As fires recently ravaged the hills and homes in Los Angeles, another similarly destructive threat looms over the hill—more specifically, Capitol Hill. With a myriad of recently signed executive orders from the new federal administration, confusion, fear and discord have already started to manifest in our communities—in the very same neighborhoods that are still grappling with the chaos caused by the devastation of the fires.
Growing up as the eldest of nine children in a low-income immigrant family, I learned early what it means to shoulder responsibility and endure hardships. At 11 years old, I helped my mother sell cleaning products door-to-door to make ends meet. My family’s story mirrors that of millions of Americans who rely on Medicaid and programs like the Affordable Care Act (ACA) to access one of the most basic human rights: healthcare. Working families aren’t looking for handouts—they are the backbone of our economy, working tirelessly to build better futures for themselves and the next generation, with Medicaid and the ACA serving as a vital bridge to opportunity.
Today, as CEO of L.A. Care Health Plan, the largest publicly operated health plan in the nation serving more than 2.6 million low-income Angelenos, I am deeply concerned about imminent threats to our healthcare system. Recent executive orders and potential Medicaid cuts proposed as part of Congress’ pending reconciliation process would undo decades of progress and leave millions vulnerable—and for Angelenos, that vulnerability is more acute now than possibly ever.
The proposed changes include:
- Ending ACA subsidies: One proposal is to shorten the enrollment periods for people choosing an ACA health plan while eliminating funding for organizations that help people enroll. The irony is that this disproportionately impacts Republican states that have not expanded Medicaid. If the enhanced subsidies for ACA marketplace plans that are currently in place are also eliminated as is anticipated, millions of people will lose affordable coverage.
- Expanding work requirements: Despite well-documented data showing that the vast majority of Medicaid beneficiaries work, work requirements simply introduce an additional hurdle to accessing needed care. This bureaucratic red tape is essentially a mechanism to drop coverage for the working poor who most need access to care.
- Switching to block grants: Converting Medicaid funding into block grants would shift the financial burden to states. Such a change would create chaos in a program that currently supports 1 in 3 Californians, and one that is already underpaying our safety net providers. On a per capita basis, Medicaid has proven to be one of the most cost-effective ways to provide essential care and economic stability—turning this into a block grant program would push millions back into financial crisis, straining families, hospitals and state budgets alike.
- Shifting more costs to California: Another proposal being discussed calls for reducing the percentage of funding that the federal government pays the states for Medicaid, and leaving it up to the states to figure out how to cover the budget shortfall. This unprecedented and shortsighted move would jeopardize the program’s sustainability, potentially leading to cuts in benefits, access and eligibility. Interestingly, this is in direct opposition to many Californians’ viewpoints, who have been in favor of expanding access to Medi-Cal, and by a wide margin recently voted to approve Prop 35, a tax on managed care organizations like L.A. Care to ensure a stable pipeline of funds for the program.
These policies may be framed as cost-saving measures, but in reality, the result will be a flailing economy, and a fragmented and inequitable healthcare system that leaves millions without access to critical care.
We’ve seen this before. During President Donald Trump’s first term, the ACA was weakened with the elimination of the individual mandate and cost-sharing subsidies. States were allowed to impose Medicaid work requirements. Now, we’re also seeing the Trump administration roll back protections for the undocumented, transgender individuals and other marginalized communities with recent executive orders.
The stakes are especially high in California, where Medi-Cal—the state’s Medicaid program—provides health coverage for more than 14 million residents. Cutting funding or imposing new restrictions would devastate families already struggling with inflation and housing instability—it would also weaken the businesses and communities that depend on them, unraveling the very fabric of our state economy.
Instead of dismantling the safety net, we should be building on it. This includes making ACA subsidies permanent, protecting eligibility for the expanded Medicaid population, and investing in preventive care to reduce long-term costs.
As someone who grew up experiencing financial uncertainty and not knowing whether my family could afford the rent every month, as a Medi-Cal recipient I always knew I could still visit the doctor’s office to receive medical care and other help should need arise. I can’t stay silent as these vital programs face the scalpel. Healthcare should not be a partisan issue; it should be a human issue.
Congress and state leaders must resist short-term cost-cutting measures that cause long-term harm, create cycles of poverty and dismantle the middle class. Instead, they should work together to ensure every American has access to the care they need. The health of our nation depends on it.
Martha Santana-Chin is CEO of L.A. Care Health Plan, the nation’s largest publicly operated health plan.