Upcoming Medi-Cal changes could leave at least 300,000 uninsured in Riverside and San Bernardino counties, according to Jarrod McNaughton, CEO of Inland Empire Health Plan. California’s new budget cuts Medi-Cal for undocumented immigrants while the recently enacted One Big Beautiful Bill Act promises more Medi-Cal changes at the federal level.

Another 172,000 Inland residents could lose their private insurance if Congress doesn’t extend Enhanced Premium Tax Credits, business executives said at a Wednesday, Aug. 6, roundtable.

Between Medi-Cal and the tax credits, the total number of people who could lose coverage amounts to about 9% of the Inland Empire’s roughly 5 million residents.

California’s version of the federal Medicaid program, Medi-Cal insures California’s poor and disabled. McNaughton’s agency oversees Medi-Cal for more than 1 million people in Riverside and San Bernardino counties — 4 in 10 are on Medi-Cal.

The situation “could have been worse,” McNaughton said. “But it is not good. It’s still bad.”

About half of the 300,000 expected to lose Medi-Cal are undocumented immigrants, McNaughton said.

“These are folks that the governor made a decision a year or so ago to actually add on to the Medi-Cal program,” he said.

In 2024, California started offering Medi-Cal to low-income undocumented immigrants.

Supporters of that move argue it’s the right thing to do and more cost effective than treating this population in the emergency room, when their health problems are more severe and expensive to deal with. But the new state budget scales back that effort amid a $12 billion shortfall.

The other half, McNaughton said, include Medi-Cal recipients who expected to leave the program due to more stringent renewal requirements. Enrollees will have to go through the renewal process every six months instead of once a year, and there’s “very much more intense paperwork for the eligibility program,” McNaughton said.

The estimates cited by McNaughton don’t include Medi-Cal enrollees in other Inland health plans, including Kaiser Permanente and Molina Healthcare.

Rep. Ken Calvert, R-Corona, who voted for the One Big Beautiful Bill Act, defended the Medi-Cal changes.

“I made it clear throughout this process that I wouldn’t, and neither would my colleagues, support cuts to Medicaid for seniors, children, mothers (or the) disabled,” he said.

“I think over time (the changes) will strengthen the program by eliminating the waste, the fraud and abuse of the program.”

He added: “We’re not cutting anything. We’re slowing the rate of increase.”

Calvert also defended Medi-Cal’s new work requirements.

“The people that are going to be removed are people who don’t want to work at least 20 hours a week … if they’re not disabled and they are capable of working or even volunteering or (getting an) education,” he said.

“These are able-bodied adults without children under 65. I think most people would support” making them work to get Medicaid.

Others take issue with the idea that Medicaid is full of freeloaders.

According to the Kaiser Family Foundation, almost two-thirds of U.S. adults ages 19 to 64 covered by Medicaid in 2023 were working and almost 3 in 10 were caregivers, sick or disabled or going to school — all exemptions under the new law.

“Based on the data, only a small share of Medicaid adults were not meeting work requirements” or didn’t qualify for exemptions, the foundation reported.

“However, many more Medicaid enrollees who would remain eligible would be at risk of losing coverage because of the administrative burden and red tape related to reporting requirements.”

McNaughton said he “remain(s) most concerned” about how the One Big Beautiful Bill Act will affect provider taxes funding hospitals.

“That whole healthcare system on the provider side of the house, which is hospitals, emergency rooms, skilled-nursing facilities, ambulance companies — all of them that really relied on those special provider taxes are just being phased way down,” he said.

Less revenue from provider taxes, combined with cuts to Medi-Cal and state-directed hospital payments,  is “in some ways a triple whammy of problems,” McNaughton said.

“We’re all going to have to kind of work through and figure out, ‘OK, how are we going to keep funding the whole system?’”

Enhanced Premium Tax Credits stem from COVID-19 relief legislation passed by Congress in 2021. The Inflation Reduction Act, which became law a year later, extended the credits through 2025.

The credits are meant to make private health insurance via the Affordable Care Act, also known as Obamacare, more affordable for a wider range of families.

If they expire, more Americans won’t be able to afford insurance, according to panelists in the Aug. 6 roundtable hosted by the Greater Riverside Chambers of Commerce, the Moreno Valley Chamber of Commerce and the Black Chamber of Commerce Inland Empire.

“My clients, small business owners in the Inland Empire, relied on the tax credits to keep their health insurance during a slow year,” Shannon Carlson-Singer, lead partner of the Riverside business consulting firm SingerLewak Accountants & Consultants, said in a news release.

“In 2021, one of them suffered a serious accident requiring multiple surgeries. Without that coverage, they would have faced bankruptcy, and he might not be here today. These tax credits don’t just save money, they save lives.”

More uninsured hurts health care providers as well, Dolores Green, CEO of the Riverside County Medical Association, said in the release.

“Riverside County already has less than half the physicians we need to care for our population today. If coverage drops, no-show rates will climb, revenue will shrink, and practices will be forced to reduce staff,” Green said.

“The medical community provides about 174,000 jobs in Riverside County. It’s a huge impact. And as we see reduction there, it’s going to be felt across the economy.”

Eighty percent of Riverside Community Hospital patients “are covered by government payers,” hospital CEO Peter Hemstead said in the release about the roundtable.

“If other hospitals close service lines, more high-acuity patients will come to us with fewer options for care. We’re already overburdened. Without these tax credits, it will only get worse.”

Calvert said the credits point out a flaw in Obamacare.

Since the Affordable Care Act became law, “healthcare costs have obviously increased and what they did is they shifted the increased cost over to the government,” Calvert said. “So it’s kind of hidden the cost because of the credits that were issued.”

He added: “We need to take a look at those credits and find some solutions that lower the cost of health care … I think we’ll have to work out some kind of compromise on that.”

“We also have to have a conversation about how we balance these subsidies and reforms and make healthcare more affordable. It’s probably the biggest driver of the deficit … We want to make sure people have healthcare. But we also want to find efficiencies within the system.”

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These aren’t just numbers — they’re people. Kristen, a young woman in my district, lives with a genetic disorder that causes developmental, learning, and cardiovascular issues. Every four months, she travels from the Inland Empire to San Diego for vital testing, care made possible by Medi-Cal. She works hard, dreams of owning a bakery, and fights to stay healthy. This bill threatens her care and her dream.

Trump and Republicans call it “One Big Beautiful Bill,” but let’s be clear: it’s one big betrayal. The bill cuts healthcare coverage, slashes food assistance, and raises costs, choosing instead to fund extravagant trips for the super-rich on private jets and yachts.

This isn’t just a budget bill, it’s a statement of Republican values that puts billionaires over our families, a calculated effort to take from the many and give to the few. Nearly 16 million Americans will lose healthcare. Three million will lose food assistance. In the Inland Empire, cuts mean longer emergency room wait times, getting turned away from a shortage of hospital beds, and fewer doctors and nurses.

Republicans voted to slash over $1.2 trillion from healthcare— $700 billion from Medicaid (known as Medi-Cal to Californians) and $500 billion from Medicare — breaking promises to protect seniors, children, and people with disabilities. Our state has 15 million on Medi-Cal, and more than half are children. Medi-Cal also covers 2.7 million here in the Inland Empire and 1 in 5 working Californians. These cuts don’t just hurt the most vulnerable — they put hard-working Californians’ health in jeopardy.

For those relying on Covered California, Republicans voted to raise premiums by ending an Affordable Care Act tax credit. A family of four making $126,000 could see costs nearly double from $10,710 to $19,643.

Republicans didn’t stop there; they’re cutting funding that helps families put food on the table. While families are struggling, Republicans are slashing $300 billion from the Supplemental Nutrition Assistance Program (SNAP) that helps low-income families buy groceries. Nearly 90 percent of SNAP participants are in households with either a child, a senior, or a person with a disability. In my district, over 112,000 people rely on these benefits. The average benefit is just $6 a day; no Member of Congress, regardless of party, should support taking that away.

Republicans claim they are helping the economy, but you can’t have a healthy economy without healthy people. These cuts are all to improve the quality of life for billionaires. People earning $4 million a year get $400,000 richer, while families earning less than $50,000 will pay more for healthcare and basic needs.

In the wealthiest country in the world, no one should go hungry or lose healthcare so the rich can get more handouts.

This is not what California stands for. In the Inland Empire, we take care of each other. Families, healthcare workers, business owners, unions, food banks, disability advocates, and faith leaders are standing up. I urge you to keep pushing my Republican colleagues. There are so many stories like Kristen’s — so many families who will suffer.

To my nine California Republican colleagues: Why didn’t you stand up for your own constituents? Just one vote was needed.

When this bill returns from the Senate to the House for a final vote, you’ll have one more chance to do right by the families you represent. I hope you’ll put people over politics. If you don’t, the constituents you’ve abandoned will remember.

Norma J. Torres represents California’s 35th congressional district.

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The project will expand access to primary and specialty care for patients and open local residencies to medical students at the university, said UCR Health CEO Tim Collins. 

“We want to build that up and bring more physicians to the marketplace to provide world-class care to the community,” Collins told CalMatters in an interview.

California doesn’t have enough primary care providers, particularly in rural areas, and the Inland Empire faces some of the most pressing shortages, the Los Angeles Times reported. About 62% of people in San Bernardino County and 42% in Riverside County have inadequate healthcare access.

“Even compared to our coastal neighbors, the Inland Empire is particularly strained when it comes to resident-to-physician ratios,” the Inland Empire Health Plan Foundation stated in an article on doctor shortages. 

The UC Riverside project aims to expand medical access, starting with a 20-acre site in Riverside off of Interstate 2015 near State Route 60, about five miles from the university campus.

The university has leased the land from a private firm, TDA Investments, and will develop it with the company. About 12 acres will house an outpatient center and hospital and another eight acres will include a parking structure and medical office building.

The first phase will start with the outpatient center, which Collins said will be a one-stop shop for services such as diagnostic imaging, outpatient surgery, oncology and digestive health.

“It will integrate all the offerings that we call out-patient that do not require a hospital,” and cost less than providing those services in a hospital, he said. 

As that’s built out, the university will begin work on the 280-bed hospital. The university doesn’t have a definite timeline for those facilities yet, Collins said.

Further down the line, the university may lease a separate 22-acre parcel across the street that could provide space for medical research, conferences or biomedical business incubators, he said.

UC Riverside also expects to open a series of outpatient medical centers throughout the Inland Empire “located in geographic areas where there are gaps in services,” Collins said.

The Inland Empire has 42 primary care physicians and 83 medical specialists per 100,000 people, compared to 60 primary care doctors and 131 specialists per 100,000 for California as a whole, Collins said, citing a report by the California Health Care Foundation. 

Residents of Riverside and San Bernardino Counties often travel to neighboring Los Angeles, Orange or San Diego counties for specialty care such as cardiology or oncology, he said. 

Part of the problem is that the pipeline to train and recruit doctors in the Inland Empire isn’t well-established, Collins said.  

UC Riverside opened its medical school in 2013, and 454 physicians have graduated since then. It’s the only University of California medical school without its own hospital, and it has trained students at other hospitals in the area through partnerships, the Riverside Press-Enterprise reported.

About three-quarters of medical students at UC Riverside have ties to the region and half come from underrepresented groups, the university reported.

But most of those students have to leave the region to complete their medical residencies, and once they go it’s hard to get them back, Collins said.

“By building the network of facilities, we’ll be able to expand the number of residencies we’re able to offer in this marketplace and retain those physicians that are trained here,” he said.

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