off what he said is billions in federal funding for state-run fraud control units that are meant to prosecute people who abuse the system, but which he said aren’t doing the work. “This is a tool that we want the states to use, but unfortunately, a lot of states aren’t using these tools at all,” he said.

The focus on fraud comes against a backdrop of criticisms that other policy measures pushed by the administration have driven healthcare costs up or made it harder for people to access healthcare — including cuts to Obamacare subsidies and new work requirements in Medicaid, which are expected to strain hospitals around the country and led to millions of people losing healthcare coverage.

Democrats and Republicans have argued over who is to blame for rising healthcare costs, and Vance and Oz have clashed with California leaders before.

In January, Newsom filed a civil rights complaint against Oz after he posted a video accusing Armenian crime groups of carrying out widespread healthcare fraud in Los Angeles. In the video, Oz was shown driving around Van Nuys, saying about $3.5 billion worth of Medicare fraud had been perpetrated by hospice and home care businesses — and “run, quite a bit of it, by the Russian Armenian mafia.”

Newsom called Oz’s claims “baseless and racist.”

The administration previously launched investigations into potential healthcare fraud in at least five states — California, Florida, Maine, Minnesota and New York — and halted some $243 million in Medicaid payments to Minnesota over fraud concerns.

The Centers for Medicare & Medicaid Services has also acknowledged using errant figures to justify a fraud probe in New York, deepening concerns in the administration’s methods for identifying problematic activity.

Vance said the deferral of funds to California and the letters warning other states to get serious is not about political retribution, but a wake up call. He said the Trump administration wants to help states root out fraud and abuse, including with new technologies — but can’t do so if they are not “willing to help themselves” first.

“We don’t want to turn off any money. What we want to do is ensure that people are taking fraud seriously. We want to protect Medicaid, we want to protect Medicare,” Vance said. “But we can’t do that if the states that are administering those programs are allowing those programs to be fleeced by fraudsters.”

The Associated Press contributed to this article.

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The mission is to raise funds for unpaid services provided by children’s hospitals statewide. The collaboration involves the Disneyland Resort, the California Children’s Hospital Assn. and the Health Facilities Financing Authority overseen by the state treasurer’s office, according to a news release.

“In this time when Californians are struggling to get access to care, we are thrilled to help unlock new funding to help expand care, improve health outcomes and promote the well-being of children with serious and complex medical needs,” State Treasurer Fiona Ma said.

Next steps toward approval

The announcement begins the process of developing a Disney-themed tag and securing approval from the Department of Motor Vehicles to add to its special license plate program.

Getting the DMV’s OK requires a pre-order minimum of 7,500 license plates. The agency also needs to sign off on the design.

It’s unclear how long this process will take. A DMV representative could not immediately be reached for comment.

The Disney-themed plates, if approved, would be among several the DMV offers to fund charities or causes, including the Arts Council, Breast Cancer Awareness, the Lake Tahoe Conservancy, museums, firefighters and veterans.

What will the license plates fund

After deducting administrative fees, proceeds from the Disney plates would go toward services provided by hospitals and clinics that are not covered by insurance or a patient.

Earnings will be deposited into the program fund established in the State Treasury and awarded to 13 children’s hospitals, including:

• Children’s Hospital Los Angeles
• Loma Linda University Children’s Hospital
• Lucile Packard Children’s Hospital Stanford
• MemorialCare Miller Children’s & Women’s Hospital Long Beach
• Rady Children’s Health Orange County
• Rady Children’s Health San Diego
• UC Davis Children’s Hospital
• UC Irvine Health Children’s Hospital
• UCLA Mattel Children’s Hospital
• UC San Diego Health Children’s Hospital
• UCSF Benioff Children’s Hospital Oakland
• UCSF Benioff Children’s Hospital San Francisco
• Valley Children’s Hospital

How much will these Disney-themes plates cost

Specialized plates cost $50 — or $103 for personalized versions — with an annual renewal fee of $40 or $83, respectively, in addition to standard vehicle registration fees.

How to pre-order

The California Health Facilities Financing Authority has launched a website for those interested in the Disney collaboration. Interested parties who fill out a form will receive updates on the program, including application details and opportunities to pre-order.

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The debate, broadcast on CNN, was one of their last chances to pitch themselves to voters and stand out from the pack in their primary election bids to succeed Democratic Gov. Gavin Newsom, who terms out in January. Mail voting is already underway, and voters have until June 2 to cast their ballots. The top-two vote getters will advance to the general election in November, regardless of party.

Though California hasn’t had a Republican governor in more than a decade, the specter hangs over the race as the field is still crowded with less than a month to go.

Candidates who took part in the debate include Democrats Xavier Becerra, a former health secretary for the Biden administration; Katie Porter, a former congresswoman; Tom Steyer, a billionaire climate activist; Matt Mahan, the mayor of San Jose; and Antonio Villaraigosa, the former mayor of Los Angeles; as well as Republicans Steve Hilton, a conservative commentator; and Chad Bianco, the Riverside County sheriff.

Here’s how they responded on some of the key issues:

Universal healthcare

The candidates sparred over whether they’d eliminate private health insurance in favor of a state-run system, an idea that has failed repeatedly in Sacramento.

Porter, who backs a government-run healthcare system, pressed Becerra on his stance since he’s wavered on the issue recently.

“Do you support CalCare — California having its own state-run, single-payer system, yes or no?” Porter asked.

Becerra gave a vague answer.

“The most important thing about having a Medicare for All plan is that it includes everyone,” he said. “What we have to do is get to the point where we are covering everyone with something like Medicare for All.”

Mahan, who opposes a state-run system, later chimed in and said Becerra “was unable to clearly answer the most important question on healthcare.”

Becerra contested: “I did answer that question.”

Steyer joined Porter in saying he’d support it, while Bianco, Hilton, and Villaraigosa said it wasn’t practical or would cost too much.

When the debate turned to healthcare access for immigrants, the candidates were divided.

Steyer, Porter and Becerra said they supported state-funded healthcare coverage for low-income immigrants without legal status, which Newsom passed then pared back. Bianco called the policy “ridiculous.”

Immigration

Other arguments about immigration fell largely along party lines.

The Democrats sharply rebuked the Trump administration’s immigration raids.

Steyer said the state should prosecute federal agents and immigration enforcement leaders who racially profile or use violence against Californians. Mahan said business owners in San Jose have lost customers because many immigrants are afraid to leave their house.

But Bianco said he supported Immigration and Customs Enforcement actions, saying agents were enforcing the law and working to deport people he referred to as “criminals” in the country illegally.

Hilton, who’s from England, pointed out that he was the only immigrant on stage. The candidates shouldn’t conflate legal and illegal immigration, he said.

“Although it is the federal government’s responsibility to determine and implement immigration policy, I think it’s important that all the laws are peacefully enforced,” Hilton said. “As governor, I would make sure that we work with the federal government to enforce our laws.”

President Donald Trump

The Democrats each emphasized they would fight Trump on immigration policy in particular.

Neither Hilton, whom Trump has endorsed, nor Bianco, invoked him much except to say that Democrats unfairly blame him for the state’s woes.

Becerra mentioned Trump the most, noting he sued the administration many times while serving as state attorney general from 2017 to 2021, when he was appointed health secretary under then-President Joe Biden.

“I’m going to repeat Donald Trump as often as I have because he’s the menace,” Becerra declared.

When Villaraigosa pressed Hilton to acknowledge Trump lost the 2020 presidential election, Hilton refused to answer.

“Endlessly going on about Donald Trump doesn’t serve the needs of the struggling families and small businesses,” Hilton said.

Mahan sought to find middle ground. He said Becerra was wrong to blame high gas prices solely on Trump, but also noted that San Jose has sued the Trump administration over immigration policy. He said it was disqualifying for the Republican candidates to support Trump’s “cruel and ineffective policies.”

Porter, meanwhile, put it simply: “Donald Trump sucks.”

Gas tax and proposed billionaires tax

Steyer was the only candidate on stage to say he’d vote for a proposed billionaires tax expected to appear before voters in November. The one-time tax proposal aims to backfill funding cuts signed into law by Trump that reduced healthcare access for low-income people.

Porter also supports some increased taxes on California’s ultrawealthy but called the proposed tax a temporary fix to a long-term problem.

Meanwhile Mahan said he would suspend the gas tax because it unfairly burdens working families.

Hilton would make people’s first $100,000 free of income tax.

Mahan and Steyer said they’d tax artificial intelligence companies and use the money to support workers, for example through workforce development training.

“The answer is to tax these companies, not to regulate them to the point that they simply go to other places,” Mahan said.

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The Centers for Disease Control and Prevention this week posted a list of more than two dozen types of testing that have become unavailable.

This is not the first time the CDC has paused some of its lab testing. But it is pausing more kinds of tests than ever before, and it is not totally clear why, said Scott Becker, chief executive officer of the Association of Public Health Laboratories.

A government spokesman called the pause temporary and attributed it to “a routine review to uphold our commitment to high quality laboratory testing.”

“We anticipate some of these tests will be available through CDC labs again in the coming weeks. In the meantime, CDC stands ready to support our state and local partners to access the public health testing they need,” said Andrew Nixon of the U.S. Department of Health and Human Services, which oversees the CDC.

CDC’s laboratory operations were faulted during the COVID-19 pandemic, and they were the subject of a subsequent work group’s review. The agency has been evaluating its testing since 2024, Becker said.

But there can be other reasons for taking tests offline, including staffing issues, he noted.

The pausing of lab testing comes in the wake of the dramatic downsizing of the CDC in the last year through layoffs, retirements, resignations and the nonrenewal of temporary appointments. Staffing fell by 20% to 25%, according to different estimates, and was felt across the agency — including in the laboratories.

The poxvirus and rabies labs lost about half their prior staff, and the CDC’s malaria branch was gutted even more, according to the National Public Health Coalition, an organization of former and current CDC workers that formed in the wake of the downsizing.

Some of the paused testing focuses on common infections for which commercial testing is available, like Epstein-Barr virus, and the varicella zoster virus behind chickenpox and shingles. But also on the list is testing for some more exotic agents, like the for parasitic worms responsible for “snail fever” and for the virus that causes “sloth fever.”

Some specialized state labs, like those in the New York and California, have the ability to pick up the slack while CDC tests are on pause, Becker said.

He called the pauses “concerning, only if it’s permanent.”

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News of the lawsuit spread quickly through chat groups of parents of transgender kids, LGBTQ organizations and the broader transgender community. It was the first major action the state has taken against a hospital that had severely limited or ended transgender health services.

Many in the community see this move as a major step towards protecting transgender health, but some still question why the state’s legal claims don’t rest on broader civil rights questions. Instead, the key argument relies on the state’s corporations code — a provision governing business transactions — to try to compel Rady into continuing gender-affirming care.

The claim filed against Rady alleges the health system violated a merger agreement signed last year when Rady took over Children’s Hospital of Orange County and Children’s Hospital of Mission. That agreement requires Rady to maintain existing services, including transgender health care.

“We have anti-discrimination laws on the books. We have legal protection of gender-affirming care on the books. But if Rob Bonta does not feel confident in his ability to win a case on the basis of those laws do we really have those laws?” said Kanan Durham, executive director of Pride at the Pier, an Orange County group organizing opposition to Rady’s announced transgender clinic closure.

Durham said he was in a room full of trans people when the news of the lawsuit broke. People cheered, he said. But many were conflicted about the narrow application of the claim.

California’s civil rights law — the Unruh Civil Rights Act — is the backbone of the state’s guarantee of equal access to transgender health services, which can include puberty blockers, hormones, surgery and therapy, said Megan Noor, a staff attorney at the Transgender Law Center. The law prohibits discrimination on the basis of sexual orientation or gender identity. 

Noor said that means, for example, if a hospital offers puberty blockers to a cisgender child who is starting puberty too young, they cannot deny access to that same treatment to a transgender child even if it is for a different purpose, such as giving the child more time to explore their gender identity. 

Other laws require insurers to cover gender-affirming care and protect the privacy of transgender patients and their doctors.

In a press release, Bonta said “We will fight to uphold the law and ensure Californians can access gender-affirming care without facing unfair roadblocks.” His office, in an unsigned statement, said it had no comment on enforcement of the state’s civil rights law.

Ben Metcalf, a spokesperson for Rady Children’s Health, said in a statement that the organization could not comment on pending litigation, but called the decision to shutter gender-affirming care services “very difficult.”

“That decision was guided by our responsibilities as a nonprofit pediatric health care system to continue serving all children and families across our communities, including through participation in essential federal programs,” Metcalf said.

Rady notified parents of transgender children in mid-January that it would be closing its Center for Gender Affirming Care on Feb. 6.

Hospitals under pressure

Over the past year, transgender youth and their parents have watched with growing fear as California’s largest health systems retreated from providing transgender health services to people under the age of 19.

Children’s Hospital of Los Angeles was the first to stop care. Then Stanford Medicine, Kaiser Permanente, Sutter Health and most recently Rady limited or announced plans to terminate care. Sutter had told parents in December that it would stop providing services to their children, but quietly backtracked under fierce public pressure.

Hospitals say their hands were forced by an unfriendly federal government that does not recognize the existence of transgender people. 

On his first day in office, President Donald Trump issued an executive order characterizing transgender health procedures as “chemical and surgical mutilation” and directing agencies to defund any supportive programs. 

Since then his administration has intensified the pressure against health care organizations. Over the summer, federal investigators issued subpoenas to clinics and hospitals around the country, alleging fraud and seeking medical records. The U.S. Department of Health and Human Services in November published a self-described peer reviewed report “on the medical dangers posed to children” of gender-affirming care.

Rady, in a statement issued prior to the state’s lawsuit, confirmed the Health and Human Services inspector general was investigating the hospital, and said “the environment around gender-affirming care has changed dramatically.” 

The American Medical Association, American Academy of Pediatrics and dozens of independent scientific studies reject the claim that gender-affirming services are harmful to children with gender dysphoria. Instead, they conclude that “trans and non-binary gender identities are normal variations of human identity and expression” and having access to supportive health care positively impacts youth mental health and decreases suicidality.

Most recently, the U.S. Centers for Medicare and Medicaid Services is considering proposed rules that would eliminate government funding for hospitals that provide transgender health care to minors. If formalized, the rules would effectively create a near-total national ban on gender-affirming services for young people because nearly all hospitals in the U.S. receive more than 50% of revenue from Medicare and Medicaid payments, according to the American Hospital Association.

Advocates, legal experts and parents say that even with this existential threat hanging over health providers, for now, it’s just that: A threat.

“Nobody needs to stop this care at this point. It is a policy that has been announced. There has not been a law passed, nothing has been finalized,” said Kathie Moehlig, executive director of TransFamily Support Services based in San Diego. “We have to resist.”

Parents and advocates look to leaders to uphold state protections

Bonta has sued the Trump administration multiple times in an effort to protect transgender patient care, but some parents and advocates say his office needs to do more to uphold state law. 

The attorney general must review nonprofit hospital transactions, and can impose conditions to preserve patient care. 

Dannie Ceseña, director of the California LGBTQ Health and Human Services Network, said it was meaningful that Bonta did that in Rady’s merger, adding language protecting gender-affirming and other specialty health services for 10 years. 

“What about all of the other hospitals and families that don’t have this protective clause? They are still violating families’ civil rights. They are still stopping access to care,” Ceseña said. “Why isn’t the attorney general doing more in regards to this issue?”

Last February, the California Department of Justice sent a letter to Children’s Hospital Los Angeles warning that its refusal to serve transgender minors would violate the state’s civil rights law. In July, the hospital permanently closed its transgender health clinic.

Ceseña says he feels the state has been inconsistent in its support of the trans community. He and other LGBTQ advocates expected the state to sue Children’s Hospital Los Angeles and others well before the Rady lawsuit. And specifically, to protect civil rights for trans children. 

“We need to stop with the letters. We need to stop with the announcements. We need to see action,” Ceseña said. “Our kids are suffering.”

Others say it’s significant that the state stepped in at all after months of “despair.”

Arne Johnson, a Bay Area parent and organizer with Rainbow Families Action, acknowledged that many members of the community had “complex feelings” about the  latest lawsuit.

But he said he cried after hearing of the lawsuit against Rady. 

“The thing that is so powerful for so many of us who have been working so hard and crying out for someone to do something is that it’s the first time the state has recognized our children are valid members of society and worthy of protection by the laws of this state,” Johnson said. “That’s all we’ve been asking for.”

Parents are fighting back 

Parents of transgender kids say they have been moved to action by the steady erosion of gender-affirming care in the state. In December, hundreds of Northern California parents protested Sutter Health’s initial decision to stop gender-affirming care.

Last month, more than 600 people rallied outside of Rady Children’s Hospital in San Diego while another 100 protested at the system’s affiliate Children’s Hospital of Orange County.

Ceseña said this marks a “huge change” since the start of the Trump administration among families who have transgender children and had previously kept their heads down in hopes that the issue would blow over.

That includes Todd, a San Diego native and father to a 15-year-old transgender boy. He asked to be identified by his middle name only to protect the identity of his son.

Before Rady informed parents it would stop services, Todd hadn’t been too involved in the transgender community. But he attended the protest and is looking to do more; Rady’s decision felt like a “betrayal,” he said.

“It felt like people who said ‘you can trust us’ were now collaborating with the people trying to hurt us,” Todd said. 

Todd’s son came out to his parents when he was 11. He saw a therapist for two years before going to Rady’s where, for more than a year, the family spoke with doctors and counselors to “help him understand himself” and “find the words and language to explain to himself what he was feeling.” 

The process looks different for every child and family, Todd said. Some kids think surgery is important to them, while others don’t; some want puberty blockers and hormone therapy, while others just want to be in an environment that is supportive. The process – broadly supported by the American Academy of Pediatrics and other leading medical societies – is often lengthy and involves the whole family, Todd said.

“If you’re not dealing with it personally, you don’t have to know those details, but what you do have to do is allow doctors and families to do the correct things to make their families healthy,” he said. 

Todd said he’s optimistic the state’s lawsuit will help Southern California families and build momentum.

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During his visit to the Inland Empire as part of his “National Latino Health Tour,” Secretary Becerra emphasized the positive impact of the Biden Administration’s Inflation Reduction Act.

“We have to remember that there were days before the Inflation Reduction Act became law and lowered the price of insulin, people were having to ration their insulin and make decisions about what to do in their daily lives if they wanted to afford it,” said Becerra. “Today, people paying no more than $35 for insulin when on Medicare is a big deal, and the fact that we now have the ability to negotiate the prices on medicine is huge.”

The $35 insulin cost cap is set to benefit 108,164 Californians on Medicare who use insulin, addressing a critical need in a state where one 10-milliliter vial of insulin can cost up to $400; a person usually needs two to three vials a month. “This is the right thing to do for our patient care. We are going to continue lowering the cost of healthcare here in the Inland Empire because it matters to people,” said Rep. Aguilar.

Further emphasizing the Act’s impact, Rep. Aguilar highlighted that drug negotiations will benefit more than 830,000 California Medicare enrollees, saving them between $64 and $4,297 in out-of-pocket costs for the first ten drugs subject to price negotiations.

Additionally, the Act ensures that recommended vaccines are now free for the more than 1.2 million Latinos in California enrolled in Medicare, and introduces a $2,000 annual out-of-pocket cost cap, effective in 2025, which will save 203,210 Californians an average of $341.84.

Secretary Becerra also noted the historic increase in Latino enrollment in health coverage through the Affordable Care Act, which jumped by 53% from 2020 to 2022, helping more than 900,000 Latinos nationwide gain health insurance than ever before.

The press event also featured a fireside chat between Congressman Pete Aguilar and Secretary Becerra, where they discussed important issues like the Affordable Care Act, health insurance, medication prices, and mental health. A SAC Health patient named Sheila provided a poignant testimony on the importance of insulin and the recent struggles faced in terms of cost and accessibility, underscoring the significance of the measures announced.

As the Inland Empire and the broader Californian community look forward to these changes, the hope is that the Inflation Reduction Act will pave the way for a healthier and more affordable future for all.

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The Biden-Harris Administration announced that Affordable Care Act (ACA) Marketplace enrollment continues to outpace previous years, with nearly 11.5 million people selecting a health plan nationwide as of December 15, 2022 – a key milestone marking the deadline for coverage starting January 1, 2023. About 1.8 million more people have signed up for health insurance, or an 18% increase, from this time last year. 

“Unprecedented investments lead to unprecedented results. Under President Biden’s leadership, we have strengthened the Affordable Care Act Marketplace with continued record affordability, robust competition, and historic outreach efforts – and today’s enrollment numbers reflect that,” said HHS Secretary Xavier Becerra. “Thanks to the Inflation Reduction Act, four out of five customers will be able to find a plan for $10 or less. As we head into the new year, there is no greater gift than the peace of mind that comes with having high-quality, affordable health care. There is still time to sign up until January 15 – visit HealthCare.gov today.”

“This year, we’re so pleased to see so many new enrollees on Healthcare.gov, taking advantage of expanded financial assistance and new eligibility to purchase affordable, comprehensive health care coverage that they can use to help keep them and their families healthy,” said CMS Administrator Chiquita Brooks-LaSure. “We look forward to a strong final month of Open Enrollment and encourage everyone who needs quality health insurance to visit HealthCare.gov and CuidadoDeSalud.gov to view plan options by January 15.” 

The Biden-Harris Administration has made expanding access to health insurance and lowering health care costs for America’s families a top priority, and under their leadership, the national uninsured rate reached an all-time low earlier this year. 

The Biden-Harris Administration encourages all families to visit HealthCare.gov and check out the health care coverage options and savings available to them. This year, thanks to the Inflation Reduction Act, more people will continue to receive enhanced tax credits to buy quality, affordable health insurance. Four out of five HealthCare.gov enrollees will be able to find a plan for $10 or less after tax credits. People with coverage through HealthCare.gov are encouraged to return and shop to see if another plan better meets their needs at a lower cost.

Individuals will also benefit from a highly competitive Marketplace. Ninety-two percent of HealthCare.gov enrollees will have access to options from three or more insurance companies when they shop for plans. The Biden-Harris Administration has also made it easier for consumers to compare and select plans by creating standardized plans that offer many of the same benefits at the same cost. 

The HealthCare.gov Marketplace Open Enrollment remains open until January 15, 2023. People who do not currently have health insurance or are already in a Marketplace plan can go to HealthCare.gov to submit or update their applications until January 15, 2023 for coverage beginning February 1, 2023. 

The next snapshot of national plan selections, including state-based Marketplaces, will be released January 11, 2023. 

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“I’ve seen the human face of this up close as a pastor. I’ve been there and witnessed what happens when diabetes goes on untreated,” Warnock said in an interview with The Associated Press. “I’ve been there with families when they received the news that a loved one will have to receive an amputation.”

That work as a pastor helped the freshman senator push Congress to take its first step in limiting the high cost of insulin for millions of Americans.

The passage of the expansive climate change and health care bill this month delivered key Democratic priorities to voters months before the midterm elections, including provisions to lower health care costs.

As a result, by 2026, Medicare will gain the power to start negotiating costs for pharmaceuticals and its beneficiaries’ out-of-pocket prescription costs will be limited to $2,000 starting in 2025.

But the most immediate relief will take effect in January when the cost of insulin for patients on Medicare will be capped at $35 a month.

The provision, a longstanding priority for Democrats, will bring relief to an estimated nearly 2 million people across the country who currently pay an average of $572 annually out-of-pocket for insulin, according to a recent analysis by the Kaiser Family Foundation.

In Warnock’s state, the annual average is higher, coming in at $591 for more than 50,000 Georgia residents whose lives are dependent on the drug.

Around 7 million Americans require insulin daily and 14% of them are spending nearly half of their income after food and housing costs on the medicine, according to a Yale University study.

“It’s devastating for a family to have to make those choices,” Lisa Murdock, chief advocacy officer for the American Diabetes Association, told the AP. “This is a life-saving medication. You can’t live without it, and we shouldn’t have people in this country who are having to choose to do that.”

The issue of insulin pricing is more pronounced in the U.S. than in other nations, and it has gotten worse over the past two decades. According to a 2016 study published in the Journal of the American Medical Association, between 2002 and 2013, the price of insulin tripled. And between 2012 and 2016, prices continued to climb, nearly doubling, a congressional report released in March found.

The issue has been a perennial one in Congress, with a broad bipartisan consensus recognizing the problem, but little agreement on a solution. That is why organizations like the American Diabetes Association have sought to fight the battle for affordable insulin in the states, starting in 2019 when Colorado became the first state to institute a cap on copays for insulin.

“From there, we just ran with it,” Murdock said. “We currently have 22 states and the District of Columbia with a monthly copay cap in place and we will continue to work on that as long as we need to raise the conversation.”

While several states passed legislation that capped the price for Medicare and private insurance, the new federal law doesn’t go as far. The legislation introduced by Warnock had initially included the monthly cap both for Medicare recipients and those privately insured.

But during an hourslong voting series, Republicans stripped out the portion that would have included private insurance, which is used by the majority of those in need of insulin. Some of the GOP senators who voted for it to be removed represent states with some of the highest mortality rates for diabetes, according to data from the Centers for Disease Control and Prevention.

At the time, Republicans who voted against the provision said it violated Senate budget rules, but Democrats intentionally did not drop it, daring their colleagues across the aisle to vote on the Senate floor to strip it out.

“In reality, the Dems wanted to break Senate rules to pass insulin pricing cap instead of going through regular order,” Sen. Ron Johnson, a Wisconsin Republican, tweeted after the vote. Johnson added that he had previously “voted for an amendment, that Dems blocked, to provide insulin at cost to low-income Americans.”

But Warnock said the quarrel over procedural rules meant failing on substance.

“The blocking of a provision that would have provided the same cap for folks on private insurance is yet another example of why people hate politics and, and what’s wrong with Washington,” he said.

The provision did however get seven Republicans on board. And while it wasn’t enough to pass the broader cap, it was more support than for any previous effort to cap insulin prices in Congress. Majority Leader Chuck Schumer indicated that expanding affordable access to insulin will be a priority for the chamber in September.

Advocates say a potential legislative response to address the gaps in coverage could come in the form of the Insulin Act, a bipartisan proposal introduced last month by Sen. Jeanne Shaheen, a Democrat from New Hampshire, and Sen. Susan Collins, a Republican from Maine, that would include a cap on the private marketplace. The legislation also has mechanisms in place that would lower the list price for insulin, providing relief for diabetes patients without insurance.

“We are grateful for the step forward in the Inflation Reduction Act, but now we’re focused and really urging Congress to bring up the Insulin Act as soon as possible,” said Campbell Hutton, vice president of regulatory and health policy at JDRF, a New York-based nonprofit that funds type 1 diabetes research.

By FARNOUSH AMIRI

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WASHINGTON (AP) — President Joe Biden declared his support Thursday for the “historic” inflation-fighting agreement struck by Senate Majority Leader Chuck Schumer and holdout Democratic Sen. Joe Manchin, an expansive health care and climate change package that had eluded the White House and seemed all but lost.

Biden said the bill will be a “godsend” for American families.

“This bill would be the most significant legislation in history to tackle the climate crisis,” Biden said. He said it will also lower healthcare costs for millions of Americans who buy their own health insurance under the Affordable Care Act.

Biden vowed the package will not raise taxes on anyone earning less than $400,000 a year. Instead the 15% corporate minimum tax will help fund the new costs, with extra going to deficit reduction.

He acknowledged the final product was a compromise, but was upbeat that it would win support in Congress.

“My plea is: Put politics aside. Get it done,” Biden said. “We should pass this.”

The $739 billion package, not as much as Biden once envisioned, remains a potentially remarkable achievement for the party, with long-sought goals of addressing health care and climate, while raising taxes on high earners and large corporations and reducing federal debt.

The Senate is expected to vote on the wide-ranging measure next week, setting up for the president and his party an unexpected victory in the runup to November elections in which their congressional control is in peril. A House vote would follow, perhaps later in August, with unanimous Republican opposition in both chambers seemingly certain.

Senate Majority Leader Chuck Schumer told fellow Senate Democrats they now have an opportunity to achieve two “hugely important” priorities on health care and climate change, if they stick together and approve a deal he brokered with Manchin.

Schumer spoke at a private meeting after the startling turnaround over an expansive agreement he and Manchin struck that had eluded them for months. The Democratic leader’s comments were relayed by a person familiar with the meeting and granted anonymity to discuss it.

Manchin called the billion package a “win-win” that shouldn’t come as such a big surprise despite the long months of on-again, off-again talks. He bristled at suggestions he’d left his own party dangling when he refused to support an earlier, broader bill.

“I’ve never walked away from anything in my life,″ Manchin told reporters via video chat because he is isolating with COVID-19. Manchin called it “a good bill” that would benefit the country. “It’s a Democrat and Republican bill.″

But bipartisan the bill is not.

Schumer warned his colleagues in the 50-50 Senate that final passage will be hard. With staunch GOP opposition, Democrats have no votes to spare, relying on their own razor-thin majority.

One key vote, Sen. Kyrsten Sinema, D-Ariz., was still reviewing the agreement, said spokeswoman Hannah Hurley. Sinema backed Manchin last year in insisting on making the legislation less expensive but objected to proposals to raise tax rates, and the spokeswoman referred a reporter to her comments last year supporting a corporate minimum tax.

Manchin said Thursday he had not talked to Sinema about the new compromise.

Just hours before the announcement late Wednesday, Schumer, D-N.Y., and Manchin, D-W.Va., seemed at loggerheads and headed toward a far narrower package limited — at Manchin’s insistence — to curbing pharmaceutical prices and extending federal health care subsidies. Earlier Wednesday, numerous Democrats said they were all but resigned to the more modest legislation.

There was no immediate explanation for Manchin’s abrupt willingness to back the new bolder measure. Since last year, he has used his pivotal vote in the 50-50 Senate to force Biden and Democrats to abandon far more ambitious, expensive versions. He dragged them through months of negotiations in which leaders’ concessions to shrink the legislation proved fruitless, antagonizing the White House and most congressional Democrats.

Tellingly, Democrats called the 725-page measure “The Inflation Reduction Act of 2022” because of provisions aimed at helping Americans cope with this year’s dramatically rising consumer costs. Polls show that inflation, embodied by gasoline prices that surpassed $5 per gallon before easing, has been voters’ chief concern. For months, Manchin’s opposition to larger proposals has been partly premised on his worry that they would fuel inflation.

Besides inflation, the measure seemed to offer something for many Democratic voters.

It dangled tax hikes on the wealthy and big corporations and environmental initiatives for progressives. And Manchin, an advocate for the fossil fuels his state produces, said the bill would invest in technologies for carbon-based and clean energy while also reducing methane and carbon emissions.

The measure would reduce carbon emissions by around 40% by 2030, Schumer and Manchin said. While that would miss Biden’s 50% goal, that reduction, the measure’s climate spending and the jobs it would create are “a big deal,” said Sen. Jeff Merkley, D-Ore., an environmental advocate who had been upset with the absence of those provisions until now.

The overall proposal is far less aspirational than the $3.5 trillion package Biden asked Democrats to push through Congress last year, and the pared-down, roughly $2 trillion version the House approved last November after Manchin insisted on shrinking it. Even then, Manchin shot down that smaller measure the following month, asserting it would fuel inflation and was loaded with budget gimmicks.

Democrats said their proposal would raise $739 billion over the decade in new revenue, including $313 billion from a 15% corporate minimum tax. They said that would affect around 200 of the country’s largest corporations, with profits exceeding $1 billion, that currently pay under the current 21% corporate rate.

The agreement also contains $288 billion the government would save from curbing pharmaceutical prices. Those provisions would require Medicare to begin negotiating prices on a modest number of drugs, pay rebates to Medicare if their price increases exceed inflation and limit that program’s beneficiaries to $2,000 annual out-of-pocket expenses.

The deal also claims to gain $124 billion from beefing up IRS tax enforcement, and $14 billion from taxing some “carried interest” profits earned by partners in entities like private equity or hedge funds.

The measure would spend $369 billion on energy and climate change initiatives. These include consumer tax credits and rebates for buying clean-energy vehicles and encouraging home energy efficiency; tax credits for solar panel manufacturers; $30 billion in grants and loans for utilities and states to gradually convert to clean energy; and $27 billion to reduce emissions, especially in lower-income areas.

It would also aim $64 billion at extending federal subsidies for three more years for some people buying private health insurance. Those subsidies, which lower people’s premiums, would otherwise expire at year’s end.

That would leave $306 billion for debt reduction, an effort Manchin has demanded. While a substantial sum, that’s a small fraction of the trillions in cumulative deficits the government is projected to amass over the coming decade.

If Democrats can hold their troops together, GOP opposition would not matter. Democrats can prevail if they lose no more than four votes in the House and remain solidly united in the 50-50 Senate, where Vice President Kamala Harris can cast the tie-breaking vote. They are using a special process that will let them pass the bill without reaching the 60 votes required for most legislation there. The chamber’s parliamentarian must verify that the bill doesn’t violate the chamber’s budget procedures, a review now underway.

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