Local officials nationwide are preparing for an estimated 10 million newly uninsured residents over the next decade following the One Big Beautiful Bill Act signed into law by President Donald Trump this past summer. The law is expected to reduce Medicaid spending by more than $900 billion over that period, straining already fragile safety nets in counties required to provide indigent care.
State-Level Budget Crises
California faces a nearly $18 billion budget deficit in the 2026-27 fiscal year according to the state’s nonpartisan Legislative Analyst’s Office. State officials have said California could lose $30 billion a year in federal funding for Medi-Cal, representing as much as 15% of the state program’s entire budget. In 2025, Governor Newsom rolled back state Medi-Cal benefits for seniors and for immigrants without legal status after the program was forced to borrow $4.4 billion from the state’s general fund. Reviving county-based programs would require “considerable fiscal restructuring” through the state budget, according to the Legislative Analyst’s Office in an October report.
Placer County estimated that 16,000 residents could lose health care coverage by 2028. The county quit operating its own clinics nearly a decade ago, with its director of health and human services stating “Most of the infrastructure that we had to meet those needs is gone. This is a much bigger problem than it was a decade ago and much more costly.” New Mexico’s Doña Ana County, the state’s second-most-populous, added dental care for seniors and behavioral health benefits after residents qualified for Medicaid, but now faces potential benefit reductions.
Insurance and Enrollment Challenges
Enrollment in county health safety net programs dropped dramatically in the first full year of ACA implementation, falling from about 858,000 people statewide in 2013 to roughly 176,000 by the end of 2014. In November, voters in affluent Santa Clara County approved a sales tax increase partly to backfill federal funding losses, though the measure is expected to cover only a third of the $1 billion annually the county stands to lose. Health advocates fear a return to previous patchwork county-run programs where local governments choose whom and what they cover. Before the ACA, many uninsured people did not receive necessary care, potentially leading to emergency room visits with untreated conditions or death.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://truthout.org/articles/local-officials-anticipate-surge-in-costs-as-residents-set-to-lose-health-care/