You could fill up Riverside and still have enough people to match Temecula’s population with the number of Inland Empire residents who could lose health insurance coverage in the coming years.
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.
RELATED: Four in 10 Inland residents are on Medi-Cal. How many might lose it if ‘Big, Beautiful Bill’ passes?
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.”
