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"content": "\n\u003cp>When a patient comes into Dr. Miguel San Miguel Benavides’ exam room at \u003ca href=\"https://www.kqed.org/news/tag/san-francisco-general-hospital\">San Francisco General Hospital\u003c/a> with a cough, a rash, diabetes or high blood pressure, he knows where to start. \u003c/p>\n\n\n\n\u003cp>But over the past year, people have been bringing him a problem he feels less equipped to tackle as a primary care physician: their fear over immigration enforcement. \u003c/p>\n\n\n\n\u003cp>Among other actions, the Trump administration has rolled back protections keeping immigration agents away from healthcare facilities and sought to \u003ca href=\"https://www.kff.org/immigrant-health/potential-implications-of-the-new-medicaid-data-sharing-agreement-between-cms-and-ice/\">give ICE access to Medicaid data\u003c/a>. Since then, San Miguel and colleagues at SF General who work with immigrant patients say they’ve watched with a sense of powerlessness as people avoid or delay treatment, and as mounting stress exacerbates their underlying conditions.\u003c/p>\n\n\n\n\u003cp>A \u003ca href=\"https://phr.org/news/ice-tactics-and-deportation-fears-limit-access-to-health-care-for-children-of-immigrants-survey/\">2025 survey\u003c/a> of healthcare workers who serve immigrants echoes that experience: Among hundreds of respondents across 30 states, 84% said patient visits were down substantially; many said their ability to provide preventive care and manage chronic conditions suffered.\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED.jpg\" alt=\"\" class=\"wp-image-12097362\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Miguel San Miguel Benavides, a resident physician at the Zuckerberg San Francisco General Hospital, poses for a portrait at the hospital on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>Now, a small study from UCSF suggests that immigration policies can force some doctors to practice in a way that’s at odds with their sense of moral or professional duty, taking a toll on them. \u003c/p>\n\n\n\n\u003cp>The experience has become routine for San Miguel as he finishes his residency.\u003c/p>\n\n\n\n\u003cp>“This is the type of care that I always wanted to give,” he said of working with patients who, like him, immigrated to this country. “But I think part of that has become realizing that the amount of support we can give isn’t necessarily enough.”\u003c/p>\n\n\n\n\u003cp>Researchers call that kind of ethical conflict “\u003ca href=\"https://www.npr.org/2012/11/21/165663154/moral-injury-the-psychological-wounds-of-war\">moral injury\u003c/a>,” a term coined by a Department of Veterans Affairs psychiatrist working with Vietnam War veterans.\u003c/p>\n\n\n\n\n\n\u003cp>Dr. Marlene Martín, a UCSF clinical medicine professor, was inspired to do the study last summer, around the time ICE was \u003ca href=\"https://www.kqed.org/news/12049326/as-ice-operations-expand-how-are-immigrant-allies-responding\">conducting widespread raids\u003c/a> in Los Angeles. A colleague who works with immigrant patients told her no one had shown up to their appointment that day at SF General. If that was happening in San Francisco, where there was relatively little high-profile ICE activity at the time, Martín wondered what doctors elsewhere were seeing. \u003c/p>\n\n\n\n\u003cp>So she and her colleagues interviewed 38 primary care doctors in 13 states about their experiences caring for immigrant patients in this climate. They recently published their findings \u003ca href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851433\">in JAMA Internal Medicine\u003c/a>.\u003c/p>\n\n\n\n\u003cp>The interviews confirmed that doctors across the country were seeing patients miss appointments, with some suffering more from chronic diseases as their treatment lapsed. For instance, Martín said, one interviewee described a patient whose diabetes had spiraled out of control because his son, who’d been driving him to his appointments, had been arrested by ICE. \u003c/p>\n\n\n\n\u003cp>“You can’t fix that,” she said. “You can’t address that in a clinical visit.”\u003c/p>\n\n\n\n\u003cp>Some doctors told the researchers they were afraid to even ask their patients how they were doing, “because it would open this whole topic that they didn’t know how to answer. They didn’t know how to make it better,” Martín said. “In medicine we’re used to being able to address things that patients are talking about and to help them get better.” \u003c/p>\n\n\n\n\u003cp>One doctor described to researchers the kind of dilemmas they face, given fears about encountering immigration agents in hospitals: “Would I rather have [my patient] be at home while they’re having substernal, crushing chest pain vs. what are the costs and benefits of going [to the hospital]?” \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1350\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg\" alt=\"\" class=\"wp-image-12097364\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED-1536x1037.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">The Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>In some cases, the interviewees reported their clinics had stopped accepting undocumented patients altogether, for fear of losing federal funding. \u003c/p>\n\n\n\n\u003cp>Those experiences, day after day, are what can lead to moral injury.\u003c/p>\n\n\n\n\u003cp>What surprised study co-author Dr. Alicia Fernandez was how much doctors changed the way they practiced in response to immigration policy changes. “What we saw was many physicians and practices, entire practices, altering their patterns of care,” the UCSF professor and SF General primary care doctor said. \u003c/p>\n\n\n\n\u003cp>Some transitioned to telehealth appointments. Others switched medications so patients didn’t have to go into the clinic or pharmacy as often. \u003c/p>\n\n\n\n\u003cp>But Fernandez said the changes can come at a cost — both for the patients and the doctors who care for them. \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1421\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED.jpg\" alt=\"\" class=\"wp-image-12097363\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED-160x114.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED-1536x1091.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Miguel San Miguel Benavides, a resident physician at the Zuckerberg San Francisco General Hospital, and Alicia Fernandez, a UCSF professor and general internist at SF General, talk at the hospital on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>“We definitely feel that our patients are getting worse, and we feel that the care that we are giving is an inferior form of care, and that’s why it’s associated with moral distress,” Fernandez said. \u003c/p>\n\n\n\n\u003cp>She points to a recent experience with an undocumented patient who’d avoided being seen out of fear. “He came in already having damage from his diabetes,” she said. “That’s a terrible feeling.” \u003c/p>\n\n\n\n\u003cp>This kind of distress isn’t just bad for individual doctors. \u003c/p>\n\n\n\n\u003cp>“Moral injury can contribute to burnout,” said Dr. Robert Pearl, a physician and Stanford professor who served as CEO of the Permanente Medical Group for nearly two decades. And data show burnout affects doctors’ quality of care.\u003c/p>\n\n\n\n\u003cp>“If the patient before you required all this extra work, has had this added fear, had all these challenges,” he said, referencing the study, “when the clinician sees you, he or she may not be as good and sharp as you would like them to be.”\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed.jpg\" alt=\"\" class=\"wp-image-12099231\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Individuals walk towards the Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>Burnout and moral injury can also lead doctors and other healthcare workers to leave their professions, he said, with particularly dire effects in primary care. \u003c/p>\n\n\n\n\u003cp>“We already have a shortage,” he said, so “when you need a primary care doctor, that individual might not be there. And we’re certainly seeing that in many communities across the United States, where it’s almost impossible to find a primary care physician with an open panel.”\u003c/p>\n\n\n\n\u003cp>For doctors in the study who were themselves immigrants, the distress was compounded. That has broad implications given that almost half of the country’s internal medicine doctors are foreign-born, according to \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2852745?guestAccessKey=da3ba888-5ff2-456f-9d94-b301cf5d2884&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081226\">a study\u003c/a> released last month. \u003c/p>\n\n\n\n\u003cp>While the UCSF study on moral injury is small and qualitative, it points to ways healthcare institutions can support staff in an increasingly difficult environment. Doctors whose clinics protected patients’ immigration-related information and expanded telehealth, for example, described ways those changes helped them care for patients.\u003c/p>\n\n\n\n\n\n\u003cp>A sense of powerlessness contributed to the moral distress doctors in the study felt. Carolyn Dewa, a psychiatry and behavioral medicine professor at the UC Davis School of Medicine, said social support can protect against that. \u003c/p>\n\n\n\n\u003cp>“If you feel supported by colleagues and peers, or you feel supported by supervisors,” she said, “if people are not isolated from one another but feel that they’re part of a group, it also is protective.” \u003c/p>\n\n\n\n\u003cp>The doctors interviewed for the study also described the importance of having a sense of agency. “This paper pointed out that feeling like you could take an active role does help mitigate some of the distress,” said Dr. Anne Rosenthal, who runs the adult primary care clinic at SF General, where Fernandez and San Miguel work. \u003c/p>\n\n\n\n\u003cp>Her clinic has tried to do that in part by training staff on what to do if immigration enforcement shows up and proactively educating patients about what they need to do to keep Medi-Cal coverage as state enrollment rules change.\u003c/p>\n\n\n\n\u003cp>The \u003ca href=\"https://laborcenter.berkeley.edu/over-two-million-more-californians-projected-to-lack-health-insurance-by-2030/\">UC Berkeley Labor Center projects\u003c/a> half of undocumented residents in California under age 65 could be uninsured by 2030, double the rate now.\u003c/p>\n\n\n\n\u003cp>“We live in fear of losing our patients, because we know that their physical health will suffer, the health of their kids will suffer, and the health of the community will suffer,” she said.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Among other actions, the Trump administration has rolled back protections keeping immigration agents away from healthcare facilities and sought to \u003ca href=\"https://www.kff.org/immigrant-health/potential-implications-of-the-new-medicaid-data-sharing-agreement-between-cms-and-ice/\">give ICE access to Medicaid data\u003c/a>. Since then, San Miguel and colleagues at SF General who work with immigrant patients say they’ve watched with a sense of powerlessness as people avoid or delay treatment, and as mounting stress exacerbates their underlying conditions.\u003c/p>\n",
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"innerHTML": "\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED.jpg\" alt=\"\" class=\"wp-image-12097362\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED-1536x1024.jpg 1536w\" sizes=\"(min-width: 992px) min(100vw, 1536px), (min-width: 768px) min(100vw, 1280px), min(100vw, 1020px)\" />\u003cfigcaption class=\"wp-element-caption\">Miguel San Miguel Benavides, a resident physician at the Zuckerberg San Francisco General Hospital, poses for a portrait at the hospital on Aug. 26, 2026.\u003ccite class=\"wp-inline-image-credit\"> (Gina Castro for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n",
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"innerHTML": "\n\u003cp>Now, a small study from UCSF suggests that immigration policies can force some doctors to practice in a way that’s at odds with their sense of moral or professional duty, taking a toll on them. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“This is the type of care that I always wanted to give,” he said of working with patients who, like him, immigrated to this country. “But I think part of that has become realizing that the amount of support we can give isn’t necessarily enough.”\u003c/p>\n",
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"innerHTML": "\n\u003cp>Researchers call that kind of ethical conflict “\u003ca href=\"https://www.npr.org/2012/11/21/165663154/moral-injury-the-psychological-wounds-of-war\">moral injury\u003c/a>,” a term coined by a Department of Veterans Affairs psychiatrist working with Vietnam War veterans.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Dr. Marlene Martín, a UCSF clinical medicine professor, was inspired to do the study last summer, around the time ICE was \u003ca href=\"https://www.kqed.org/news/12049326/as-ice-operations-expand-how-are-immigrant-allies-responding\">conducting widespread raids\u003c/a> in Los Angeles. A colleague who works with immigrant patients told her no one had shown up to their appointment that day at SF General. If that was happening in San Francisco, where there was relatively little high-profile ICE activity at the time, Martín wondered what doctors elsewhere were seeing. \u003c/p>\n",
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"\n\u003cp>Dr. Marlene Martín, a UCSF clinical medicine professor, was inspired to do the study last summer, around the time ICE was \u003ca href=\"https://www.kqed.org/news/12049326/as-ice-operations-expand-how-are-immigrant-allies-responding\">conducting widespread raids\u003c/a> in Los Angeles. A colleague who works with immigrant patients told her no one had shown up to their appointment that day at SF General. If that was happening in San Francisco, where there was relatively little high-profile ICE activity at the time, Martín wondered what doctors elsewhere were seeing. \u003c/p>\n"
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"innerHTML": "\n\u003cp>So she and her colleagues interviewed 38 primary care doctors in 13 states about their experiences caring for immigrant patients in this climate. They recently published their findings \u003ca href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851433\">in JAMA Internal Medicine\u003c/a>.\u003c/p>\n",
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"innerHTML": "\n\u003cp>The interviews confirmed that doctors across the country were seeing patients miss appointments, with some suffering more from chronic diseases as their treatment lapsed. For instance, Martín said, one interviewee described a patient whose diabetes had spiraled out of control because his son, who’d been driving him to his appointments, had been arrested by ICE. \u003c/p>\n",
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"\n\u003cp>The interviews confirmed that doctors across the country were seeing patients miss appointments, with some suffering more from chronic diseases as their treatment lapsed. For instance, Martín said, one interviewee described a patient whose diabetes had spiraled out of control because his son, who’d been driving him to his appointments, had been arrested by ICE. \u003c/p>\n"
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"innerHTML": "\n\u003cp>“You can’t fix that,” she said. “You can’t address that in a clinical visit.”\u003c/p>\n",
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"\n\u003cp>“You can’t fix that,” she said. “You can’t address that in a clinical visit.”\u003c/p>\n"
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"innerHTML": "\n\u003cp>Some doctors told the researchers they were afraid to even ask their patients how they were doing, “because it would open this whole topic that they didn’t know how to answer. They didn’t know how to make it better,” Martín said. “In medicine we’re used to being able to address things that patients are talking about and to help them get better.” \u003c/p>\n",
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"innerHTML": "\n\u003cp>One doctor described to researchers the kind of dilemmas they face, given fears about encountering immigration agents in hospitals: “Would I rather have [my patient] be at home while they’re having substernal, crushing chest pain vs. what are the costs and benefits of going [to the hospital]?” \u003c/p>\n",
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"\n\u003cp>One doctor described to researchers the kind of dilemmas they face, given fears about encountering immigration agents in hospitals: “Would I rather have [my patient] be at home while they’re having substernal, crushing chest pain vs. what are the costs and benefits of going [to the hospital]?” \u003c/p>\n"
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"innerHTML": "\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg\" alt=\"\" class=\"wp-image-12097364\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED-1536x1037.jpg 1536w\" sizes=\"(min-width: 992px) min(100vw, 1536px), (min-width: 768px) min(100vw, 1280px), min(100vw, 1020px)\" />\u003cfigcaption class=\"wp-element-caption\">The Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026.\u003ccite class=\"wp-inline-image-credit\"> (Gina Castro for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n",
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"\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg\" alt=\"\" class=\"wp-image-12097364\" />\u003cfigcaption class=\"wp-element-caption\">The Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026.\u003ccite class=\"wp-inline-image-credit\"> (Gina Castro for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n"
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"innerHTML": "\n\u003cp>In some cases, the interviewees reported their clinics had stopped accepting undocumented patients altogether, for fear of losing federal funding. \u003c/p>\n",
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"innerHTML": "\n\u003cp>What surprised study co-author Dr. Alicia Fernandez was how much doctors changed the way they practiced in response to immigration policy changes. “What we saw was many physicians and practices, entire practices, altering their patterns of care,” the UCSF professor and SF General primary care doctor said. \u003c/p>\n",
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"innerHTML": "\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED.jpg\" alt=\"\" class=\"wp-image-12097363\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED-160x114.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED-1536x1091.jpg 1536w\" sizes=\"(min-width: 992px) min(100vw, 1536px), (min-width: 768px) min(100vw, 1280px), min(100vw, 1020px)\" />\u003cfigcaption class=\"wp-element-caption\">Miguel San Miguel Benavides, a resident physician at the Zuckerberg San Francisco General Hospital, and Alicia Fernandez, a UCSF professor and general internist at SF General, talk at the hospital on Aug. 26, 2026.\u003ccite class=\"wp-inline-image-credit\"> (Gina Castro for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n",
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"innerHTML": "\n\u003cp>“We definitely feel that our patients are getting worse, and we feel that the care that we are giving is an inferior form of care, and that’s why it’s associated with moral distress,” Fernandez said. \u003c/p>\n",
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"innerHTML": "\n\u003cp>She points to a recent experience with an undocumented patient who’d avoided being seen out of fear. “He came in already having damage from his diabetes,” she said. “That’s a terrible feeling.” \u003c/p>\n",
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"\n\u003cp>She points to a recent experience with an undocumented patient who’d avoided being seen out of fear. “He came in already having damage from his diabetes,” she said. “That’s a terrible feeling.” \u003c/p>\n"
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"innerHTML": "\n\u003cp>This kind of distress isn’t just bad for individual doctors. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“Moral injury can contribute to burnout,” said Dr. Robert Pearl, a physician and Stanford professor who served as CEO of the Permanente Medical Group for nearly two decades. And data show burnout affects doctors’ quality of care.\u003c/p>\n",
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"\n\u003cp>“Moral injury can contribute to burnout,” said Dr. Robert Pearl, a physician and Stanford professor who served as CEO of the Permanente Medical Group for nearly two decades. And data show burnout affects doctors’ quality of care.\u003c/p>\n"
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"innerHTML": "\n\u003cp>“If the patient before you required all this extra work, has had this added fear, had all these challenges,” he said, referencing the study, “when the clinician sees you, he or she may not be as good and sharp as you would like them to be.”\u003c/p>\n",
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"\n\u003cp>“If the patient before you required all this extra work, has had this added fear, had all these challenges,” he said, referencing the study, “when the clinician sees you, he or she may not be as good and sharp as you would like them to be.”\u003c/p>\n"
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"\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed.jpg\" alt=\"\" class=\"wp-image-12099231\" />\u003cfigcaption class=\"wp-element-caption\">Individuals walk towards the Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026.\u003ccite class=\"wp-inline-image-credit\"> (Gina Castro for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n"
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"innerHTML": "\n\u003cp>Burnout and moral injury can also lead doctors and other healthcare workers to leave their professions, he said, with particularly dire effects in primary care. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“We already have a shortage,” he said, so “when you need a primary care doctor, that individual might not be there. And we’re certainly seeing that in many communities across the United States, where it’s almost impossible to find a primary care physician with an open panel.”\u003c/p>\n",
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"\n\u003cp>“We already have a shortage,” he said, so “when you need a primary care doctor, that individual might not be there. And we’re certainly seeing that in many communities across the United States, where it’s almost impossible to find a primary care physician with an open panel.”\u003c/p>\n"
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"innerHTML": "\n\u003cp>For doctors in the study who were themselves immigrants, the distress was compounded. That has broad implications given that almost half of the country’s internal medicine doctors are foreign-born, according to \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2852745?guestAccessKey=da3ba888-5ff2-456f-9d94-b301cf5d2884&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081226\">a study\u003c/a> released last month. \u003c/p>\n",
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"\n\u003cp>For doctors in the study who were themselves immigrants, the distress was compounded. That has broad implications given that almost half of the country’s internal medicine doctors are foreign-born, according to \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2852745?guestAccessKey=da3ba888-5ff2-456f-9d94-b301cf5d2884&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081226\">a study\u003c/a> released last month. \u003c/p>\n"
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"innerHTML": "\n\u003cp>While the UCSF study on moral injury is small and qualitative, it points to ways healthcare institutions can support staff in an increasingly difficult environment. Doctors whose clinics protected patients’ immigration-related information and expanded telehealth, for example, described ways those changes helped them care for patients.\u003c/p>\n",
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"\n\u003cp>While the UCSF study on moral injury is small and qualitative, it points to ways healthcare institutions can support staff in an increasingly difficult environment. Doctors whose clinics protected patients’ immigration-related information and expanded telehealth, for example, described ways those changes helped them care for patients.\u003c/p>\n"
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"innerHTML": "\n\u003cp>A sense of powerlessness contributed to the moral distress doctors in the study felt. Carolyn Dewa, a psychiatry and behavioral medicine professor at the UC Davis School of Medicine, said social support can protect against that. \u003c/p>\n",
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"\n\u003cp>A sense of powerlessness contributed to the moral distress doctors in the study felt. Carolyn Dewa, a psychiatry and behavioral medicine professor at the UC Davis School of Medicine, said social support can protect against that. \u003c/p>\n"
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"innerHTML": "\n\u003cp>“If you feel supported by colleagues and peers, or you feel supported by supervisors,” she said, “if people are not isolated from one another but feel that they’re part of a group, it also is protective.” \u003c/p>\n",
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"\n\u003cp>“If you feel supported by colleagues and peers, or you feel supported by supervisors,” she said, “if people are not isolated from one another but feel that they’re part of a group, it also is protective.” \u003c/p>\n"
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"innerHTML": "\n\u003cp>The doctors interviewed for the study also described the importance of having a sense of agency. “This paper pointed out that feeling like you could take an active role does help mitigate some of the distress,” said Dr. Anne Rosenthal, who runs the adult primary care clinic at SF General, where Fernandez and San Miguel work. \u003c/p>\n",
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"\n\u003cp>The doctors interviewed for the study also described the importance of having a sense of agency. “This paper pointed out that feeling like you could take an active role does help mitigate some of the distress,” said Dr. Anne Rosenthal, who runs the adult primary care clinic at SF General, where Fernandez and San Miguel work. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Her clinic has tried to do that in part by training staff on what to do if immigration enforcement shows up and proactively educating patients about what they need to do to keep Medi-Cal coverage as state enrollment rules change.\u003c/p>\n",
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"\n\u003cp>Her clinic has tried to do that in part by training staff on what to do if immigration enforcement shows up and proactively educating patients about what they need to do to keep Medi-Cal coverage as state enrollment rules change.\u003c/p>\n"
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"innerHTML": "\n\u003cp>The \u003ca href=\"https://laborcenter.berkeley.edu/over-two-million-more-californians-projected-to-lack-health-insurance-by-2030/\">UC Berkeley Labor Center projects\u003c/a> half of undocumented residents in California under age 65 could be uninsured by 2030, double the rate now.\u003c/p>\n",
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"\n\u003cp>The \u003ca href=\"https://laborcenter.berkeley.edu/over-two-million-more-californians-projected-to-lack-health-insurance-by-2030/\">UC Berkeley Labor Center projects\u003c/a> half of undocumented residents in California under age 65 could be uninsured by 2030, double the rate now.\u003c/p>\n"
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"innerHTML": "\n\u003cp>“We live in fear of losing our patients, because we know that their physical health will suffer, the health of their kids will suffer, and the health of the community will suffer,” she said.\u003c/p>\n",
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"excerpt": "The Trump administration’s immigration crackdown is making it harder for primary care doctors who work with immigrant patients to do their jobs, a UCSF study finds.",
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"title": "How Trump’s Immigration Policies Can Leave Doctors Feeling Powerless | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>When a patient comes into Dr. Miguel San Miguel Benavides’ exam room at \u003ca href=\"https://www.kqed.org/news/tag/san-francisco-general-hospital\">San Francisco General Hospital\u003c/a> with a cough, a rash, diabetes or high blood pressure, he knows where to start. \u003c/p>\n\n\n\n\u003cp>But over the past year, people have been bringing him a problem he feels less equipped to tackle as a primary care physician: their fear over immigration enforcement. \u003c/p>\n\n\n\n\u003cp>Among other actions, the Trump administration has rolled back protections keeping immigration agents away from healthcare facilities and sought to \u003ca href=\"https://www.kff.org/immigrant-health/potential-implications-of-the-new-medicaid-data-sharing-agreement-between-cms-and-ice/\">give ICE access to Medicaid data\u003c/a>. Since then, San Miguel and colleagues at SF General who work with immigrant patients say they’ve watched with a sense of powerlessness as people avoid or delay treatment, and as mounting stress exacerbates their underlying conditions.\u003c/p>\n\n\n\n\u003cp>A \u003ca href=\"https://phr.org/news/ice-tactics-and-deportation-fears-limit-access-to-health-care-for-children-of-immigrants-survey/\">2025 survey\u003c/a> of healthcare workers who serve immigrants echoes that experience: Among hundreds of respondents across 30 states, 84% said patient visits were down substantially; many said their ability to provide preventive care and manage chronic conditions suffered.\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED.jpg\" alt=\"\" class=\"wp-image-12097362\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-5-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Miguel San Miguel Benavides, a resident physician at the Zuckerberg San Francisco General Hospital, poses for a portrait at the hospital on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>Now, a small study from UCSF suggests that immigration policies can force some doctors to practice in a way that’s at odds with their sense of moral or professional duty, taking a toll on them. \u003c/p>\n\n\n\n\u003cp>The experience has become routine for San Miguel as he finishes his residency.\u003c/p>\n\n\n\n\u003cp>“This is the type of care that I always wanted to give,” he said of working with patients who, like him, immigrated to this country. “But I think part of that has become realizing that the amount of support we can give isn’t necessarily enough.”\u003c/p>\n\n\n\n\u003cp>Researchers call that kind of ethical conflict “\u003ca href=\"https://www.npr.org/2012/11/21/165663154/moral-injury-the-psychological-wounds-of-war\">moral injury\u003c/a>,” a term coined by a Department of Veterans Affairs psychiatrist working with Vietnam War veterans.\u003c/p>\n\n\n\n\n\n\u003cp>Dr. Marlene Martín, a UCSF clinical medicine professor, was inspired to do the study last summer, around the time ICE was \u003ca href=\"https://www.kqed.org/news/12049326/as-ice-operations-expand-how-are-immigrant-allies-responding\">conducting widespread raids\u003c/a> in Los Angeles. A colleague who works with immigrant patients told her no one had shown up to their appointment that day at SF General. If that was happening in San Francisco, where there was relatively little high-profile ICE activity at the time, Martín wondered what doctors elsewhere were seeing. \u003c/p>\n\n\n\n\u003cp>So she and her colleagues interviewed 38 primary care doctors in 13 states about their experiences caring for immigrant patients in this climate. They recently published their findings \u003ca href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851433\">in JAMA Internal Medicine\u003c/a>.\u003c/p>\n\n\n\n\u003cp>The interviews confirmed that doctors across the country were seeing patients miss appointments, with some suffering more from chronic diseases as their treatment lapsed. For instance, Martín said, one interviewee described a patient whose diabetes had spiraled out of control because his son, who’d been driving him to his appointments, had been arrested by ICE. \u003c/p>\n\n\n\n\u003cp>“You can’t fix that,” she said. “You can’t address that in a clinical visit.”\u003c/p>\n\n\n\n\u003cp>Some doctors told the researchers they were afraid to even ask their patients how they were doing, “because it would open this whole topic that they didn’t know how to answer. They didn’t know how to make it better,” Martín said. “In medicine we’re used to being able to address things that patients are talking about and to help them get better.” \u003c/p>\n\n\n\n\u003cp>One doctor described to researchers the kind of dilemmas they face, given fears about encountering immigration agents in hospitals: “Would I rather have [my patient] be at home while they’re having substernal, crushing chest pain vs. what are the costs and benefits of going [to the hospital]?” \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1350\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg\" alt=\"\" class=\"wp-image-12097364\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-10-KQED-1536x1037.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">The Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>In some cases, the interviewees reported their clinics had stopped accepting undocumented patients altogether, for fear of losing federal funding. \u003c/p>\n\n\n\n\u003cp>Those experiences, day after day, are what can lead to moral injury.\u003c/p>\n\n\n\n\u003cp>What surprised study co-author Dr. Alicia Fernandez was how much doctors changed the way they practiced in response to immigration policy changes. “What we saw was many physicians and practices, entire practices, altering their patterns of care,” the UCSF professor and SF General primary care doctor said. \u003c/p>\n\n\n\n\u003cp>Some transitioned to telehealth appointments. Others switched medications so patients didn’t have to go into the clinic or pharmacy as often. \u003c/p>\n\n\n\n\u003cp>But Fernandez said the changes can come at a cost — both for the patients and the doctors who care for them. \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1421\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED.jpg\" alt=\"\" class=\"wp-image-12097363\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED-160x114.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/20260826_UCSFStudy_GC-8-KQED-1536x1091.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Miguel San Miguel Benavides, a resident physician at the Zuckerberg San Francisco General Hospital, and Alicia Fernandez, a UCSF professor and general internist at SF General, talk at the hospital on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>“We definitely feel that our patients are getting worse, and we feel that the care that we are giving is an inferior form of care, and that’s why it’s associated with moral distress,” Fernandez said. \u003c/p>\n\n\n\n\u003cp>She points to a recent experience with an undocumented patient who’d avoided being seen out of fear. “He came in already having damage from his diabetes,” she said. “That’s a terrible feeling.” \u003c/p>\n\n\n\n\u003cp>This kind of distress isn’t just bad for individual doctors. \u003c/p>\n\n\n\n\u003cp>“Moral injury can contribute to burnout,” said Dr. Robert Pearl, a physician and Stanford professor who served as CEO of the Permanente Medical Group for nearly two decades. And data show burnout affects doctors’ quality of care.\u003c/p>\n\n\n\n\u003cp>“If the patient before you required all this extra work, has had this added fear, had all these challenges,” he said, referencing the study, “when the clinician sees you, he or she may not be as good and sharp as you would like them to be.”\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed.jpg\" alt=\"\" class=\"wp-image-12099231\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/20260826_UCSFStudy_GC-11_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Individuals walk towards the Zuckerberg San Francisco General Hospital and Trauma Center on Aug. 26, 2026. (Gina Castro for KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>Burnout and moral injury can also lead doctors and other healthcare workers to leave their professions, he said, with particularly dire effects in primary care. \u003c/p>\n\n\n\n\u003cp>“We already have a shortage,” he said, so “when you need a primary care doctor, that individual might not be there. And we’re certainly seeing that in many communities across the United States, where it’s almost impossible to find a primary care physician with an open panel.”\u003c/p>\n\n\n\n\u003cp>For doctors in the study who were themselves immigrants, the distress was compounded. That has broad implications given that almost half of the country’s internal medicine doctors are foreign-born, according to \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2852745?guestAccessKey=da3ba888-5ff2-456f-9d94-b301cf5d2884&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081226\">a study\u003c/a> released last month. \u003c/p>\n\n\n\n\u003cp>While the UCSF study on moral injury is small and qualitative, it points to ways healthcare institutions can support staff in an increasingly difficult environment. Doctors whose clinics protected patients’ immigration-related information and expanded telehealth, for example, described ways those changes helped them care for patients.\u003c/p>\n\n\n\n\n\n\u003cp>A sense of powerlessness contributed to the moral distress doctors in the study felt. Carolyn Dewa, a psychiatry and behavioral medicine professor at the UC Davis School of Medicine, said social support can protect against that. \u003c/p>\n\n\n\n\u003cp>“If you feel supported by colleagues and peers, or you feel supported by supervisors,” she said, “if people are not isolated from one another but feel that they’re part of a group, it also is protective.” \u003c/p>\n\n\n\n\u003cp>The doctors interviewed for the study also described the importance of having a sense of agency. “This paper pointed out that feeling like you could take an active role does help mitigate some of the distress,” said Dr. Anne Rosenthal, who runs the adult primary care clinic at SF General, where Fernandez and San Miguel work. \u003c/p>\n\n\n\n\u003cp>Her clinic has tried to do that in part by training staff on what to do if immigration enforcement shows up and proactively educating patients about what they need to do to keep Medi-Cal coverage as state enrollment rules change.\u003c/p>\n\n\n\n\u003cp>The \u003ca href=\"https://laborcenter.berkeley.edu/over-two-million-more-californians-projected-to-lack-health-insurance-by-2030/\">UC Berkeley Labor Center projects\u003c/a> half of undocumented residents in California under age 65 could be uninsured by 2030, double the rate now.\u003c/p>\n\n\n\n\u003cp>“We live in fear of losing our patients, because we know that their physical health will suffer, the health of their kids will suffer, and the health of the community will suffer,” she said.\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "medi-cal-wont-pay-for-assisted-living-in-most-of-california-one-brother-fought-back",
"title": "Medi-Cal Won’t Pay for Assisted Living in Most of California. One Brother Fought Back",
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"headTitle": "Medi-Cal Won’t Pay for Assisted Living in Most of California. One Brother Fought Back | KQED",
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"content": "\n\u003cp>\u003cem>Welcome to CalMatters, the only nonprofit newsroom devoted solely to covering issues that affect all Californians. Sign up for \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/whatmatters\">WhatMatters\u003c/a> to receive the latest news and commentary on the most important issues in the Golden State.\u003c/em>\u003c/p>\n\n\n\n\u003cp>Last summer, siblings Roselie and John Aiello decided it was time for Roselie to leave her home of 73 years. \u003c/p>\n\n\n\n\u003cp>Raised on a cattle ranch in the small town of Mount Shasta, Roselie spent her life working as a butcher and handling animals, assisting her father until his death. When her three brothers moved away, she stayed at home on the ranch, with its winding dirt roads and green pastures. But over the years, the hard manual labor left her bones weak and her back curved, slowing her pace. \u003c/p>\n\n\n\n\u003cp>John moved back to the ranch in far \u003ca href=\"https://www.kqed.org/news/tag/northern-california\">Northern California\u003c/a> to take care of Roselie, who needed some assistance with showering and getting dressed. But these tasks began to weigh on John as he balanced his career as a writer with tending to the land, which was getting more difficult for Roselie to navigate. \u003c/p>\n\n\n\n\u003cp>The two siblings made a decision: Roselie, who qualified for Medicaid, would move into assisted living. John would find an appropriate place for her to live and receive care.\u003c/p>\n\n\n\n\u003cp>But when John tried to apply for assisted living benefits on his sister’s behalf, he found that Medi-Cal — California’s version of Medicaid — does not offer a waiver to pay for assisted living care in Siskiyou County, nor does it in 42 others across the state. Only \u003ca href=\"https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/assisted-living-waiver/\">15 California counties\u003c/a>, most of them urban, offer this option.\u003c/p>\n\n\n\n\u003cp>This has created geographic disparity that gives aging adults in urban areas more options for care than those in rural areas, pushing Northern California seniors like Roselie Aiello into nursing homes or out of their communities, not because they need that level of care, but because they can’t afford to pay out of pocket for assisted living. \u003c/p>\n\n\n\n\u003cp>“You’re wasting money by dumping somebody like my sister in a skilled nursing facility and lessening her quality of life and her chance at doing better,” John said. “By doing this, it makes no fundamental sense.”\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n\u003cfigure class=\"wp-block-image size-large\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" data-id=\"12098658\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2.jpg\" alt=\"\" class=\"wp-image-12098658\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Roselie Aiello at Sundial Assisted Living in Shasta County on March 25, 2026. \u003cbr> (Jessica Blough for CalMatters)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cfigure class=\"wp-block-image size-large\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" data-id=\"12098659\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3.jpg\" alt=\"\" class=\"wp-image-12098659\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Roselie Aiello at Sundial Assisted Living in Shasta County on March 25, 2026. (Jessica Blough for CalMatters)\u003c/figcaption>\u003c/figure>\n\u003c/figure>\n\n\n\n\u003cp>In the coming decade, many more Californians may face the same predicament, given that one in four will be older than 60. As the state prepares for this explosion in the older adult population, it is prioritizing the ability to age in community-based settings like homes or assisted living facilities. \u003c/p>\n\n\n\n\u003cp>But availability of assisted living options varies county to county and is based on decisions by the various managed care providers contracted to deliver healthcare to the state’s lowest-income residents.\u003c/p>\n\n\n\n\u003cp>“There’s not a lot of options to begin with in rural counties. You take (the assisted living waiver) off a table, which already has a history of a long waiting list, and the options are pretty bleak,” said Maura Gibney, executive director of California Advocates for Nursing Home Reform.\u003c/p>\n\n\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr />\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/PCZuA/\" width=\"800\" height=\"800\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\n\n\u003cp>Partnership HealthPlan, which Roselie Aiello is enrolled in, contracts with the state to provide coverage to almost a million Californians on Medi-Cal, making it the largest Medi-Cal managed care plan in Northern California. It is the only Medi-Cal managed care plan available in a separate set of 15 California counties. \u003c/p>\n\n\n\n\u003cp>Managed care providers are encouraged, but not required, to offer as many “\u003ca href=\"https://calaim.dhcs.ca.gov/pages/community-supports\">community supports\u003c/a>” as they can, Tessa Outhyse, a spokesperson for the California Department of Health Care Services, said in an email. CalAIM, the state’s multiyear initiative to overhaul Medi-Cal, includes community supports such as assistance transitioning to an assisted living facility as well as transitional rent, caregiver respite and personal care services. \u003c/p>\n\n\n\n\u003cp>These services are intended to offer healthcare options to Medi-Cal members before their conditions escalate to needing more serious care, therefore saving money. Even when CalAIM’s current waivers expire at the end of the year, the community supports benefits will continue through the managed care plans. \u003c/p>\n\n\n\n\u003cp>When determining which supports to offer, managed care plans take into consideration provider availability and local capacity to offer care, Outhyse said. Partnership chose not to offer assisted living support based on financial factors and a lack of appropriate facilities in the rural areas where it provides care, said Dustin Lyda, spokesperson for the organization. \u003c/p>\n\n\n\n\u003cp>Lyda said any change in what the organization offers would require proof that assisted living facilities would be safer and healthier for members than nursing homes. But he acknowledged that options are more limited for rural members. \u003c/p>\n\n\n\n\u003cp>“There’s definitely a lot more work that we need to do on our end to navigate the more rural areas,” Lyda said. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\" id=\"hitting-roadblocks\">Hitting roadblocks\u003c/h2>\n\n\n\n\u003cp>When John Aiello heard about assisted living benefits through Medi-Cal, he saw it as the perfect match for his sister’s needs. He knew that he likely would have to move her out of Siskiyou County, where there was only one facility for Medi-Cal recipients, a nursing home.\u003c/p>\n\n\n\n\u003cp>Roselie had spent some time at an assisted living facility in neighboring Shasta County, which they saw as a better fit. But Partnership didn’t offer assisted living as a community support in that county. \u003c/p>\n\n\n\n\n\n\u003cp>Instead, the provider offered Roselie a waiver to go into assisted living in Sonoma County, which is about five hours from her home. The Aiellos turned that down, thinking it would not be good for Roselie. \u003c/p>\n\n\n\n\u003cp>“If you remove her totally from a family contact, she would not be thriving right now. She needs to see family,” John Aiello said. “When there were resources available that fit her needs in Redding — that’s the closest point to her home county — why do I need to move her to Oakland, to Los Angeles, to San Diego?”\u003c/p>\n\n\n\n\u003cp>Over the course of nine months, John sent dozens of emails and spent hours on phone calls to get Partnership HealthPlan to cover Roselie’s placement in assisted living. He had the support of her doctor and a spot for Roselie at the residence in Shasta County. \u003c/p>\n\n\n\n\u003cp>The process was so intense and frustrating that it drove a wedge between him and his sister in their final months of living together. \u003c/p>\n\n\n\n\u003cp>“He was doing all of this to help me,” Roselie said. “Where was it going to end?”\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\" id=\"encouraged-or-required\">Encouraged or required? \u003c/h2>\n\n\n\n\u003cp>Most people prefer community-based services over skilled nursing care, which is \u003ca href=\"https://heller.brandeis.edu/community-living-policy/research-policy/publications/pdfs/briefs/hcbs-improve-outcomes-and-reduce-costs.pdf\">generally more expensive\u003c/a>. But nursing home beds are in short supply and should be reserved for those who truly need them, Gibney said.\u003c/p>\n\n\n\n\u003cp>“We really try to help people look at the other options that exist for remaining in the community,” Gibney said. “You’re going to have better health outcomes, better quality of care, if you can stay in the community and out of an institutional setting.”\u003c/p>\n\n\n\n\u003cp>Research indicates that while assisted living may provide better outcomes for some, people in assisted living are more likely than nursing home residents to be hospitalized, which can drive up costs, said Dr. Kenneth Lam, a geriatrician and assistant professor at the University of Colorado Anschutz Medical Campus. \u003c/p>\n\n\n\n\u003cp>“The evidence suggests that it’s a trade-off,” he said. \u003c/p>\n\n\n\n\n\n\u003cp>Contracts for managed care plans are not competitively bid, Outhyse said. And potential contractors aren’t asked to include specific community supports, such as assisted living, in their managed care plans.\u003c/p>\n\n\n\n\u003cp>“Whether a plan chooses to provide specific community supports is not a factor in contract renewal, which focuses instead on overall compliance with state and federal performance standards,” Outhyse wrote in the email.\u003c/p>\n\n\n\n\u003cp>Partnership’s contract with the state was set to expire in December, but will be extended until 2029 because the state \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/ManagedCarePlanProcurementUpdate.aspx\">delayed\u003c/a> the process of soliciting managed care contracts. Lyda said Partnership is facing increasing demand for its community supports — which mainly address social needs, such as housing and food security — and for assisted living benefits. But even people in counties where the managed care provider offers an assisted living benefit can have a long wait for placement. \u003c/p>\n\n\n\n\u003cp>After years of constant increases, the number of Californians receiving an assisted living waiver for the first time dropped at the beginning of 2025, though the waitlist continued to climb. \u003c/p>\n\n\n\n\u003cp>By September, the number of Californians waiting for a waiver had surpassed the number of people who were being supported by it.\u003c/p>\n\n\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr />\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/kH9D7\" width=\"800\" height=\"800\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\n\n\u003cp>Gibney said that Medi-Cal members are often encouraged to get on the waitlist before applying for assisted living funding, which could contribute to the long wait. \u003c/p>\n\n\n\n\u003cp>Older adults might spend months on a waitlist, only to be told that they are ineligible for assisted living coverage. \u003c/p>\n\n\n\n\u003cp>“It’s a lot of shifting sand, that’s what people are finding themselves in the middle of,” Lam said. “They’re being told that they get to choose, but it’s a complex choice.”\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\" id=\"a-new-home\">A new home\u003c/h2>\n\n\n\n\u003cp>In March, Roselie moved into her new home, Sundial Assisted Living, the Shasta County facility where she had previously spent some time. Two months earlier, Partnership had informed the Aiellos that it would cover Roselie’s assisted living care. \u003c/p>\n\n\n\n\u003cp>Partnership offered Roselie early access to a pilot program that launched on July 1, which extends the assisted living options to select members of the network. There will be no open application process, but members can ask to be considered or referred through a healthcare provider. \u003c/p>\n\n\n\n\u003cp>The goal is to discover if offering the assisted living option will provide better health outcomes at a lower price.\u003c/p>\n\n\n\n\u003cp>“Success would also be having these individuals being able to continue to receive care within their community setting, being in their home,” Lyda said. “We know that that is more impactful to health than being completely taken out of a familiar area.” \u003c/p>\n\n\n\n\u003cp>The adjustment has not been easy for Roselie. She has been hospitalized twice since she moved to Sundial and briefly entered a nursing home. \u003cs> \u003c/s>\u003c/p>\n\n\n\n\u003cp>Socially, things have gone better. Roselie has made friends and is often called on to teach card games to her fellow Sundial residents. While she was hospitalized, her neighbors and caretakers at Sundial visited her. She’s grateful to John for navigating through red tape to get her here. \u003c/p>\n\n\n\n\u003cp>“I’m looking at it like this: It’s a new adventure,” she said. \u003c/p>\n\n\n\n\u003cp>John worries about his sister’s health issues and whether Sundial will be a long-term solution for her. He’s gratified that his fight ended with his sister’s placement in their chosen facility. But he resents having to wage the battle.\u003c/p>\n\n\n\n\u003cp>“I don’t understand why I was the guy fighting for everybody,” John said. “I’m just one person trying to support myself, trying to take care of a family member.”\u003c/p>\n\n\n\n\u003cp>\u003cem>Jessica Blough reported on this story while with the\u003c/em> \u003ca href=\"https://journalism.berkeley.edu/programs/mj/investigative-reporting/\">\u003cem>Investigative Reporting Program\u003c/em>\u003c/a> \u003cem>at UC Berkeley Journalism School, with a grant from\u003c/em> \u003ca href=\"https://www.thescanfoundation.org/\">\u003cem>The SCAN Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n",
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"innerHTML": "\n\u003cp>\u003cem>Welcome to CalMatters, the only nonprofit newsroom devoted solely to covering issues that affect all Californians. Sign up for \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/whatmatters\">WhatMatters\u003c/a> to receive the latest news and commentary on the most important issues in the Golden State.\u003c/em>\u003c/p>\n",
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"innerHTML": "\n\u003cp>But when John tried to apply for assisted living benefits on his sister’s behalf, he found that Medi-Cal — California’s version of Medicaid — does not offer a waiver to pay for assisted living care in Siskiyou County, nor does it in 42 others across the state. Only \u003ca href=\"https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/assisted-living-waiver/\">15 California counties\u003c/a>, most of them urban, offer this option.\u003c/p>\n",
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"\n\u003cp>But when John tried to apply for assisted living benefits on his sister’s behalf, he found that Medi-Cal — California’s version of Medicaid — does not offer a waiver to pay for assisted living care in Siskiyou County, nor does it in 42 others across the state. Only \u003ca href=\"https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/assisted-living-waiver/\">15 California counties\u003c/a>, most of them urban, offer this option.\u003c/p>\n"
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"\n\u003cp>This has created geographic disparity that gives aging adults in urban areas more options for care than those in rural areas, pushing Northern California seniors like Roselie Aiello into nursing homes or out of their communities, not because they need that level of care, but because they can’t afford to pay out of pocket for assisted living. \u003c/p>\n"
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"innerHTML": "\n\u003cp>In the coming decade, many more Californians may face the same predicament, given that one in four will be older than 60. As the state prepares for this explosion in the older adult population, it is prioritizing the ability to age in community-based settings like homes or assisted living facilities. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“There’s not a lot of options to begin with in rural counties. You take (the assisted living waiver) off a table, which already has a history of a long waiting list, and the options are pretty bleak,” said Maura Gibney, executive director of California Advocates for Nursing Home Reform.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Partnership HealthPlan, which Roselie Aiello is enrolled in, contracts with the state to provide coverage to almost a million Californians on Medi-Cal, making it the largest Medi-Cal managed care plan in Northern California. It is the only Medi-Cal managed care plan available in a separate set of 15 California counties. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Managed care providers are encouraged, but not required, to offer as many “\u003ca href=\"https://calaim.dhcs.ca.gov/pages/community-supports\">community supports\u003c/a>” as they can, Tessa Outhyse, a spokesperson for the California Department of Health Care Services, said in an email. CalAIM, the state’s multiyear initiative to overhaul Medi-Cal, includes community supports such as assistance transitioning to an assisted living facility as well as transitional rent, caregiver respite and personal care services. \u003c/p>\n",
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"innerHTML": "\n\u003cp>When determining which supports to offer, managed care plans take into consideration provider availability and local capacity to offer care, Outhyse said. Partnership chose not to offer assisted living support based on financial factors and a lack of appropriate facilities in the rural areas where it provides care, said Dustin Lyda, spokesperson for the organization. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Lyda said any change in what the organization offers would require proof that assisted living facilities would be safer and healthier for members than nursing homes. But he acknowledged that options are more limited for rural members. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“There’s definitely a lot more work that we need to do on our end to navigate the more rural areas,” Lyda said. \u003c/p>\n",
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"innerHTML": "\n\u003cp>When John Aiello heard about assisted living benefits through Medi-Cal, he saw it as the perfect match for his sister’s needs. He knew that he likely would have to move her out of Siskiyou County, where there was only one facility for Medi-Cal recipients, a nursing home.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Roselie had spent some time at an assisted living facility in neighboring Shasta County, which they saw as a better fit. But Partnership didn’t offer assisted living as a community support in that county. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Instead, the provider offered Roselie a waiver to go into assisted living in Sonoma County, which is about five hours from her home. The Aiellos turned that down, thinking it would not be good for Roselie. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“If you remove her totally from a family contact, she would not be thriving right now. She needs to see family,” John Aiello said. “When there were resources available that fit her needs in Redding — that’s the closest point to her home county — why do I need to move her to Oakland, to Los Angeles, to San Diego?”\u003c/p>\n",
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"innerHTML": "\n\u003cp>Over the course of nine months, John sent dozens of emails and spent hours on phone calls to get Partnership HealthPlan to cover Roselie’s placement in assisted living. He had the support of her doctor and a spot for Roselie at the residence in Shasta County. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“He was doing all of this to help me,” Roselie said. “Where was it going to end?”\u003c/p>\n",
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"innerHTML": "\n\u003cp>Most people prefer community-based services over skilled nursing care, which is \u003ca href=\"https://heller.brandeis.edu/community-living-policy/research-policy/publications/pdfs/briefs/hcbs-improve-outcomes-and-reduce-costs.pdf\">generally more expensive\u003c/a>. But nursing home beds are in short supply and should be reserved for those who truly need them, Gibney said.\u003c/p>\n",
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"innerHTML": "\n\u003cp>“We really try to help people look at the other options that exist for remaining in the community,” Gibney said. “You’re going to have better health outcomes, better quality of care, if you can stay in the community and out of an institutional setting.”\u003c/p>\n",
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"innerHTML": "\n\u003cp>Research indicates that while assisted living may provide better outcomes for some, people in assisted living are more likely than nursing home residents to be hospitalized, which can drive up costs, said Dr. Kenneth Lam, a geriatrician and assistant professor at the University of Colorado Anschutz Medical Campus. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Contracts for managed care plans are not competitively bid, Outhyse said. And potential contractors aren’t asked to include specific community supports, such as assisted living, in their managed care plans.\u003c/p>\n",
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"innerHTML": "\n\u003cp>“Whether a plan chooses to provide specific community supports is not a factor in contract renewal, which focuses instead on overall compliance with state and federal performance standards,” Outhyse wrote in the email.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Partnership’s contract with the state was set to expire in December, but will be extended until 2029 because the state \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/ManagedCarePlanProcurementUpdate.aspx\">delayed\u003c/a> the process of soliciting managed care contracts. Lyda said Partnership is facing increasing demand for its community supports — which mainly address social needs, such as housing and food security — and for assisted living benefits. But even people in counties where the managed care provider offers an assisted living benefit can have a long wait for placement. \u003c/p>\n",
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"innerHTML": "\n\u003cp>After years of constant increases, the number of Californians receiving an assisted living waiver for the first time dropped at the beginning of 2025, though the waitlist continued to climb. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Gibney said that Medi-Cal members are often encouraged to get on the waitlist before applying for assisted living funding, which could contribute to the long wait. \u003c/p>\n",
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"innerHTML": "\n\u003cp>In March, Roselie moved into her new home, Sundial Assisted Living, the Shasta County facility where she had previously spent some time. Two months earlier, Partnership had informed the Aiellos that it would cover Roselie’s assisted living care. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“Success would also be having these individuals being able to continue to receive care within their community setting, being in their home,” Lyda said. “We know that that is more impactful to health than being completely taken out of a familiar area.” \u003c/p>\n",
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"innerHTML": "\n\u003cp>Socially, things have gone better. Roselie has made friends and is often called on to teach card games to her fellow Sundial residents. While she was hospitalized, her neighbors and caretakers at Sundial visited her. She’s grateful to John for navigating through red tape to get her here. \u003c/p>\n",
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"innerHTML": "\n\u003cp>John worries about his sister’s health issues and whether Sundial will be a long-term solution for her. He’s gratified that his fight ended with his sister’s placement in their chosen facility. But he resents having to wage the battle.\u003c/p>\n",
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"innerHTML": "\n\u003cp>\u003cem>Jessica Blough reported on this story while with the\u003c/em> \u003ca href=\"https://journalism.berkeley.edu/programs/mj/investigative-reporting/\">\u003cem>Investigative Reporting Program\u003c/em>\u003c/a> \u003cem>at UC Berkeley Journalism School, with a grant from\u003c/em> \u003ca href=\"https://www.thescanfoundation.org/\">\u003cem>The SCAN Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n",
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"excerpt": "A pilot program providing more assisted living coverage in rural California has emerged from one man’s fight to change his sister’s options.",
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"title": "Medi-Cal Won’t Pay for Assisted Living in Most of California. One Brother Fought Back | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>\u003cem>Welcome to CalMatters, the only nonprofit newsroom devoted solely to covering issues that affect all Californians. Sign up for \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/whatmatters\">WhatMatters\u003c/a> to receive the latest news and commentary on the most important issues in the Golden State.\u003c/em>\u003c/p>\n\n\n\n\u003cp>Last summer, siblings Roselie and John Aiello decided it was time for Roselie to leave her home of 73 years. \u003c/p>\n\n\n\n\u003cp>Raised on a cattle ranch in the small town of Mount Shasta, Roselie spent her life working as a butcher and handling animals, assisting her father until his death. When her three brothers moved away, she stayed at home on the ranch, with its winding dirt roads and green pastures. But over the years, the hard manual labor left her bones weak and her back curved, slowing her pace. \u003c/p>\n\n\n\n\u003cp>John moved back to the ranch in far \u003ca href=\"https://www.kqed.org/news/tag/northern-california\">Northern California\u003c/a> to take care of Roselie, who needed some assistance with showering and getting dressed. But these tasks began to weigh on John as he balanced his career as a writer with tending to the land, which was getting more difficult for Roselie to navigate. \u003c/p>\n\n\n\n\u003cp>The two siblings made a decision: Roselie, who qualified for Medicaid, would move into assisted living. John would find an appropriate place for her to live and receive care.\u003c/p>\n\n\n\n\u003cp>But when John tried to apply for assisted living benefits on his sister’s behalf, he found that Medi-Cal — California’s version of Medicaid — does not offer a waiver to pay for assisted living care in Siskiyou County, nor does it in 42 others across the state. Only \u003ca href=\"https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/assisted-living-waiver/\">15 California counties\u003c/a>, most of them urban, offer this option.\u003c/p>\n\n\n\n\u003cp>This has created geographic disparity that gives aging adults in urban areas more options for care than those in rural areas, pushing Northern California seniors like Roselie Aiello into nursing homes or out of their communities, not because they need that level of care, but because they can’t afford to pay out of pocket for assisted living. \u003c/p>\n\n\n\n\u003cp>“You’re wasting money by dumping somebody like my sister in a skilled nursing facility and lessening her quality of life and her chance at doing better,” John said. “By doing this, it makes no fundamental sense.”\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n\u003cfigure class=\"wp-block-image size-large\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" data-id=\"12098658\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2.jpg\" alt=\"\" class=\"wp-image-12098658\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare2-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Roselie Aiello at Sundial Assisted Living in Shasta County on March 25, 2026. \u003cbr> (Jessica Blough for CalMatters)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cfigure class=\"wp-block-image size-large\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" data-id=\"12098659\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3.jpg\" alt=\"\" class=\"wp-image-12098659\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/09/CMHealthCare3-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Roselie Aiello at Sundial Assisted Living in Shasta County on March 25, 2026. (Jessica Blough for CalMatters)\u003c/figcaption>\u003c/figure>\n\u003c/figure>\n\n\n\n\u003cp>In the coming decade, many more Californians may face the same predicament, given that one in four will be older than 60. As the state prepares for this explosion in the older adult population, it is prioritizing the ability to age in community-based settings like homes or assisted living facilities. \u003c/p>\n\n\n\n\u003cp>But availability of assisted living options varies county to county and is based on decisions by the various managed care providers contracted to deliver healthcare to the state’s lowest-income residents.\u003c/p>\n\n\n\n\u003cp>“There’s not a lot of options to begin with in rural counties. You take (the assisted living waiver) off a table, which already has a history of a long waiting list, and the options are pretty bleak,” said Maura Gibney, executive director of California Advocates for Nursing Home Reform.\u003c/p>\n\n\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr />\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/PCZuA/\" width=\"800\" height=\"800\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\n\n\u003cp>Partnership HealthPlan, which Roselie Aiello is enrolled in, contracts with the state to provide coverage to almost a million Californians on Medi-Cal, making it the largest Medi-Cal managed care plan in Northern California. It is the only Medi-Cal managed care plan available in a separate set of 15 California counties. \u003c/p>\n\n\n\n\u003cp>Managed care providers are encouraged, but not required, to offer as many “\u003ca href=\"https://calaim.dhcs.ca.gov/pages/community-supports\">community supports\u003c/a>” as they can, Tessa Outhyse, a spokesperson for the California Department of Health Care Services, said in an email. CalAIM, the state’s multiyear initiative to overhaul Medi-Cal, includes community supports such as assistance transitioning to an assisted living facility as well as transitional rent, caregiver respite and personal care services. \u003c/p>\n\n\n\n\u003cp>These services are intended to offer healthcare options to Medi-Cal members before their conditions escalate to needing more serious care, therefore saving money. Even when CalAIM’s current waivers expire at the end of the year, the community supports benefits will continue through the managed care plans. \u003c/p>\n\n\n\n\u003cp>When determining which supports to offer, managed care plans take into consideration provider availability and local capacity to offer care, Outhyse said. Partnership chose not to offer assisted living support based on financial factors and a lack of appropriate facilities in the rural areas where it provides care, said Dustin Lyda, spokesperson for the organization. \u003c/p>\n\n\n\n\u003cp>Lyda said any change in what the organization offers would require proof that assisted living facilities would be safer and healthier for members than nursing homes. But he acknowledged that options are more limited for rural members. \u003c/p>\n\n\n\n\u003cp>“There’s definitely a lot more work that we need to do on our end to navigate the more rural areas,” Lyda said. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\" id=\"hitting-roadblocks\">Hitting roadblocks\u003c/h2>\n\n\n\n\u003cp>When John Aiello heard about assisted living benefits through Medi-Cal, he saw it as the perfect match for his sister’s needs. He knew that he likely would have to move her out of Siskiyou County, where there was only one facility for Medi-Cal recipients, a nursing home.\u003c/p>\n\n\n\n\u003cp>Roselie had spent some time at an assisted living facility in neighboring Shasta County, which they saw as a better fit. But Partnership didn’t offer assisted living as a community support in that county. \u003c/p>\n\n\n\n\n\n\u003cp>Instead, the provider offered Roselie a waiver to go into assisted living in Sonoma County, which is about five hours from her home. The Aiellos turned that down, thinking it would not be good for Roselie. \u003c/p>\n\n\n\n\u003cp>“If you remove her totally from a family contact, she would not be thriving right now. She needs to see family,” John Aiello said. “When there were resources available that fit her needs in Redding — that’s the closest point to her home county — why do I need to move her to Oakland, to Los Angeles, to San Diego?”\u003c/p>\n\n\n\n\u003cp>Over the course of nine months, John sent dozens of emails and spent hours on phone calls to get Partnership HealthPlan to cover Roselie’s placement in assisted living. He had the support of her doctor and a spot for Roselie at the residence in Shasta County. \u003c/p>\n\n\n\n\u003cp>The process was so intense and frustrating that it drove a wedge between him and his sister in their final months of living together. \u003c/p>\n\n\n\n\u003cp>“He was doing all of this to help me,” Roselie said. “Where was it going to end?”\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\" id=\"encouraged-or-required\">Encouraged or required? \u003c/h2>\n\n\n\n\u003cp>Most people prefer community-based services over skilled nursing care, which is \u003ca href=\"https://heller.brandeis.edu/community-living-policy/research-policy/publications/pdfs/briefs/hcbs-improve-outcomes-and-reduce-costs.pdf\">generally more expensive\u003c/a>. But nursing home beds are in short supply and should be reserved for those who truly need them, Gibney said.\u003c/p>\n\n\n\n\u003cp>“We really try to help people look at the other options that exist for remaining in the community,” Gibney said. “You’re going to have better health outcomes, better quality of care, if you can stay in the community and out of an institutional setting.”\u003c/p>\n\n\n\n\u003cp>Research indicates that while assisted living may provide better outcomes for some, people in assisted living are more likely than nursing home residents to be hospitalized, which can drive up costs, said Dr. Kenneth Lam, a geriatrician and assistant professor at the University of Colorado Anschutz Medical Campus. \u003c/p>\n\n\n\n\u003cp>“The evidence suggests that it’s a trade-off,” he said. \u003c/p>\n\n\n\n\n\n\u003cp>Contracts for managed care plans are not competitively bid, Outhyse said. And potential contractors aren’t asked to include specific community supports, such as assisted living, in their managed care plans.\u003c/p>\n\n\n\n\u003cp>“Whether a plan chooses to provide specific community supports is not a factor in contract renewal, which focuses instead on overall compliance with state and federal performance standards,” Outhyse wrote in the email.\u003c/p>\n\n\n\n\u003cp>Partnership’s contract with the state was set to expire in December, but will be extended until 2029 because the state \u003ca href=\"https://www.dhcs.ca.gov/services/Pages/ManagedCarePlanProcurementUpdate.aspx\">delayed\u003c/a> the process of soliciting managed care contracts. Lyda said Partnership is facing increasing demand for its community supports — which mainly address social needs, such as housing and food security — and for assisted living benefits. But even people in counties where the managed care provider offers an assisted living benefit can have a long wait for placement. \u003c/p>\n\n\n\n\u003cp>After years of constant increases, the number of Californians receiving an assisted living waiver for the first time dropped at the beginning of 2025, though the waitlist continued to climb. \u003c/p>\n\n\n\n\u003cp>By September, the number of Californians waiting for a waiver had surpassed the number of people who were being supported by it.\u003c/p>\n\n\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr />\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/kH9D7\" width=\"800\" height=\"800\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\n\n\u003cp>Gibney said that Medi-Cal members are often encouraged to get on the waitlist before applying for assisted living funding, which could contribute to the long wait. \u003c/p>\n\n\n\n\u003cp>Older adults might spend months on a waitlist, only to be told that they are ineligible for assisted living coverage. \u003c/p>\n\n\n\n\u003cp>“It’s a lot of shifting sand, that’s what people are finding themselves in the middle of,” Lam said. “They’re being told that they get to choose, but it’s a complex choice.”\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\" id=\"a-new-home\">A new home\u003c/h2>\n\n\n\n\u003cp>In March, Roselie moved into her new home, Sundial Assisted Living, the Shasta County facility where she had previously spent some time. Two months earlier, Partnership had informed the Aiellos that it would cover Roselie’s assisted living care. \u003c/p>\n\n\n\n\u003cp>Partnership offered Roselie early access to a pilot program that launched on July 1, which extends the assisted living options to select members of the network. There will be no open application process, but members can ask to be considered or referred through a healthcare provider. \u003c/p>\n\n\n\n\u003cp>The goal is to discover if offering the assisted living option will provide better health outcomes at a lower price.\u003c/p>\n\n\n\n\u003cp>“Success would also be having these individuals being able to continue to receive care within their community setting, being in their home,” Lyda said. “We know that that is more impactful to health than being completely taken out of a familiar area.” \u003c/p>\n\n\n\n\u003cp>The adjustment has not been easy for Roselie. She has been hospitalized twice since she moved to Sundial and briefly entered a nursing home. \u003cs> \u003c/s>\u003c/p>\n\n\n\n\u003cp>Socially, things have gone better. Roselie has made friends and is often called on to teach card games to her fellow Sundial residents. While she was hospitalized, her neighbors and caretakers at Sundial visited her. She’s grateful to John for navigating through red tape to get her here. \u003c/p>\n\n\n\n\u003cp>“I’m looking at it like this: It’s a new adventure,” she said. \u003c/p>\n\n\n\n\u003cp>John worries about his sister’s health issues and whether Sundial will be a long-term solution for her. He’s gratified that his fight ended with his sister’s placement in their chosen facility. But he resents having to wage the battle.\u003c/p>\n\n\n\n\u003cp>“I don’t understand why I was the guy fighting for everybody,” John said. “I’m just one person trying to support myself, trying to take care of a family member.”\u003c/p>\n\n\n\n\u003cp>\u003cem>Jessica Blough reported on this story while with the\u003c/em> \u003ca href=\"https://journalism.berkeley.edu/programs/mj/investigative-reporting/\">\u003cem>Investigative Reporting Program\u003c/em>\u003c/a> \u003cem>at UC Berkeley Journalism School, with a grant from\u003c/em> \u003ca href=\"https://www.thescanfoundation.org/\">\u003cem>The SCAN Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003c/div>\u003c/p>",
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"title": "Bay Area Nurses Protest Use of Palantir’s AI Tech at Hospitals",
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"content": "\n\u003cp>More than a hundred registered nurses in red union T-shirts blocked traffic and chanted outside \u003ca href=\"https://www.kqed.org/forum/2010101864924/a-deeper-look-into-palantir-technologies\">Palantir’s\u003c/a> former headquarters in Palo Alto on Thursday, calling on hospital executives and elected officials to cut ties with the artificial intelligence software and data analytics giant. \u003c/p>\n\n\n\n\u003cp>National Nurses United, which held similar protests in Los Angeles, Chicago, Washington, D.C. and four other cities, said the demonstrations were the union’s largest to date against Palantir, now based in the Miami area. \u003c/p>\n\n\n\n\u003cp>Nurses are worried that the company, which has won lucrative but controversial contracts with federal defense and immigration enforcement agencies, is expanding into healthcare.\u003c/p>\n\n\n\n\u003cp>Hospital executives at HCA Healthcare, one of the largest for-profit hospital operators in the U.S., have introduced Palantir’s AI-powered tools for nurse staffing and scheduling. New York’s Mount Sinai Health System uses the company’s products to evaluate patient records and determine which ones are eligible for at-home care, according to Palantir’s \u003ca href=\"https://www.palantir.com/offerings/palantir-for-hospitals/\">website\u003c/a>.\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1500\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED.jpg\" alt=\"\" class=\"wp-image-12097137\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Nurses place Band-Aids over photos of notes written by children detained by U.S. immigration agents at a protest against intelligence giant Palantir in Palo Alto on Aug. 27, 2026. (Courtesy of National Nurses United)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>Craig Cedotal, a pediatric nurse at Kaiser Oakland who previously worked at an HCA hospital in New Orleans, said nurses want more transparency and a greater say in the use of AI in hospitals, including Palantir’s platforms.\u003c/p>\n\n\n\n\u003cp>“It’s affecting staffing decisions and care decisions in ways that are not in line with what healthcare should be,” said Cedotal, one of the protesters in Palo Alto. “A machine should not make decisions about how we take care of each other. That is not good healthcare.”\u003c/p>\n\n\n\n\u003cp>Palantir did not respond to a request for comment. \u003c/p>\n\n\n\n\u003cp>In a \u003ca href=\"https://www.palantir.com/q2-2026-letter/en/\">letter to\u003c/a> shareholders this month, CEO Alex Karp said the company’s business has nearly doubled in a span of 12 months. Palantir earned nearly \u003ca href=\"https://investors.palantir.com/news-details/2026/Palantir-Reports-Q2-2026-U-S--Comm-Revenue-Growth-of-149-YY-and-Revenue-Growth-of-93-YY-Raises-FY-2026-Revenue-Guidance-to-82-YY-Growth-and-U-S--Comm-Revenue-Guidance-to-134-YY-Crushing-Consensus-Expectations/\">$2 billion\u003c/a> in net income, after expenses, during the first half of this year. \u003c/p>\n\n\n\n\n\n\u003cp>“The core of our business, in the United States, continues to expand at an unrelenting and breakneck pace,” Karp said. \u003c/p>\n\n\n\n\u003cp>On Thursday, California lawmakers approved a bill sponsored by the California Nurses Association that would establish some guardrails in the deployment of AI in patient care. \u003c/p>\n\n\n\n\u003cp>The \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260ab1979\">bill\u003c/a>, by Assemblymember Mia Bonta, D-Oakland, would prohibit a health facility or doctor’s office from using an AI tool to perform any function that requires a professional license. Gov. Gavin Newsom is considering the proposed legislation.\u003c/p>\n\n\n\n\u003cp>Cedotal said that nurses at HCA hospitals have found the new automated staffing platform disruptive, with scheduling not always matching the needs of the day. The union contends the technology is exacerbating an understaffing crisis in the healthcare industry.\u003c/p>\n\n\n\n\u003cp>“The major concern is that humans are not involved in the equation,” said Cedotal, who has worked as a nurse for 32 years. The software “recommendations usually end up being something unfavorable for staffing or the nurses or patient care in general, or all three together.”\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1500\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED.jpg\" alt=\"\" class=\"wp-image-12097138\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Nurses block the street in Palo Alto outside the headquarters of artificial intelligence giant Palantir on Aug. 27, 2026. The actions cited the “deadly costs” of Palantir’s products, including its development and operation of ELITE, an application used by federal agents that identifies people for arrest using, in part, Medicaid data. (Courtesy of National Nurses United)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>\u003ca href=\"https://www.hcahealthcare.com/about\">HCA Healthcare\u003c/a>, which operates about 190 hospitals in the U.S. and the United Kingdom, did not respond to a request for comment. Good Samaritan Hospital in San José is affiliated with the company.\u003c/p>\n\n\n\n\u003cp>National Nurses United, which represents more than 225,000 members nationwide with affiliates like the California Nurses Association, is getting ready to begin contract negotiations with HCA, Kaiser Permanente and other major employers. \u003c/p>\n\n\n\n\u003cp>At the protest Thursday, the union joined community groups in criticizing Palantir for profiting from the Trump administration’s push to arrest and deport thousands of immigrants, and working with Israel’s Ministry of Defense to support its war in Gaza.\u003c/p>\n\n\n\n\u003cp>“Their technology has enabled the systematic destruction of hospitals, the killing of hundreds of healthcare workers, and the collapse of Gaza’s most vital infrastructure, how can we in good conscience place that same technology at the heart of U.S. healthcare facilities?” said Aisha Nizar with the Palestinian Youth Movement, in a statement. “Our message for the Bay Area is clear: Protect patients, stop fueling genocide, and cut ties with Palantir immediately.”\u003c/p>\n",
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"innerHTML": "\n\u003cp>Nurses are worried that the company, which has won lucrative but controversial contracts with federal defense and immigration enforcement agencies, is expanding into healthcare.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Hospital executives at HCA Healthcare, one of the largest for-profit hospital operators in the U.S., have introduced Palantir’s AI-powered tools for nurse staffing and scheduling. New York’s Mount Sinai Health System uses the company’s products to evaluate patient records and determine which ones are eligible for at-home care, according to Palantir’s \u003ca href=\"https://www.palantir.com/offerings/palantir-for-hospitals/\">website\u003c/a>.\u003c/p>\n",
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"innerHTML": "\n\u003cp>In a \u003ca href=\"https://www.palantir.com/q2-2026-letter/en/\">letter to\u003c/a> shareholders this month, CEO Alex Karp said the company’s business has nearly doubled in a span of 12 months. Palantir earned nearly \u003ca href=\"https://investors.palantir.com/news-details/2026/Palantir-Reports-Q2-2026-U-S--Comm-Revenue-Growth-of-149-YY-and-Revenue-Growth-of-93-YY-Raises-FY-2026-Revenue-Guidance-to-82-YY-Growth-and-U-S--Comm-Revenue-Guidance-to-134-YY-Crushing-Consensus-Expectations/\">$2 billion\u003c/a> in net income, after expenses, during the first half of this year. \u003c/p>\n",
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"innerHTML": "\n\u003cp>On Thursday, California lawmakers approved a bill sponsored by the California Nurses Association that would establish some guardrails in the deployment of AI in patient care. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Cedotal said that nurses at HCA hospitals have found the new automated staffing platform disruptive, with scheduling not always matching the needs of the day. The union contends the technology is exacerbating an understaffing crisis in the healthcare industry.\u003c/p>\n",
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"innerHTML": "\n\u003cp>“The major concern is that humans are not involved in the equation,” said Cedotal, who has worked as a nurse for 32 years. The software “recommendations usually end up being something unfavorable for staffing or the nurses or patient care in general, or all three together.”\u003c/p>\n",
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"innerHTML": "\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED.jpg\" alt=\"\" class=\"wp-image-12097138\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED-1536x1152.jpg 1536w\" sizes=\"(min-width: 992px) min(100vw, 1536px), (min-width: 768px) min(100vw, 1280px), min(100vw, 1020px)\" />\u003cfigcaption class=\"wp-element-caption\">Nurses block the street in Palo Alto outside the headquarters of artificial intelligence giant Palantir on Aug. 27, 2026. The actions cited the “deadly costs” of Palantir’s products, including its development and operation of ELITE, an application used by federal agents that identifies people for arrest using, in part, Medicaid data.\u003ccite class=\"wp-inline-image-credit\"> (Courtesy of National Nurses United)\u003c/cite>\u003c/figcaption>\u003c/figure>\n",
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"innerHTML": "\n\u003cp>\u003ca href=\"https://www.hcahealthcare.com/about\">HCA Healthcare\u003c/a>, which operates about 190 hospitals in the U.S. and the United Kingdom, did not respond to a request for comment. Good Samaritan Hospital in San José is affiliated with the company.\u003c/p>\n",
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"innerHTML": "\n\u003cp>At the protest Thursday, the union joined community groups in criticizing Palantir for profiting from the Trump administration’s push to arrest and deport thousands of immigrants, and working with Israel’s Ministry of Defense to support its war in Gaza.\u003c/p>\n",
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"innerHTML": "\n\u003cp>“Their technology has enabled the systematic destruction of hospitals, the killing of hundreds of healthcare workers, and the collapse of Gaza’s most vital infrastructure, how can we in good conscience place that same technology at the heart of U.S. healthcare facilities?” said Aisha Nizar with the Palestinian Youth Movement, in a statement. “Our message for the Bay Area is clear: Protect patients, stop fueling genocide, and cut ties with Palantir immediately.”\u003c/p>\n",
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"excerpt": "Nurses held protests in Palo Alto, Los Angeles and six other cities, calling on hospitals and elected officials to cut ties with the AI software and data analytics company.",
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"title": "Bay Area Nurses Protest Use of Palantir’s AI Tech at Hospitals | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>More than a hundred registered nurses in red union T-shirts blocked traffic and chanted outside \u003ca href=\"https://www.kqed.org/forum/2010101864924/a-deeper-look-into-palantir-technologies\">Palantir’s\u003c/a> former headquarters in Palo Alto on Thursday, calling on hospital executives and elected officials to cut ties with the artificial intelligence software and data analytics giant. \u003c/p>\n\n\n\n\u003cp>National Nurses United, which held similar protests in Los Angeles, Chicago, Washington, D.C. and four other cities, said the demonstrations were the union’s largest to date against Palantir, now based in the Miami area. \u003c/p>\n\n\n\n\u003cp>Nurses are worried that the company, which has won lucrative but controversial contracts with federal defense and immigration enforcement agencies, is expanding into healthcare.\u003c/p>\n\n\n\n\u003cp>Hospital executives at HCA Healthcare, one of the largest for-profit hospital operators in the U.S., have introduced Palantir’s AI-powered tools for nurse staffing and scheduling. New York’s Mount Sinai Health System uses the company’s products to evaluate patient records and determine which ones are eligible for at-home care, according to Palantir’s \u003ca href=\"https://www.palantir.com/offerings/palantir-for-hospitals/\">website\u003c/a>.\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1500\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED.jpg\" alt=\"\" class=\"wp-image-12097137\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-03-KQED-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Nurses place Band-Aids over photos of notes written by children detained by U.S. immigration agents at a protest against intelligence giant Palantir in Palo Alto on Aug. 27, 2026. (Courtesy of National Nurses United)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>Craig Cedotal, a pediatric nurse at Kaiser Oakland who previously worked at an HCA hospital in New Orleans, said nurses want more transparency and a greater say in the use of AI in hospitals, including Palantir’s platforms.\u003c/p>\n\n\n\n\u003cp>“It’s affecting staffing decisions and care decisions in ways that are not in line with what healthcare should be,” said Cedotal, one of the protesters in Palo Alto. “A machine should not make decisions about how we take care of each other. That is not good healthcare.”\u003c/p>\n\n\n\n\u003cp>Palantir did not respond to a request for comment. \u003c/p>\n\n\n\n\u003cp>In a \u003ca href=\"https://www.palantir.com/q2-2026-letter/en/\">letter to\u003c/a> shareholders this month, CEO Alex Karp said the company’s business has nearly doubled in a span of 12 months. Palantir earned nearly \u003ca href=\"https://investors.palantir.com/news-details/2026/Palantir-Reports-Q2-2026-U-S--Comm-Revenue-Growth-of-149-YY-and-Revenue-Growth-of-93-YY-Raises-FY-2026-Revenue-Guidance-to-82-YY-Growth-and-U-S--Comm-Revenue-Guidance-to-134-YY-Crushing-Consensus-Expectations/\">$2 billion\u003c/a> in net income, after expenses, during the first half of this year. \u003c/p>\n\n\n\n\n\n\u003cp>“The core of our business, in the United States, continues to expand at an unrelenting and breakneck pace,” Karp said. \u003c/p>\n\n\n\n\u003cp>On Thursday, California lawmakers approved a bill sponsored by the California Nurses Association that would establish some guardrails in the deployment of AI in patient care. \u003c/p>\n\n\n\n\u003cp>The \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260ab1979\">bill\u003c/a>, by Assemblymember Mia Bonta, D-Oakland, would prohibit a health facility or doctor’s office from using an AI tool to perform any function that requires a professional license. Gov. Gavin Newsom is considering the proposed legislation.\u003c/p>\n\n\n\n\u003cp>Cedotal said that nurses at HCA hospitals have found the new automated staffing platform disruptive, with scheduling not always matching the needs of the day. The union contends the technology is exacerbating an understaffing crisis in the healthcare industry.\u003c/p>\n\n\n\n\u003cp>“The major concern is that humans are not involved in the equation,” said Cedotal, who has worked as a nurse for 32 years. The software “recommendations usually end up being something unfavorable for staffing or the nurses or patient care in general, or all three together.”\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1500\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED.jpg\" alt=\"\" class=\"wp-image-12097138\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/08/260827-Palantir-Nurses-04-KQED-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">Nurses block the street in Palo Alto outside the headquarters of artificial intelligence giant Palantir on Aug. 27, 2026. The actions cited the “deadly costs” of Palantir’s products, including its development and operation of ELITE, an application used by federal agents that identifies people for arrest using, in part, Medicaid data. (Courtesy of National Nurses United)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp>\u003ca href=\"https://www.hcahealthcare.com/about\">HCA Healthcare\u003c/a>, which operates about 190 hospitals in the U.S. and the United Kingdom, did not respond to a request for comment. Good Samaritan Hospital in San José is affiliated with the company.\u003c/p>\n\n\n\n\u003cp>National Nurses United, which represents more than 225,000 members nationwide with affiliates like the California Nurses Association, is getting ready to begin contract negotiations with HCA, Kaiser Permanente and other major employers. \u003c/p>\n\n\n\n\u003cp>At the protest Thursday, the union joined community groups in criticizing Palantir for profiting from the Trump administration’s push to arrest and deport thousands of immigrants, and working with Israel’s Ministry of Defense to support its war in Gaza.\u003c/p>\n\n\n\n\u003cp>“Their technology has enabled the systematic destruction of hospitals, the killing of hundreds of healthcare workers, and the collapse of Gaza’s most vital infrastructure, how can we in good conscience place that same technology at the heart of U.S. healthcare facilities?” said Aisha Nizar with the Palestinian Youth Movement, in a statement. “Our message for the Bay Area is clear: Protect patients, stop fueling genocide, and cut ties with Palantir immediately.”\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Here are the morning’s top stories for Monday, July 27, 2026: \u003c/strong>\u003c/p>\n\n\n\n\u003cul class=\"wp-block-list\">\n\u003cli>The city of Avenal in Kings County \u003ca href=\"https://www.kvpr.org/government-politics/2026-07-24/lawsuits-recalled-council-members-a-self-appointed-mayor-who-is-in-charge-in-avenal\">is facing a political power struggle\u003c/a>. Voters recently recalled four council members, but the city is disputing the election results, and the only member who wasn’t recalled now claims he is the mayor. \u003c/li>\n\n\n\n\u003cli>Health care advocates are \u003ca href=\"https://www.kcbx.org/health-science-and-technology/2026-07-22/health-advocates-urge-stronger-oversight-of-hospital-costs-in-santa-barbara-county\">calling for stronger state oversight\u003c/a> over rising hospital costs in Santa Barbara County.\u003c/li>\n\n\n\n\u003cli>A team leading the closure of L.A. County’s aging Men’s Central Jail \u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">says people will have to be held there for at least five more years\u003c/a> even though the facility was supposed to close in 2021.\u003c/li>\n\n\n\n\u003cli>A judge has convicted a man of igniting the Park Fire in 2024, the largest wildfire that year and the fourth largest in the state’s history. He’s facing up to 25 years to life in prison for what prosecutors said was him pushing a burning car into an embankment, where the fire started. \u003c/li>\n\u003c/ul>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://www.kvpr.org/government-politics/2026-07-24/lawsuits-recalled-council-members-a-self-appointed-mayor-who-is-in-charge-in-avenal\">A small Kings County community has big struggles\u003c/a>\u003c/h2>\n\n\n\n\u003cp>Arriving in Avenal, known as the “Pistachio Capital of the World,” nothing seems out of the ordinary at first. The streets are quiet. Residents are going about their daily routines, stopping at local businesses or chatting with neighbors.\u003c/p>\n\n\n\n\u003cp>The loudest sounds come from birds perched in the trees, and large pickup trucks that roll through.\u003c/p>\n\n\n\n\u003cp>But behind its small-town charm, Avenal has become the center of one of the most unusual political disputes unfolding anywhere in California. It’s a battle over city leadership that has divided residents, drawn legal scrutiny and raised questions about how local government should function.\u003c/p>\n\n\n\n\u003cp>It all started last year when elected officials in Avenal wanted to establish their \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>own fire department\u003c/u>\u003c/a>. At one point, the city was paying Kings County $425,000 each year for fire services, but last year, the county informed the city that the annual fee would increase to nearly $1.1 million.\u003c/p>\n\n\n\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Avenal officials, feeling the pinch of rising costs for fire services, ultimately pushed the city to consider creating its own fire department.\u003c/p>\n\n\n\n\u003cp>Kings County sued the City of Avenal for alleged \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">Brown Act violations\u003c/a> involving decisions made over the department. \u003c/p>\n\n\n\n\u003cp>The Registrar of Voters also certified the election results in May. Not all residents cast a vote, but of those who did, more than \u003ca href=\"https://www.kvpr.org/2026-05-29/in-avenal-four-of-five-city-councilmembers-ousted-in-citizen-led-recall-effort\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>75% voted to oust\u003c/u>\u003c/a> Mayor Alvaro Preciado and Councilmembers Leticia Gamez, David Reynosa and Pablo Hernandez.\u003c/p>\n\n\n\n\u003cp>The officials who were recalled have contested the election results, saying the election wasn’t valid because it wasn’t ordered by the city.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://www.kcbx.org/health-science-and-technology/2026-07-22/health-advocates-urge-stronger-oversight-of-hospital-costs-in-santa-barbara-county\">Stronger health care oversight in Santa Barbara County\u003c/a>\u003c/h2>\n\n\n\n\u003cp>Health care advocates are calling for stronger state oversight of hospital costs in Santa Barbara County. During a virtual town hall last week hosted by Health Access California, advocates said rising hospital prices are driving up insurance premiums, deductibles and other out-of-pocket costs for patients.\u003c/p>\n\n\n\n\u003cp>The group released a report highlighting Santa Barbara Cottage Hospital as one of seven hospitals statewide — identified by California’s Office of Health Care Affordability — as unusually expensive.\u003c/p>\n\n\n\n\u003cp>According to the report, nearly 48,000 Santa Barbara County residents report having difficulty paying medical bills. Health Access California argues that high hospital prices contribute to rising health care costs across the region.\u003c/p>\n\n\n\n\u003cp>“When hospital prices go up, that directly impacts how much people are paying for their premiums, as well as their deductibles and other cost sharing,” said Katie Van Deynze, policy and legislative advocate for Health Access California.\u003c/p>\n\n\n\n\u003cp>The report says Santa Barbara Cottage Hospital receives payments from commercial insurers that are significantly higher than Medicare reimbursement rates for the same care.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">Los Angeles jail operates longer\u003c/a>\u003c/h2>\n\n\n\n\u003cp>The team leading L.A. County’s push to close Men’s Central Jail says a full closure is not feasible in the next five years.\u003c/p>\n\n\n\n\u003cp>This is yet another delay since the county Board of Supervisors voted in July 2020 to close the jail within one year. A \u003ca href=\"https://file.lacounty.gov/SDSInter/bos/bc/1104568_DEVELO_1.PDF\" target=\"_blank\" rel=\"noreferrer noopener\">two-year \u003cu>plan\u003c/u>\u003c/a> was announced in 2021, then a \u003ca href=\"https://laist.com/news/criminal-justice/activists-frustrated-with-countys-5-year-plan-to-close-uninhabitable-mens-central-jail\">five-year plan\u003c/a> in 2024.\u003c/p>\n\n\n\n\u003cp>The Jail Closure Implementation Team, also known as JCIT, told the Board of Supervisors this week that they’ve outlined a framework that will improve conditions for thousands of people in L.A. County’s justice system, but the steps they’ve identified are still not enough to safely close the jail within the five-year timeline.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">Park Fire conviction two years after the blaze started\u003c/h2>\n\n\n\n\u003cp>A judge convicted a Northern California man last week \u003ca href=\"https://www.kqed.org/news/11998589/park-fire-is-now-4th-largest-in-california-history-and-growing-amid-dangerous-weather\">of starting the fire that destroyed hundreds of homes and burned for hundreds of miles\u003c/a>. \u003c/p>\n\n\n\n\u003cp>Known as the \u003ca href=\"https://www.kqed.org/news/tag/park-fire\">Park Fire\u003c/a>, the 2024 blaze was started by what prosecutors say was Ronnie Stout II pushing his mom’s burning car into an embankment. The fire started there, authorities said. \u003c/p>\n\n\n\n\u003cp>Stout faces 25 years to life for the crimes, with enhancements from the state’s so-called “Three Strikes Law” and for arson with special circumstances. \u003c/p>\n\n\n\n\u003cp>A witness for the state said that Stout had physically pushed the burning car he had previously been driving, though Stout’s lawyer argued that the vehicle could have been in the embankment because of its own movement. \u003c/p>\n\n\n\n\u003cp>\u003c/p>\n\u003cp>Stout is scheduled to be sentenced on Oct. 9. \u003c/p>\n\n",
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"innerHTML": "\n\u003cli>The city of Avenal in Kings County \u003ca href=\"https://www.kvpr.org/government-politics/2026-07-24/lawsuits-recalled-council-members-a-self-appointed-mayor-who-is-in-charge-in-avenal\">is facing a political power struggle\u003c/a>. Voters recently recalled four council members, but the city is disputing the election results, and the only member who wasn’t recalled now claims he is the mayor. \u003c/li>\n",
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"innerHTML": "\n\u003cli>Health care advocates are \u003ca href=\"https://www.kcbx.org/health-science-and-technology/2026-07-22/health-advocates-urge-stronger-oversight-of-hospital-costs-in-santa-barbara-county\">calling for stronger state oversight\u003c/a> over rising hospital costs in Santa Barbara County.\u003c/li>\n",
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"innerHTML": "\n\u003cli>A team leading the closure of L.A. County’s aging Men’s Central Jail \u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">says people will have to be held there for at least five more years\u003c/a> even though the facility was supposed to close in 2021.\u003c/li>\n",
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"innerHTML": "\n\u003cp>But behind its small-town charm, Avenal has become the center of one of the most unusual political disputes unfolding anywhere in California. It’s a battle over city leadership that has divided residents, drawn legal scrutiny and raised questions about how local government should function.\u003c/p>\n",
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"\n\u003cp>But behind its small-town charm, Avenal has become the center of one of the most unusual political disputes unfolding anywhere in California. It’s a battle over city leadership that has divided residents, drawn legal scrutiny and raised questions about how local government should function.\u003c/p>\n"
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"innerHTML": "\n\u003cp>It all started last year when elected officials in Avenal wanted to establish their \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>own fire department\u003c/u>\u003c/a>. At one point, the city was paying Kings County $425,000 each year for fire services, but last year, the county informed the city that the annual fee would increase to nearly $1.1 million.\u003c/p>\n",
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"\n\u003cp>It all started last year when elected officials in Avenal wanted to establish their \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>own fire department\u003c/u>\u003c/a>. At one point, the city was paying Kings County $425,000 each year for fire services, but last year, the county informed the city that the annual fee would increase to nearly $1.1 million.\u003c/p>\n"
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"innerHTML": "\n\u003cp>Avenal officials, feeling the pinch of rising costs for fire services, ultimately pushed the city to consider creating its own fire department.\u003c/p>\n",
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"innerHTML": "\n\u003cp>Kings County sued the City of Avenal for alleged \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">Brown Act violations\u003c/a> involving decisions made over the department. \u003c/p>\n",
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"\n\u003cp>Kings County sued the City of Avenal for alleged \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">Brown Act violations\u003c/a> involving decisions made over the department. \u003c/p>\n"
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"innerHTML": "\n\u003cp>The Registrar of Voters also certified the election results in May. Not all residents cast a vote, but of those who did, more than \u003ca href=\"https://www.kvpr.org/2026-05-29/in-avenal-four-of-five-city-councilmembers-ousted-in-citizen-led-recall-effort\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>75% voted to oust\u003c/u>\u003c/a> Mayor Alvaro Preciado and Councilmembers Leticia Gamez, David Reynosa and Pablo Hernandez.\u003c/p>\n",
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"\n\u003cp>The Registrar of Voters also certified the election results in May. Not all residents cast a vote, but of those who did, more than \u003ca href=\"https://www.kvpr.org/2026-05-29/in-avenal-four-of-five-city-councilmembers-ousted-in-citizen-led-recall-effort\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>75% voted to oust\u003c/u>\u003c/a> Mayor Alvaro Preciado and Councilmembers Leticia Gamez, David Reynosa and Pablo Hernandez.\u003c/p>\n"
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"innerHTML": "\n\u003cp>The officials who were recalled have contested the election results, saying the election wasn’t valid because it wasn’t ordered by the city.\u003c/p>\n",
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"text": "Stronger health care oversight in Santa Barbara County",
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"innerHTML": "\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://www.kcbx.org/health-science-and-technology/2026-07-22/health-advocates-urge-stronger-oversight-of-hospital-costs-in-santa-barbara-county\">Stronger health care oversight in Santa Barbara County\u003c/a>\u003c/h2>\n",
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"innerHTML": "\n\u003cp>Health care advocates are calling for stronger state oversight of hospital costs in Santa Barbara County. During a virtual town hall last week hosted by Health Access California, advocates said rising hospital prices are driving up insurance premiums, deductibles and other out-of-pocket costs for patients.\u003c/p>\n",
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"\n\u003cp>Health care advocates are calling for stronger state oversight of hospital costs in Santa Barbara County. During a virtual town hall last week hosted by Health Access California, advocates said rising hospital prices are driving up insurance premiums, deductibles and other out-of-pocket costs for patients.\u003c/p>\n"
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"innerHTML": "\n\u003cp>The group released a report highlighting Santa Barbara Cottage Hospital as one of seven hospitals statewide — identified by California’s Office of Health Care Affordability — as unusually expensive.\u003c/p>\n",
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"\n\u003cp>The group released a report highlighting Santa Barbara Cottage Hospital as one of seven hospitals statewide — identified by California’s Office of Health Care Affordability — as unusually expensive.\u003c/p>\n"
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"innerHTML": "\n\u003cp>According to the report, nearly 48,000 Santa Barbara County residents report having difficulty paying medical bills. Health Access California argues that high hospital prices contribute to rising health care costs across the region.\u003c/p>\n",
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"\n\u003cp>According to the report, nearly 48,000 Santa Barbara County residents report having difficulty paying medical bills. Health Access California argues that high hospital prices contribute to rising health care costs across the region.\u003c/p>\n"
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"innerHTML": "\n\u003cp>“When hospital prices go up, that directly impacts how much people are paying for their premiums, as well as their deductibles and other cost sharing,” said Katie Van Deynze, policy and legislative advocate for Health Access California.\u003c/p>\n",
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"\n\u003cp>“When hospital prices go up, that directly impacts how much people are paying for their premiums, as well as their deductibles and other cost sharing,” said Katie Van Deynze, policy and legislative advocate for Health Access California.\u003c/p>\n"
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"innerHTML": "\n\u003cp>The report says Santa Barbara Cottage Hospital receives payments from commercial insurers that are significantly higher than Medicare reimbursement rates for the same care.\u003c/p>\n",
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"\n\u003cp>The report says Santa Barbara Cottage Hospital receives payments from commercial insurers that are significantly higher than Medicare reimbursement rates for the same care.\u003c/p>\n"
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"attrs": {
"text": "Los Angeles jail operates longer",
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"innerHTML": "\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">Los Angeles jail operates longer\u003c/a>\u003c/h2>\n",
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"\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">Los Angeles jail operates longer\u003c/a>\u003c/h2>\n"
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"innerHTML": "\n\u003cp>The team leading L.A. County’s push to close Men’s Central Jail says a full closure is not feasible in the next five years.\u003c/p>\n",
"innerContent": [
"\n\u003cp>The team leading L.A. County’s push to close Men’s Central Jail says a full closure is not feasible in the next five years.\u003c/p>\n"
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"innerHTML": "\n\u003cp>This is yet another delay since the county Board of Supervisors voted in July 2020 to close the jail within one year. A \u003ca href=\"https://file.lacounty.gov/SDSInter/bos/bc/1104568_DEVELO_1.PDF\" target=\"_blank\" rel=\"noreferrer noopener\">two-year \u003cu>plan\u003c/u>\u003c/a> was announced in 2021, then a \u003ca href=\"https://laist.com/news/criminal-justice/activists-frustrated-with-countys-5-year-plan-to-close-uninhabitable-mens-central-jail\">five-year plan\u003c/a> in 2024.\u003c/p>\n",
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"\n\u003cp>This is yet another delay since the county Board of Supervisors voted in July 2020 to close the jail within one year. A \u003ca href=\"https://file.lacounty.gov/SDSInter/bos/bc/1104568_DEVELO_1.PDF\" target=\"_blank\" rel=\"noreferrer noopener\">two-year \u003cu>plan\u003c/u>\u003c/a> was announced in 2021, then a \u003ca href=\"https://laist.com/news/criminal-justice/activists-frustrated-with-countys-5-year-plan-to-close-uninhabitable-mens-central-jail\">five-year plan\u003c/a> in 2024.\u003c/p>\n"
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"innerHTML": "\n\u003cp>The Jail Closure Implementation Team, also known as JCIT, told the Board of Supervisors this week that they’ve outlined a framework that will improve conditions for thousands of people in L.A. County’s justice system, but the steps they’ve identified are still not enough to safely close the jail within the five-year timeline.\u003c/p>\n",
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"\n\u003cp>The Jail Closure Implementation Team, also known as JCIT, told the Board of Supervisors this week that they’ve outlined a framework that will improve conditions for thousands of people in L.A. County’s justice system, but the steps they’ve identified are still not enough to safely close the jail within the five-year timeline.\u003c/p>\n"
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"text": "Park Fire conviction two years after the blaze started",
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"innerHTML": "\n\u003ch2 class=\"wp-block-heading\">Park Fire conviction two years after the blaze started\u003c/h2>\n",
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"innerHTML": "\n\u003cp>A judge convicted a Northern California man last week \u003ca href=\"https://www.kqed.org/news/11998589/park-fire-is-now-4th-largest-in-california-history-and-growing-amid-dangerous-weather\">of starting the fire that destroyed hundreds of homes and burned for hundreds of miles\u003c/a>. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Known as the \u003ca href=\"https://www.kqed.org/news/tag/park-fire\">Park Fire\u003c/a>, the 2024 blaze was started by what prosecutors say was Ronnie Stout II pushing his mom’s burning car into an embankment. The fire started there, authorities said. \u003c/p>\n",
"innerContent": [
"\n\u003cp>Known as the \u003ca href=\"https://www.kqed.org/news/tag/park-fire\">Park Fire\u003c/a>, the 2024 blaze was started by what prosecutors say was Ronnie Stout II pushing his mom’s burning car into an embankment. The fire started there, authorities said. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Stout faces 25 years to life for the crimes, with enhancements from the state’s so-called “Three Strikes Law” and for arson with special circumstances. \u003c/p>\n",
"innerContent": [
"\n\u003cp>Stout faces 25 years to life for the crimes, with enhancements from the state’s so-called “Three Strikes Law” and for arson with special circumstances. \u003c/p>\n"
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"innerHTML": "\n\u003cp>A witness for the state said that Stout had physically pushed the burning car he had previously been driving, though Stout’s lawyer argued that the vehicle could have been in the embankment because of its own movement. \u003c/p>\n",
"innerContent": [
"\n\u003cp>A witness for the state said that Stout had physically pushed the burning car he had previously been driving, though Stout’s lawyer argued that the vehicle could have been in the embankment because of its own movement. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Stout is scheduled to be sentenced on Oct. 9. \u003c/p>\n",
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"excerpt": "Voters in the small Kings County city of Avenal recently recalled four council members, but the city is disputing the election results, and the only member who wasn’t recalled now claims he is the mayor.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Here are the morning’s top stories for Monday, July 27, 2026: \u003c/strong>\u003c/p>\n\n\n\n\u003cul class=\"wp-block-list\">\n\u003cli>The city of Avenal in Kings County \u003ca href=\"https://www.kvpr.org/government-politics/2026-07-24/lawsuits-recalled-council-members-a-self-appointed-mayor-who-is-in-charge-in-avenal\">is facing a political power struggle\u003c/a>. Voters recently recalled four council members, but the city is disputing the election results, and the only member who wasn’t recalled now claims he is the mayor. \u003c/li>\n\n\n\n\u003cli>Health care advocates are \u003ca href=\"https://www.kcbx.org/health-science-and-technology/2026-07-22/health-advocates-urge-stronger-oversight-of-hospital-costs-in-santa-barbara-county\">calling for stronger state oversight\u003c/a> over rising hospital costs in Santa Barbara County.\u003c/li>\n\n\n\n\u003cli>A team leading the closure of L.A. County’s aging Men’s Central Jail \u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">says people will have to be held there for at least five more years\u003c/a> even though the facility was supposed to close in 2021.\u003c/li>\n\n\n\n\u003cli>A judge has convicted a man of igniting the Park Fire in 2024, the largest wildfire that year and the fourth largest in the state’s history. He’s facing up to 25 years to life in prison for what prosecutors said was him pushing a burning car into an embankment, where the fire started. \u003c/li>\n\u003c/ul>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://www.kvpr.org/government-politics/2026-07-24/lawsuits-recalled-council-members-a-self-appointed-mayor-who-is-in-charge-in-avenal\">A small Kings County community has big struggles\u003c/a>\u003c/h2>\n\n\n\n\u003cp>Arriving in Avenal, known as the “Pistachio Capital of the World,” nothing seems out of the ordinary at first. The streets are quiet. Residents are going about their daily routines, stopping at local businesses or chatting with neighbors.\u003c/p>\n\n\n\n\u003cp>The loudest sounds come from birds perched in the trees, and large pickup trucks that roll through.\u003c/p>\n\n\n\n\u003cp>But behind its small-town charm, Avenal has become the center of one of the most unusual political disputes unfolding anywhere in California. It’s a battle over city leadership that has divided residents, drawn legal scrutiny and raised questions about how local government should function.\u003c/p>\n\n\n\n\u003cp>It all started last year when elected officials in Avenal wanted to establish their \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>own fire department\u003c/u>\u003c/a>. At one point, the city was paying Kings County $425,000 each year for fire services, but last year, the county informed the city that the annual fee would increase to nearly $1.1 million.\u003c/p>\n\n\n\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Avenal officials, feeling the pinch of rising costs for fire services, ultimately pushed the city to consider creating its own fire department.\u003c/p>\n\n\n\n\u003cp>Kings County sued the City of Avenal for alleged \u003ca href=\"https://www.kvpr.org/government-politics/2026-03-29/lives-at-stake-a-fire-department-divides-a-california-town\" target=\"_blank\" rel=\"noreferrer noopener\">Brown Act violations\u003c/a> involving decisions made over the department. \u003c/p>\n\n\n\n\u003cp>The Registrar of Voters also certified the election results in May. Not all residents cast a vote, but of those who did, more than \u003ca href=\"https://www.kvpr.org/2026-05-29/in-avenal-four-of-five-city-councilmembers-ousted-in-citizen-led-recall-effort\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cu>75% voted to oust\u003c/u>\u003c/a> Mayor Alvaro Preciado and Councilmembers Leticia Gamez, David Reynosa and Pablo Hernandez.\u003c/p>\n\n\n\n\u003cp>The officials who were recalled have contested the election results, saying the election wasn’t valid because it wasn’t ordered by the city.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://www.kcbx.org/health-science-and-technology/2026-07-22/health-advocates-urge-stronger-oversight-of-hospital-costs-in-santa-barbara-county\">Stronger health care oversight in Santa Barbara County\u003c/a>\u003c/h2>\n\n\n\n\u003cp>Health care advocates are calling for stronger state oversight of hospital costs in Santa Barbara County. During a virtual town hall last week hosted by Health Access California, advocates said rising hospital prices are driving up insurance premiums, deductibles and other out-of-pocket costs for patients.\u003c/p>\n\n\n\n\u003cp>The group released a report highlighting Santa Barbara Cottage Hospital as one of seven hospitals statewide — identified by California’s Office of Health Care Affordability — as unusually expensive.\u003c/p>\n\n\n\n\u003cp>According to the report, nearly 48,000 Santa Barbara County residents report having difficulty paying medical bills. Health Access California argues that high hospital prices contribute to rising health care costs across the region.\u003c/p>\n\n\n\n\u003cp>“When hospital prices go up, that directly impacts how much people are paying for their premiums, as well as their deductibles and other cost sharing,” said Katie Van Deynze, policy and legislative advocate for Health Access California.\u003c/p>\n\n\n\n\u003cp>The report says Santa Barbara Cottage Hospital receives payments from commercial insurers that are significantly higher than Medicare reimbursement rates for the same care.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003ca href=\"https://laist.com/news/criminal-justice/mens-central-jail-closure-beyond-2031\">Los Angeles jail operates longer\u003c/a>\u003c/h2>\n\n\n\n\u003cp>The team leading L.A. County’s push to close Men’s Central Jail says a full closure is not feasible in the next five years.\u003c/p>\n\n\n\n\u003cp>This is yet another delay since the county Board of Supervisors voted in July 2020 to close the jail within one year. A \u003ca href=\"https://file.lacounty.gov/SDSInter/bos/bc/1104568_DEVELO_1.PDF\" target=\"_blank\" rel=\"noreferrer noopener\">two-year \u003cu>plan\u003c/u>\u003c/a> was announced in 2021, then a \u003ca href=\"https://laist.com/news/criminal-justice/activists-frustrated-with-countys-5-year-plan-to-close-uninhabitable-mens-central-jail\">five-year plan\u003c/a> in 2024.\u003c/p>\n\n\n\n\u003cp>The Jail Closure Implementation Team, also known as JCIT, told the Board of Supervisors this week that they’ve outlined a framework that will improve conditions for thousands of people in L.A. County’s justice system, but the steps they’ve identified are still not enough to safely close the jail within the five-year timeline.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">Park Fire conviction two years after the blaze started\u003c/h2>\n\n\n\n\u003cp>A judge convicted a Northern California man last week \u003ca href=\"https://www.kqed.org/news/11998589/park-fire-is-now-4th-largest-in-california-history-and-growing-amid-dangerous-weather\">of starting the fire that destroyed hundreds of homes and burned for hundreds of miles\u003c/a>. \u003c/p>\n\n\n\n\u003cp>Known as the \u003ca href=\"https://www.kqed.org/news/tag/park-fire\">Park Fire\u003c/a>, the 2024 blaze was started by what prosecutors say was Ronnie Stout II pushing his mom’s burning car into an embankment. The fire started there, authorities said. \u003c/p>\n\n\n\n\u003cp>Stout faces 25 years to life for the crimes, with enhancements from the state’s so-called “Three Strikes Law” and for arson with special circumstances. \u003c/p>\n\n\n\n\u003cp>A witness for the state said that Stout had physically pushed the burning car he had previously been driving, though Stout’s lawyer argued that the vehicle could have been in the embankment because of its own movement. \u003c/p>\n\n\n\n\u003cp>\u003c/p>\n\u003cp>Stout is scheduled to be sentenced on Oct. 9. \u003c/p>\n\n\u003c/div>\u003c/p>",
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His lawyer, Roberto Escobar, said he planned to appeal.\u003c/p>\n\u003cp>Prior to his sentencing, he said he was remorseful for his actions and asked to be sentenced to home confinement. His defense counsel said he had spent three decades providing mental-health care to underserved communities in San Francisco.\u003c/p>\n\u003cp>“I was faced with a challenging situational operation, and I chose poorly,” he told Breyer. “I relied too heavily on my own judgment. At the very moment when outside input would have made a crucial difference, I failed to engage others. I also owe an apology to the patients and staff of Done.”\u003c/p>\n\u003cfigure id=\"attachment_12003275\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003275\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/USDeptofJusticeGetty-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">The U.S. Department of Justice headquarters, pictured on Sept. 5, 2024. \u003ccite>(J. David Ake/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Both will be fined $1 million, in addition to restitution to the families of victims.\u003c/p>\n\u003cp>The pair spearheaded the online mental health treatment venture to provide easy access to Adderall, Vyvanse and other stimulants. The Department of Justice alleged that they took advantage of eased restrictions on prescribing controlled substances without in-person consultations amid the COVID-19 pandemic.\u003c/p>\n\u003cp>“The defendants allegedly preyed on Americans and put profits over patients by exploiting telemedicine rules that facilitated access to medications during the unprecedented COVID-19 public health emergency,” Anne Milgram, then-administrator of the Drug Enforcement Administration, said in a statement after their arrests.\u003c/p>\n\u003cp>Since the beginning of the pandemic, the company arranged for the prescription of more than 40 million pills, according to court documents.[aside postID=news_12089481 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/260420-SCCDAANNOUNCEMENT-17-BL-KQED-1536x1024.jpg']“Instead of properly addressing medical needs, the defendants allegedly made millions of dollars by pushing addictive medications,” Milgram said.\u003c/p>\n\u003cp>According to the company’s now-defunct website, Brody \u003ca href=\"https://pitchbook.com/profiles/company/442850-23\">co-founded\u003c/a> Done Global in 2019, calling it a “passion project” to help friends and coworkers in need of mental-health care navigate a complex system.\u003c/p>\n\u003cp>The startup promoted a quick and easy process to become a monthly subscriber: members completed a one-minute assessment, followed by a telehealth appointment with a licensed clinician before paying the $79 monthly fee for “worry-free refills” and ongoing care.\u003c/p>\n\u003cp>In 2022, major pharmacies stopped filling prescriptions from prescribers at Done, and another online mental health company, Cerebral — which also came under federal investigation — after reports that some healthcare professionals felt pressured into diagnoses. In 2024, Cerebral agreed to pay more than $3.6 million “for engaging in practices that encouraged the unauthorized distribution of controlled substances” as part of a \u003ca href=\"https://www.justice.gov/usao-edny/pr/telehealth-company-cerebral-agrees-pay-over-36-million-connection-business-practices\">non-prosecution agreement\u003c/a> with the U.S. Attorney’s Office in the Eastern District of New York.\u003c/p>\n\u003cp>Done faced similar scrutiny, and according to court documents, paid medical professionals to diagnose members with attention-deficit hyperactivity disorder and write them prescriptions for Adderall and other stimulants, even when people did not qualify for the medications.\u003c/p>\n\u003cp>He and Brody, among others at the company, created policies including limiting the information available to prescribers, instructing them to issue Adderall and other stimulants even if the Done member did not qualify, and limiting appointments to under 30 minutes.\u003c/p>\n\u003cp>The Department of Justice alleged that they falsely represented their prescription policies, claiming that they were able to keep appointments short with a screening process designed to weed out people who were unlikely to qualify for a diagnosis — a factor that could have diverted Adderall from people who needed it amid a nationwide shortage that began in 2022.\u003c/p>\n\u003cp>The DOJ also claimed that the company continued to operate even after He and Brody became aware that information had been posted on social media instructing people to use Done to gain easy access to stimulants — and that some members had overdosed and died.\u003c/p>\n\u003cp>On Tuesday, Kimberly Atwood told Breyer and the court that her brother Michael had died after he was misdiagnosed by a Done provider and relapsed.\u003c/p>\n\u003cp>“I have a mistrust of doctors now,” she said.\u003c/p>\n\u003cp>\u003cem>KQED’s \u003c/em>\u003ca href=\"https://www.kqed.org/author/adahlstromeckman\">\u003cem>Azul Dahlstrom-Eckman\u003c/em>\u003c/a>\u003cem> contributed to this report. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Instead of properly addressing medical needs, the defendants allegedly made millions of dollars by pushing addictive medications,” Milgram said.\u003c/p>\n\u003cp>According to the company’s now-defunct website, Brody \u003ca href=\"https://pitchbook.com/profiles/company/442850-23\">co-founded\u003c/a> Done Global in 2019, calling it a “passion project” to help friends and coworkers in need of mental-health care navigate a complex system.\u003c/p>\n\u003cp>The startup promoted a quick and easy process to become a monthly subscriber: members completed a one-minute assessment, followed by a telehealth appointment with a licensed clinician before paying the $79 monthly fee for “worry-free refills” and ongoing care.\u003c/p>\n\u003cp>In 2022, major pharmacies stopped filling prescriptions from prescribers at Done, and another online mental health company, Cerebral — which also came under federal investigation — after reports that some healthcare professionals felt pressured into diagnoses. In 2024, Cerebral agreed to pay more than $3.6 million “for engaging in practices that encouraged the unauthorized distribution of controlled substances” as part of a \u003ca href=\"https://www.justice.gov/usao-edny/pr/telehealth-company-cerebral-agrees-pay-over-36-million-connection-business-practices\">non-prosecution agreement\u003c/a> with the U.S. Attorney’s Office in the Eastern District of New York.\u003c/p>\n\u003cp>Done faced similar scrutiny, and according to court documents, paid medical professionals to diagnose members with attention-deficit hyperactivity disorder and write them prescriptions for Adderall and other stimulants, even when people did not qualify for the medications.\u003c/p>\n\u003cp>He and Brody, among others at the company, created policies including limiting the information available to prescribers, instructing them to issue Adderall and other stimulants even if the Done member did not qualify, and limiting appointments to under 30 minutes.\u003c/p>\n\u003cp>The Department of Justice alleged that they falsely represented their prescription policies, claiming that they were able to keep appointments short with a screening process designed to weed out people who were unlikely to qualify for a diagnosis — a factor that could have diverted Adderall from people who needed it amid a nationwide shortage that began in 2022.\u003c/p>\n\u003cp>The DOJ also claimed that the company continued to operate even after He and Brody became aware that information had been posted on social media instructing people to use Done to gain easy access to stimulants — and that some members had overdosed and died.\u003c/p>\n\u003cp>On Tuesday, Kimberly Atwood told Breyer and the court that her brother Michael had died after he was misdiagnosed by a Done provider and relapsed.\u003c/p>\n\u003cp>“I have a mistrust of doctors now,” she said.\u003c/p>\n\u003cp>\u003cem>KQED’s \u003c/em>\u003ca href=\"https://www.kqed.org/author/adahlstromeckman\">\u003cem>Azul Dahlstrom-Eckman\u003c/em>\u003c/a>\u003cem> contributed to this report. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "1-in-4-covered-california-enrollees-could-get-state-aid-under-newsom-proposal",
"title": "1 in 4 Covered California Enrollees Could Get State Aid Under Newsom Proposal",
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"content": "\u003cp>When Congress allowed COVID-era subsidies for health insurance to expire, \u003ca href=\"https://www.kqed.org/news/tag/california\">California\u003c/a> used its own funds to offset the hike in Obamacare premium costs for residents with low incomes.\u003c/p>\n\u003cp>But the reach has been limited.\u003c/p>\n\u003cp>As Gov. Gavin Newsom negotiates his last budget with the legislature, the Democrat wants to offer financial help to more than 1 in 4 enrollees in Covered California, the nation’s largest state-run health insurance marketplace. Democratic lawmakers, who hold a supermajority, are still debating the plan.\u003c/p>\n\u003cp>“My budget proposal would KEEP $0 monthly plans for low-income Californians to help clean up the financial disaster Trump created,” Newsom \u003ca href=\"https://www.facebook.com/CAgovernor/posts/pfbid0D7ZbfX4NexjyjBrNuyXribDdCep4aDahzNSHaZX9g8Cnyu9MA7AaUAg99dxp7K7Sl\">posted on Facebook\u003c/a>, where he often chides the president and GOP Congress.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://stateline.org/2026/02/18/some-states-are-helping-to-make-obamacare-plans-more-affordable/\">Ten blue states\u003c/a> have put up their own funds to keep Affordable Care Act plans affordable and residents insured, as the rising cost of healthcare has emerged as a \u003ca href=\"https://www.kff.org/public-opinion/poll-the-cost-of-health-care-remains-at-the-top-of-the-publics-list-of-economic-concerns-even-as-concerns-about-gas-prices-climb/\">top concern\u003c/a> among voters. Newsom’s $300 million proposal would make California’s program among the most generous, but even the nation’s richest state can’t patch a \u003ca href=\"https://hbex.coveredca.com/data-research/library/Brief%201%20IRA%20ACA%20Premium%20Impacts%202026.pdf\">$2.5 billion hole\u003c/a> left by the expiration of enhanced subsidies at the end of last year.\u003c/p>\n\u003cp>“The gap between what people can pay in their monthly budget and what health insurance costs is so big that it’s a lot for states to take on,” said \u003ca href=\"https://www.commonwealthfund.org/person/stacey-pogue\">Stacey Pogue\u003c/a>, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. “They’re going to have to figure out how they can finance that.”\u003c/p>\n\u003cp>New Mexico lawmakers have \u003ca href=\"https://stateline.org/2026/02/18/some-states-are-helping-to-make-obamacare-plans-more-affordable/\">backfilled 100%\u003c/a> of the lost federal subsidies with state money. It seems to have worked; New Mexico saw \u003ca href=\"https://www.hca.nm.gov/2026/02/10/health-insurance-enrollment-up-in-new-mexico-amid-national-decline/\">double-digit increases\u003c/a> in marketplace enrollment this year, but state analysts \u003ca href=\"https://www.nmlegis.gov/Sessions/26%20Regular/firs/HB0004.PDF\">have warned\u003c/a> that the subsidy program isn’t sustainable.\u003c/p>\n\u003cfigure id=\"attachment_12040844\" class=\"wp-caption aligncenter\" style=\"max-width: 1760px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12040844\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn.jpg\" alt=\"\" width=\"1760\" height=\"1174\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn.jpg 1760w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-1536x1025.jpg 1536w\" sizes=\"auto, (max-width: 1760px) 100vw, 1760px\">\u003cfigcaption class=\"wp-caption-text\">Protesters gather outside Kern Medical Hospital in Bakersfield. They’re opposing proposed GOP cuts to Medicaid, which provides health insurance to lower-income Americans. \u003ccite>(Joshua Yeager/KVPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://www.wgbh.org/news/politics/2026-01-08/massachusetts-spending-250-million-to-blunt-cost-increases-from-expired-health-care-subsidies\">Massachusetts\u003c/a> and \u003ca href=\"https://newjerseymonitor.com/2026/05/20/new-jersey-healthcare-fiscal-abyss/\">New Jersey\u003c/a>, which, like California, tax residents \u003ca href=\"https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/marketplace-basics/im-uninsured-am-i-required-to-get-health-insurance/\">for not having health insurance\u003c/a>, are also spending hundreds of millions of dollars to try to keep premium payments low. Their hope, healthcare experts say, is to avoid the exodus seen in states such as Georgia that didn’t offer enrollees help.\u003c/p>\n\u003cp>Since the enhanced subsidies expired, \u003ca href=\"https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/\">enrollees nationwide\u003c/a> have seen their premium payments increase by $65 a month on average.\u003c/p>\n\u003cp>Conservatives, including \u003ca href=\"https://www.ocregister.com/2026/01/13/insurance-company-subsidies-are-no-prescription-for-lowering-healthcare-costs/\">congressional Republicans\u003c/a>, have long argued that the subsidy expansion was too generous to high-income enrollees and \u003ca href=\"https://www.facebook.com/reel/25473637075567865\">inflated healthcare costs\u003c/a>.\u003c/p>\n\u003cp>“There are never enough subsidies to make health insurance affordable because subsidies are the problem,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute. “They are causing people to turn a blind eye to fraud and waste and excessive prices because it’s someone else’s money that they’re spending, not their own.”\u003c/p>\n\u003ch2>Helping the poorest?\u003c/h2>\n\u003cp>People who earn too much to qualify for Medicaid got relief starting in January after Newsom and legislators softened the blow for about 300,000 of the lowest-income enrollees. They offset lost federal premium tax credits for individuals who \u003ca href=\"https://board.coveredca.com/meetings/2026/May%2021,%202026/Presentation_2027_State_Premium_Subsidy_Program_Design.pdf\">earned up to $23,475\u003c/a> last year and partially filled the gap for those who earned up to $25,823.\u003c/p>\n\u003cp>The governor now wants to expand subsidies to those who earn up to $31,920 this year for an individual and $66,000 for a family of four — an estimated 218,000 additional people.\u003c/p>\n\u003cp>Veronica and William Walter, who live in the San Francisco Bay Area, earn less than $40,000 a year in one of the nation’s most expensive regions. They’re counting on a more generous state healthcare tax credit if they have to pay for health insurance next year.\u003c/p>\n\u003cfigure id=\"attachment_12086988\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12086988\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2.jpg\" alt=\"\" width=\"2000\" height=\"1500\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Veronica Walter talks through her financial challenges while sitting at the dining table in her two-bedroom condo in Newark, California. Walter says she wouldn’t be able to afford the nearly $200 monthly premium for health insurance that she and her husband would likely pay on Covered California, even after a proposed expansion of state subsidies. \u003ccite>(Christine Mai-Duc/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A car accident two years ago left William temporarily disabled, qualifying the couple for Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>Now he’s back at work as a security guard, and Veronica said she’s worried they’ll be kicked off Medi-Cal. She’s even more worried about how they’ll get by with federal premium tax credits not nearly as generous as before.\u003c/p>\n\u003cp>“Without it, we’re going to be facing worse problems than we have now,” she said. Under Newsom’s proposal, Veronica and others in the highest eligible income bracket could receive an average monthly subsidy of $36 a person.[aside postID=news_12084761 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/IMG_1522.jpg']“For them, $36 a month is the sort of thing that can make a difference between keeping coverage and losing coverage,” said Peter Lee, former executive director of Covered California. “We can’t fix everything with that gap, but we can focus the dollars on those who need it most.”\u003c/p>\n\u003cp>The Walter family, though, may still face a nearly $200 monthly premium payment to cover both of them, $130 more than they previously paid for healthcare and prescriptions through Covered California.\u003c/p>\n\u003cp>“I can’t afford that, not really,” said Veronica, a pet sitter who works part-time at a school. “A giant state like this with this many people, and this many resources? You can’t just leave the people with nothing for healthcare or healthcare they can’t afford.”\u003c/p>\n\u003cp>California policy researchers and health advocates acknowledge the limits of a partial subsidy but say that concentrating funds on those who earn less is the most efficient way to maximize impact. People who drop coverage are \u003ca href=\"https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/#:~:text=Declines%20in%20plan%20sign%2Dups%20for%20young%20adults%20ages%2018%20to%2034%20account%20for%20more%20of%20the%20decrease%20in%20ACA%20Marketplace%20plan%20selections%20than%20any%20other%20age%20group.\">often younger\u003c/a>, healthier, and less likely to have high healthcare costs — all factors that help stabilize the insurance risk pool. Without coverage, Lee said, they’re also more likely to experience debt from medical emergencies or leave unpaid hospital bills that strain the \u003ca href=\"https://lao.ca.gov/Publications/Report/5180\">taxpayer-funded safety net\u003c/a>.\u003c/p>\n\u003cp>Cary Sanders, senior policy director at the California Pan-Ethnic Health Network, a health advocacy group, said the state’s move last year kept low-income enrollment in Covered California steady and reduced racial disparities in coverage.\u003c/p>\n\u003cp>“It’s working; it’s just that it’s not enough,” Sanders said. “We need the federal subsidies back.”\u003c/p>\n\u003ch2>Still no help for many\u003c/h2>\n\u003cp>When Congress passed enhanced subsidies in 2021, it capped monthly premium payments for \u003ca href=\"https://kffhealthnews.org/health-industry/obamacare-premiums-subsidies-trump-republicans-policy-fallout-kff-analysis/\">even the highest earners\u003c/a> at 8.5% of income. Those temporary enhancements allowed about 8 million Americans to choose robust plans with no monthly premium payment last year and helped double Obamacare enrollment to \u003ca href=\"https://www.kff.org/affordable-care-act/enrollment-growth-in-the-aca-marketplaces/\">an all-time high\u003c/a> of 24 million.\u003c/p>\n\u003cp>At the end of last year, 22 million of them lost that help when the GOP Congress blocked the extension.\u003c/p>\n\u003cp>The pressures on Obamacare enrollees don’t stop at premiums. Federal legislation Republicans passed last summer, known as the \u003ca href=\"https://dmhc.ca.gov/Portals/0/Docs/OFR/FSSB/Feb2026/CoveredCaliforniaUpdate.pdf#page=11\">One Big Beautiful Bill Act\u003c/a>, also shortens enrollment windows, tightens income verification requirements for subsidies, and requires enrollees who earn more than they projected to pay back the full amount.\u003c/p>\n\u003cfigure id=\"attachment_12052592\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12052592\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign.jpg\" alt=\"Una persona camina sobre la acera, a lado del patio de una casa donde está el letrero de Covered California.\" width=\"2000\" height=\"1232\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign-160x99.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign-1536x946.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Carteles de Covered California en Berkeley el 13 de enero de 2017. A partir del 31 de agosto, los beneficiarios de DACA ya no podrán encontrar planes de salud a través de Covered California. Hay algunas opciones limitadas disponibles. \u003ccite>(Lea Suzuki/The San Francisco Chronicle vía Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even if Newsom’s proposal passes, most Covered California customers won’t get state help. Nearly 1 million enrollees — 52% — earn above the $31,300-a-year individual earning cutoff.\u003c/p>\n\u003cp>Victoria Garzouzi was one of many \u003ca href=\"https://kffhealthnews.org/health-care-costs/insurance-premium-payments-terminal-diagnosis-aca-subsidies-covered-california/\">middle-income retirees\u003c/a> hit with one of the most extreme premium increases: The monthly payment for her low-level bronze plan jumped eightfold to $1,600.\u003c/p>\n\u003cp>To make ends meet, she came out of retirement and dipped into her savings. “I’m working to pay for my insurance,” she said. “I am an army of one.”\u003c/p>\n\u003cp>Despite a $6,000 deductible, her health insurance premium payment is more than the mortgage on her two-bedroom house. She’s putting off a needed cataract surgery until October, when she turns 65 and qualifies for Medicare.\u003c/p>\n\u003cp>While GOP leaders have not publicly weighed in on the state subsidies, some Democratic lawmakers have questioned why more help hasn’t been proposed.[aside postID=news_12086370 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/MBC-profile-view-with-driver.jpg']Assembly member Dawn Addis, who chairs the chamber’s budget subcommittee on health, suggested Newsom could tap an additional $230 million from a fund for healthcare cost relief — money raised from a state penalty levied on those who can afford to enroll in health insurance but choose not to.\u003c/p>\n\u003cp>Lawmakers have \u003ca href=\"https://kffhealthnews.org/health-care-costs/california-stockpiles-penalties-from-uninsured-residents-instead-of-lowering-care-costs/\">previously criticized state officials\u003c/a> for socking away much of the penalty revenue, which was supposed to go toward healthcare affordability. After California discontinued its premium subsidies thanks to increased federal assistance, the Newsom administration said the state was saving to help consumers once those temporary subsidies expired. Instead, California borrowed from the subsidy fund to cover state budget shortfalls, to the tune of $771 million. Starting this year, the subsidy fund should see an influx of cash as the state pays back the loan.\u003c/p>\n\u003cp>At a May legislative hearing, Joseph Donaldson, then a Department of Finance analyst, said maintaining the reserve was a prudent and financially sustainable approach.\u003c/p>\n\u003cp>Dylan Roby, a public health professor at the University of California-Irvine who consults for Covered California, said the focus on lower-income enrollees is deliberate. They qualify for federal subsidies that higher earners don’t, maximizing federal investment and strengthening the broader system.\u003c/p>\n\u003cp>“You end up with more advanced premium tax credits flowing into the state that you would have been leaving on the table,” he said.\u003c/p>\n\u003cp>State lawmakers have until June 15 to pass a state budget. Then, Covered California’s board would decide eligibility and benefit amounts, a decision that could come this summer, with new subsidies starting Jan. 1.\u003c/p>\n\u003cp>Even with the extra help, Walter and her husband worry they won’t be able to afford a potential $200 monthly premium payment. Walter said she’d likely have to rely on free clinics or ration medications.\u003c/p>\n\u003cp>“I take so many pills, I rattle,” she said. “That, on top of the $200? For us, it really adds up.”\u003c/p>\n\u003cp>\u003cem>Are you struggling to afford your health insurance? Have you decided to forgo coverage? \u003c/em>\u003ca href=\"https://kffhealthnews.org/help-us-report-on-rising-insurance-costs/\">\u003cem>Click here\u003c/em>\u003c/a>\u003cem> to contact KFF Health News and share your story.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://kffhealthnews.org/about-us/\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at\u003c/em> \u003ca href=\"https://www.kff.org/about-us/\">\u003cem>KFF\u003c/em>\u003c/a>\u003cem> — the independent source for health policy research, polling, and journalism.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "California is considering expanding financial help for low-income residents struggling to pay high health insurance premiums after losing federal subsidies. But relief for state marketplace customers will be limited. Here’s who may get help and what it could mean for premiums.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Congress allowed COVID-era subsidies for health insurance to expire, \u003ca href=\"https://www.kqed.org/news/tag/california\">California\u003c/a> used its own funds to offset the hike in Obamacare premium costs for residents with low incomes.\u003c/p>\n\u003cp>But the reach has been limited.\u003c/p>\n\u003cp>As Gov. Gavin Newsom negotiates his last budget with the legislature, the Democrat wants to offer financial help to more than 1 in 4 enrollees in Covered California, the nation’s largest state-run health insurance marketplace. Democratic lawmakers, who hold a supermajority, are still debating the plan.\u003c/p>\n\u003cp>“My budget proposal would KEEP $0 monthly plans for low-income Californians to help clean up the financial disaster Trump created,” Newsom \u003ca href=\"https://www.facebook.com/CAgovernor/posts/pfbid0D7ZbfX4NexjyjBrNuyXribDdCep4aDahzNSHaZX9g8Cnyu9MA7AaUAg99dxp7K7Sl\">posted on Facebook\u003c/a>, where he often chides the president and GOP Congress.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://stateline.org/2026/02/18/some-states-are-helping-to-make-obamacare-plans-more-affordable/\">Ten blue states\u003c/a> have put up their own funds to keep Affordable Care Act plans affordable and residents insured, as the rising cost of healthcare has emerged as a \u003ca href=\"https://www.kff.org/public-opinion/poll-the-cost-of-health-care-remains-at-the-top-of-the-publics-list-of-economic-concerns-even-as-concerns-about-gas-prices-climb/\">top concern\u003c/a> among voters. Newsom’s $300 million proposal would make California’s program among the most generous, but even the nation’s richest state can’t patch a \u003ca href=\"https://hbex.coveredca.com/data-research/library/Brief%201%20IRA%20ACA%20Premium%20Impacts%202026.pdf\">$2.5 billion hole\u003c/a> left by the expiration of enhanced subsidies at the end of last year.\u003c/p>\n\u003cp>“The gap between what people can pay in their monthly budget and what health insurance costs is so big that it’s a lot for states to take on,” said \u003ca href=\"https://www.commonwealthfund.org/person/stacey-pogue\">Stacey Pogue\u003c/a>, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. “They’re going to have to figure out how they can finance that.”\u003c/p>\n\u003cp>New Mexico lawmakers have \u003ca href=\"https://stateline.org/2026/02/18/some-states-are-helping-to-make-obamacare-plans-more-affordable/\">backfilled 100%\u003c/a> of the lost federal subsidies with state money. It seems to have worked; New Mexico saw \u003ca href=\"https://www.hca.nm.gov/2026/02/10/health-insurance-enrollment-up-in-new-mexico-amid-national-decline/\">double-digit increases\u003c/a> in marketplace enrollment this year, but state analysts \u003ca href=\"https://www.nmlegis.gov/Sessions/26%20Regular/firs/HB0004.PDF\">have warned\u003c/a> that the subsidy program isn’t sustainable.\u003c/p>\n\u003cfigure id=\"attachment_12040844\" class=\"wp-caption aligncenter\" style=\"max-width: 1760px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12040844\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn.jpg\" alt=\"\" width=\"1760\" height=\"1174\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn.jpg 1760w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/05/npr.brightspotcdn-1536x1025.jpg 1536w\" sizes=\"auto, (max-width: 1760px) 100vw, 1760px\">\u003cfigcaption class=\"wp-caption-text\">Protesters gather outside Kern Medical Hospital in Bakersfield. They’re opposing proposed GOP cuts to Medicaid, which provides health insurance to lower-income Americans. \u003ccite>(Joshua Yeager/KVPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://www.wgbh.org/news/politics/2026-01-08/massachusetts-spending-250-million-to-blunt-cost-increases-from-expired-health-care-subsidies\">Massachusetts\u003c/a> and \u003ca href=\"https://newjerseymonitor.com/2026/05/20/new-jersey-healthcare-fiscal-abyss/\">New Jersey\u003c/a>, which, like California, tax residents \u003ca href=\"https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/marketplace-basics/im-uninsured-am-i-required-to-get-health-insurance/\">for not having health insurance\u003c/a>, are also spending hundreds of millions of dollars to try to keep premium payments low. Their hope, healthcare experts say, is to avoid the exodus seen in states such as Georgia that didn’t offer enrollees help.\u003c/p>\n\u003cp>Since the enhanced subsidies expired, \u003ca href=\"https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/\">enrollees nationwide\u003c/a> have seen their premium payments increase by $65 a month on average.\u003c/p>\n\u003cp>Conservatives, including \u003ca href=\"https://www.ocregister.com/2026/01/13/insurance-company-subsidies-are-no-prescription-for-lowering-healthcare-costs/\">congressional Republicans\u003c/a>, have long argued that the subsidy expansion was too generous to high-income enrollees and \u003ca href=\"https://www.facebook.com/reel/25473637075567865\">inflated healthcare costs\u003c/a>.\u003c/p>\n\u003cp>“There are never enough subsidies to make health insurance affordable because subsidies are the problem,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute. “They are causing people to turn a blind eye to fraud and waste and excessive prices because it’s someone else’s money that they’re spending, not their own.”\u003c/p>\n\u003ch2>Helping the poorest?\u003c/h2>\n\u003cp>People who earn too much to qualify for Medicaid got relief starting in January after Newsom and legislators softened the blow for about 300,000 of the lowest-income enrollees. They offset lost federal premium tax credits for individuals who \u003ca href=\"https://board.coveredca.com/meetings/2026/May%2021,%202026/Presentation_2027_State_Premium_Subsidy_Program_Design.pdf\">earned up to $23,475\u003c/a> last year and partially filled the gap for those who earned up to $25,823.\u003c/p>\n\u003cp>The governor now wants to expand subsidies to those who earn up to $31,920 this year for an individual and $66,000 for a family of four — an estimated 218,000 additional people.\u003c/p>\n\u003cp>Veronica and William Walter, who live in the San Francisco Bay Area, earn less than $40,000 a year in one of the nation’s most expensive regions. They’re counting on a more generous state healthcare tax credit if they have to pay for health insurance next year.\u003c/p>\n\u003cfigure id=\"attachment_12086988\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12086988\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2.jpg\" alt=\"\" width=\"2000\" height=\"1500\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/06/PricedOutCA2-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Veronica Walter talks through her financial challenges while sitting at the dining table in her two-bedroom condo in Newark, California. Walter says she wouldn’t be able to afford the nearly $200 monthly premium for health insurance that she and her husband would likely pay on Covered California, even after a proposed expansion of state subsidies. \u003ccite>(Christine Mai-Duc/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A car accident two years ago left William temporarily disabled, qualifying the couple for Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>Now he’s back at work as a security guard, and Veronica said she’s worried they’ll be kicked off Medi-Cal. She’s even more worried about how they’ll get by with federal premium tax credits not nearly as generous as before.\u003c/p>\n\u003cp>“Without it, we’re going to be facing worse problems than we have now,” she said. Under Newsom’s proposal, Veronica and others in the highest eligible income bracket could receive an average monthly subsidy of $36 a person.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“For them, $36 a month is the sort of thing that can make a difference between keeping coverage and losing coverage,” said Peter Lee, former executive director of Covered California. “We can’t fix everything with that gap, but we can focus the dollars on those who need it most.”\u003c/p>\n\u003cp>The Walter family, though, may still face a nearly $200 monthly premium payment to cover both of them, $130 more than they previously paid for healthcare and prescriptions through Covered California.\u003c/p>\n\u003cp>“I can’t afford that, not really,” said Veronica, a pet sitter who works part-time at a school. “A giant state like this with this many people, and this many resources? You can’t just leave the people with nothing for healthcare or healthcare they can’t afford.”\u003c/p>\n\u003cp>California policy researchers and health advocates acknowledge the limits of a partial subsidy but say that concentrating funds on those who earn less is the most efficient way to maximize impact. People who drop coverage are \u003ca href=\"https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/#:~:text=Declines%20in%20plan%20sign%2Dups%20for%20young%20adults%20ages%2018%20to%2034%20account%20for%20more%20of%20the%20decrease%20in%20ACA%20Marketplace%20plan%20selections%20than%20any%20other%20age%20group.\">often younger\u003c/a>, healthier, and less likely to have high healthcare costs — all factors that help stabilize the insurance risk pool. Without coverage, Lee said, they’re also more likely to experience debt from medical emergencies or leave unpaid hospital bills that strain the \u003ca href=\"https://lao.ca.gov/Publications/Report/5180\">taxpayer-funded safety net\u003c/a>.\u003c/p>\n\u003cp>Cary Sanders, senior policy director at the California Pan-Ethnic Health Network, a health advocacy group, said the state’s move last year kept low-income enrollment in Covered California steady and reduced racial disparities in coverage.\u003c/p>\n\u003cp>“It’s working; it’s just that it’s not enough,” Sanders said. “We need the federal subsidies back.”\u003c/p>\n\u003ch2>Still no help for many\u003c/h2>\n\u003cp>When Congress passed enhanced subsidies in 2021, it capped monthly premium payments for \u003ca href=\"https://kffhealthnews.org/health-industry/obamacare-premiums-subsidies-trump-republicans-policy-fallout-kff-analysis/\">even the highest earners\u003c/a> at 8.5% of income. Those temporary enhancements allowed about 8 million Americans to choose robust plans with no monthly premium payment last year and helped double Obamacare enrollment to \u003ca href=\"https://www.kff.org/affordable-care-act/enrollment-growth-in-the-aca-marketplaces/\">an all-time high\u003c/a> of 24 million.\u003c/p>\n\u003cp>At the end of last year, 22 million of them lost that help when the GOP Congress blocked the extension.\u003c/p>\n\u003cp>The pressures on Obamacare enrollees don’t stop at premiums. Federal legislation Republicans passed last summer, known as the \u003ca href=\"https://dmhc.ca.gov/Portals/0/Docs/OFR/FSSB/Feb2026/CoveredCaliforniaUpdate.pdf#page=11\">One Big Beautiful Bill Act\u003c/a>, also shortens enrollment windows, tightens income verification requirements for subsidies, and requires enrollees who earn more than they projected to pay back the full amount.\u003c/p>\n\u003cfigure id=\"attachment_12052592\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12052592\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign.jpg\" alt=\"Una persona camina sobre la acera, a lado del patio de una casa donde está el letrero de Covered California.\" width=\"2000\" height=\"1232\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign-160x99.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/08/Covered-CA-lawn-sign-1536x946.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Carteles de Covered California en Berkeley el 13 de enero de 2017. A partir del 31 de agosto, los beneficiarios de DACA ya no podrán encontrar planes de salud a través de Covered California. Hay algunas opciones limitadas disponibles. \u003ccite>(Lea Suzuki/The San Francisco Chronicle vía Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even if Newsom’s proposal passes, most Covered California customers won’t get state help. Nearly 1 million enrollees — 52% — earn above the $31,300-a-year individual earning cutoff.\u003c/p>\n\u003cp>Victoria Garzouzi was one of many \u003ca href=\"https://kffhealthnews.org/health-care-costs/insurance-premium-payments-terminal-diagnosis-aca-subsidies-covered-california/\">middle-income retirees\u003c/a> hit with one of the most extreme premium increases: The monthly payment for her low-level bronze plan jumped eightfold to $1,600.\u003c/p>\n\u003cp>To make ends meet, she came out of retirement and dipped into her savings. “I’m working to pay for my insurance,” she said. “I am an army of one.”\u003c/p>\n\u003cp>Despite a $6,000 deductible, her health insurance premium payment is more than the mortgage on her two-bedroom house. She’s putting off a needed cataract surgery until October, when she turns 65 and qualifies for Medicare.\u003c/p>\n\u003cp>While GOP leaders have not publicly weighed in on the state subsidies, some Democratic lawmakers have questioned why more help hasn’t been proposed.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Assembly member Dawn Addis, who chairs the chamber’s budget subcommittee on health, suggested Newsom could tap an additional $230 million from a fund for healthcare cost relief — money raised from a state penalty levied on those who can afford to enroll in health insurance but choose not to.\u003c/p>\n\u003cp>Lawmakers have \u003ca href=\"https://kffhealthnews.org/health-care-costs/california-stockpiles-penalties-from-uninsured-residents-instead-of-lowering-care-costs/\">previously criticized state officials\u003c/a> for socking away much of the penalty revenue, which was supposed to go toward healthcare affordability. After California discontinued its premium subsidies thanks to increased federal assistance, the Newsom administration said the state was saving to help consumers once those temporary subsidies expired. Instead, California borrowed from the subsidy fund to cover state budget shortfalls, to the tune of $771 million. Starting this year, the subsidy fund should see an influx of cash as the state pays back the loan.\u003c/p>\n\u003cp>At a May legislative hearing, Joseph Donaldson, then a Department of Finance analyst, said maintaining the reserve was a prudent and financially sustainable approach.\u003c/p>\n\u003cp>Dylan Roby, a public health professor at the University of California-Irvine who consults for Covered California, said the focus on lower-income enrollees is deliberate. They qualify for federal subsidies that higher earners don’t, maximizing federal investment and strengthening the broader system.\u003c/p>\n\u003cp>“You end up with more advanced premium tax credits flowing into the state that you would have been leaving on the table,” he said.\u003c/p>\n\u003cp>State lawmakers have until June 15 to pass a state budget. Then, Covered California’s board would decide eligibility and benefit amounts, a decision that could come this summer, with new subsidies starting Jan. 1.\u003c/p>\n\u003cp>Even with the extra help, Walter and her husband worry they won’t be able to afford a potential $200 monthly premium payment. Walter said she’d likely have to rely on free clinics or ration medications.\u003c/p>\n\u003cp>“I take so many pills, I rattle,” she said. “That, on top of the $200? For us, it really adds up.”\u003c/p>\n\u003cp>\u003cem>Are you struggling to afford your health insurance? Have you decided to forgo coverage? \u003c/em>\u003ca href=\"https://kffhealthnews.org/help-us-report-on-rising-insurance-costs/\">\u003cem>Click here\u003c/em>\u003c/a>\u003cem> to contact KFF Health News and share your story.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://kffhealthnews.org/about-us/\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at\u003c/em> \u003ca href=\"https://www.kff.org/about-us/\">\u003cem>KFF\u003c/em>\u003c/a>\u003cem> — the independent source for health policy research, polling, and journalism.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "retiring-savings-retirement-planning-california-bay-area",
"title": "Didn’t Save Enough for Retirement? Here’s How to Afford Aging in the Bay Area",
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"headTitle": "Didn’t Save Enough for Retirement? Here’s How to Afford Aging in the Bay Area | KQED",
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"content": "\u003cp>\u003cem>This story is part of \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>How We Get By\u003c/em>\u003c/a>\u003cem>, a KQED series exploring how people are coping with rising costs in the Bay Area and California. Find the \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>full series here\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>At 74, Teresa Chan is still working.\u003c/p>\n\u003cp>When she started thinking about retirement about a decade ago, Chan realized that financially, she still didn’t feel ready to live without a regular income. “I did not prepare,” she said. “I had no money. If I had money, I would have bought a home, but that was not possible.”\u003c/p>\n\u003cp>For more than 30 years, Chan has worked in various administrative jobs in San Francisco — most recently in a remote data entry role. Through it all, paying rent and healthcare — for her family, as well as herself— were always her biggest expenses.\u003c/p>\n\u003cp>“I had nothing to save after paying my bills,” she said, even with her Social Security benefits, which she began receiving at 66 after she reached full retirement age.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Last year, Chan moved from San Francisco to an apartment in Contra Costa County to save on housing costs. And she doesn’t plan to ever stop working. It’s her best way to support herself and hopefully save enough to one day visit her mother — who is now in her 90s — in Hong Kong, she said.\u003c/p>\n\u003cp>“While I can still have the job, then I want to work,” Chan said, although she said that she wishes she had another option. “Maybe I’ll quit if I win the lottery.”\u003c/p>\n\u003cfigure id=\"attachment_11953002\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11953002\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED.jpg\" alt=\"A woman with white hair and a warm coat picks through a huge box of ears of corn in a paved outdoor area where lots of other people are also circulating.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Volunteers distribute food items at a San Francisco-Marin Food Bank pop-up pantry in the Richmond District of San Francisco on June 13, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Chan is not alone. According to federal data from the \u003ca href=\"https://www.gao.gov/financial-security-older-americans\">Government Accountability Office\u003c/a> (GAO), about half of households nationwide with a worker aged 55 or older had no retirement savings. And like her, more seniors are \u003ca href=\"https://www.gao.gov/blog/older-americans-are-working-longer-how-do-we-support-them\">staying in the workforce longer\u003c/a>, downsizing and depending more than ever on family and social services to meet essential needs.\u003c/p>\n\u003cp>But if you’re already approaching your 60s and don’t have much saved, what options are available for potentially changing that?\u003c/p>\n\u003cp>KQED reached out to financial advisers and groups that serve seniors to better understand what older adults with fewer savings in the Bay Area are doing to make retirement possible.\u003c/p>\n\u003ch2>In the Bay Area, inequalities before and after retirement\u003c/h2>\n\u003cp>Planning for retirement is even more difficult for low-income older adults — \u003ca href=\"https://www.gao.gov/assets/gao-23-105342.pdf\">only 15%\u003c/a> of this group report having anything saved at all.\u003c/p>\n\u003cp>The GAO also found that \u003ca href=\"https://www.gao.gov/assets/gao-23-105342.pdf\">lower-income workers are effectively shut out\u003c/a> from workplace retirement accounts, such as 401(k)s. By contrast, higher earners consistently have greater access to these kinds of accounts and usually receive larger employer contributions.\u003c/p>\n\u003cp>And the Bay Area’s high cost of living makes preparing for retirement even more complicated, said Vanessa Merlano Sittauer, director of Santa Clara County’s Department of Aging and Adult Services. “We need to talk about retirement [in] the greater context of what it’s like to live in a place like the Bay Area,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11986980\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11986980 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut.jpg\" alt=\"\" width=\"1920\" height=\"1446\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-800x603.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-1020x768.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-160x121.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-1536x1157.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">People gathered at a rally on May 20, 2024, in support of a San Francisco proposal to expand funding for affordable housing for seniors and others with low incomes. \u003ccite>(Joe Fitzgerald Rodriguez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Sittauer points to data from the research publication \u003ca href=\"https://jointventure.org/images/stories/pdf/index2026-jvsv.pdf\">Silicon Valley Index\u003c/a> that shows that more that 40% of renters ages 18-64 across the South Bay and the Peninsula are severely rent burdened — meaning that at least half of their monthly income pays housing costs. For residents older than 65, that number climbs to 67%.\u003c/p>\n\u003cp>But if living in the Bay Area means spending more on housing — along with \u003ca href=\"https://www.kqed.org/news/12075761/when-child-care-costs-half-a-paycheck-bay-area-parents-must-choose-kids-or-career\">childcare\u003c/a>, \u003ca href=\"https://www.kqed.org/news/12081471/driving-in-the-bay-area-is-essential-for-many-its-only-gotten-more-expensive\">transportation\u003c/a>, \u003ca href=\"https://www.kqed.org/news/12082251/after-the-one-big-beautiful-bill-free-clinics-are-stepping-up\">healthcare\u003c/a> and almost everything else — younger people \u003ca href=\"https://www.reddit.com/r/AskSF/comments/1t5or0s/retirement_in_sf_as_a_lifelong_renter_whats_the\">are asking\u003c/a> if it’s even \u003cem>possible \u003c/em>to retire here when not much is left over at the end of every month.\u003c/p>\n\u003ch2>What does retirement planning with less time look like?\u003c/h2>\n\u003cp>Starting to plan for retirement in your 50s can feel overwhelming, said Matt Gellene, head of Specialized Consumer Client Solutions for Bank of America. “But the first and most important step is to be honest about your full financial picture,” he said.\u003c/p>\n\u003cp>“Take a full inventory: what you have saved, what you owe, what you expect from Social Security, and what you want retirement to look like,” he said.\u003c/p>\n\u003ch2>Plan out your spending — and debt payments\u003c/h2>\n\u003cp>Think carefully about the debt you have \u003cem>now\u003c/em>, Gellene said. “High-interest debt can erode retirement readiness faster than many people realize,” he said. “Paying down that debt in the years before retirement reduces the monthly income you’ll need to cover fixed costs once you stop working.”\u003c/p>\n\u003cp>Even setting a realistic monthly budget now that limits lifestyle expenses can help down the road. Many Bay Area public libraries offer \u003ca href=\"https://advisersgiveback.org/sf-library/\">free workshops with financial advisers\u003c/a> who can help you figure out what you can start cutting back on now.\u003c/p>\n\u003cfigure id=\"attachment_11946480\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946480 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-scaled-e1779405949186.jpg\" alt=\"A woman sits at her kitchen table and sifts through documents, looking concerned. Next to her is her opened laptop.\" width=\"2000\" height=\"1334\">\u003cfigcaption class=\"wp-caption-text\">According to federal data from the Government Accountability Office (GAO), about half of households nationwide with a worker aged 55 or older had no retirement savings. \u003ccite>(MoMo Productions/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>United Way Bay Area, known by many in the region for its\u003ca href=\"https://www.kqed.org/news/11909786/how-to-find-free-tax-help-near-you-and-prepare-everything-you-need-for-your-appointment\"> free tax filing services\u003c/a>, also runs a network of free financial coaching centers known as \u003ca href=\"https://uwba.org/what-we-do/sparkpoint-program/\">SparkPoint\u003c/a>.\u003c/p>\n\u003cp>There are centers in San Francisco, Alameda, Contra Costa, San Mateo and Marin counties, where financial coaches can help with making plans to achieve long-term goals like reducing debt and growing savings.\u003c/p>\n\u003ch2>Know your options if you need to continue working\u003c/h2>\n\u003cp>Seniors who feel they are not ready to leave the workforce but are looking for a job with more flexibility can also contact \u003ca href=\"https://www.selfhelpelderly.org/\">Self-Help for the Elderly\u003c/a>, a nonprofit organization that provides seniors in San Francisco, Santa Clara and San Mateo counties with housing, food and other social services.\u003c/p>\n\u003cp>“We train older workers as home health aides, housekeepers and restaurant workers,” CEO Anni Chung said. Seniors who are trained as housekeepers, for example, can work a few hours a week for several different clients. Multiple trainings for \u003ca href=\"https://www.selfhelpelderly.org/our-services/employment-services/job-placements-and-employment-training\">this older worker program\u003c/a> are held throughout the year.\u003c/p>\n\u003ch2>Remember healthcare costs\u003c/h2>\n\u003cp>Another huge retirement expense to consider is healthcare costs. Seniors with Medicare may still have to pay monthly premiums and deductibles, depending on what coverage plan they sign up for. Medicare Part A, which does not charge monthly premiums and covers major hospital bills, \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles\">still comes with deductibles\u003c/a> that beneficiaries pay if they are admitted to the hospital.\u003c/p>\n\u003cp>Other Medicare options can cover additional medical expenses, like lab tests and medication, but those plans come with monthly premiums. And researchers have found that out-of-pocket healthcare expenses increase significantly \u003ca href=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC3614143/\">for Medicare recipients\u003c/a> in the last years of life, and most individuals are considered \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2686318\">high-need, high-cost patients\u003c/a> prior to death.\u003c/p>\n\u003cfigure id=\"attachment_12058933\" class=\"wp-caption aligncenter\" style=\"max-width: 1829px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12058933 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed.jpg\" alt=\"\" width=\"1829\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed.jpg 1829w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed-160x117.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed-1536x1119.jpg 1536w\" sizes=\"auto, (max-width: 1829px) 100vw, 1829px\">\u003cfigcaption class=\"wp-caption-text\">Protestors carry signs as they demonstrate against proposed cuts to Medi-Cal and Medicare outside San Francisco city hall on Sept. 21, 2011, in San Francisco, California. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>You can start preparing for medical expenses now with a health savings account, or HSA. This kind of savings account “offers what we call triple tax savings,” said Gellene from Bank of America. “Your money goes in pre-tax, it can grow tax-free if you invest it and you can withdraw it tax-free for qualified medical expenses.”\u003c/p>\n\u003cp>And if you can save a little more in the next few years, there may still be some options to make what you have grow. If you have one, Gellene recommends maxing out your 401(k) — that is, contributing as much as the IRS allows you to — especially if your employer offers a match.\u003c/p>\n\u003cp>“That’s essentially free money, and you don’t want to leave any of it on the table,” he said.\u003c/p>\n\u003ch2>Think about where you’ll live\u003c/h2>\n\u003cp>At a recent \u003ca href=\"https://www.instagram.com/p/DWlMAlHFX9N/\">affordable housing fair\u003c/a> in San Francisco, several seniors had the same question for Anni Chung, from Self-Help for the Elderly. “Either their spouse or other family members have passed away, and they can’t keep up with the rent just on their own.”\u003c/p>\n\u003cp>When the biggest expense is housing, Chung and her team help seniors apply for affordable housing via \u003ca href=\"https://housing.sfgov.org/\">San Francisco’s Dahlia portal\u003c/a>, where eligible residents can enter different lotteries for affordable apartments or studios. The available units listed can sometimes be smaller than where seniors lived when they had a full-time job, Chung said.[aside postID=news_12082251 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_012_qed.jpg']Some financial advisers shared with KQED that often, clients are able to bring their living expenses way down when they plan for retirement far from California. The state consistently ranks as one of the most expensive places for long-term care services. For example, the \u003ca href=\"https://assets.carescout.com/x/5c90319b6a/298701.pdf\">median monthly price\u003c/a> for a private room in a nursing home in California is about $15,000 — compared to roughly $10,000 in Ohio and $7,600 in Texas.\u003c/p>\n\u003cp>Another option for some seniors is moving in with their adult children. In many circumstances, this is an ideal arrangement for all parties. “They take care of each other, and it’s one big happy family,” Chung said. But even in these cases, she said it’s important to set up clear expectations about living together — especially if a family is already living in a smaller Bay Area apartment.\u003c/p>\n\u003cp>And even if actual cohabitation isn’t on the table, it’s still important to maintain family connections and support, Chung said. “If living with family is complicated, then the seniors would rather have their own place but still have a good relationship with the family,” she said.\u003c/p>\n\u003cp>If someone has little savings in the bank but was able to buy a home earlier in their life, they can also look into home-sharing programs like \u003ca href=\"https://frontporch.net/live/home-match/#request-info\">Home Match\u003c/a>. This program in San Francisco, Alameda, Contra Costa and Marin counties connects homeowners with folks looking to rent a room or an accessory dwelling unit on their property.\u003c/p>\n\u003cp>As they figure out next steps, Bay Area seniors should remember they can consult — and lean on — groups like Self-Help for the Elderly, Chung said. “We need our seniors. We don’t want to see them have to move,” she said.\u003c/p>\n\u003cp>“They worked hard here. They should enjoy their golden years here.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Many older adults in the region are working longer, moving to smaller homes in cheaper places and depending more than ever on social services.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story is part of \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>How We Get By\u003c/em>\u003c/a>\u003cem>, a KQED series exploring how people are coping with rising costs in the Bay Area and California. Find the \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>full series here\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>At 74, Teresa Chan is still working.\u003c/p>\n\u003cp>When she started thinking about retirement about a decade ago, Chan realized that financially, she still didn’t feel ready to live without a regular income. “I did not prepare,” she said. “I had no money. If I had money, I would have bought a home, but that was not possible.”\u003c/p>\n\u003cp>For more than 30 years, Chan has worked in various administrative jobs in San Francisco — most recently in a remote data entry role. Through it all, paying rent and healthcare — for her family, as well as herself— were always her biggest expenses.\u003c/p>\n\u003cp>“I had nothing to save after paying my bills,” she said, even with her Social Security benefits, which she began receiving at 66 after she reached full retirement age.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Last year, Chan moved from San Francisco to an apartment in Contra Costa County to save on housing costs. And she doesn’t plan to ever stop working. It’s her best way to support herself and hopefully save enough to one day visit her mother — who is now in her 90s — in Hong Kong, she said.\u003c/p>\n\u003cp>“While I can still have the job, then I want to work,” Chan said, although she said that she wishes she had another option. “Maybe I’ll quit if I win the lottery.”\u003c/p>\n\u003cfigure id=\"attachment_11953002\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11953002\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED.jpg\" alt=\"A woman with white hair and a warm coat picks through a huge box of ears of corn in a paved outdoor area where lots of other people are also circulating.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/06/RS66300_230613-SFMarinFoodPantry-11-BL-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Volunteers distribute food items at a San Francisco-Marin Food Bank pop-up pantry in the Richmond District of San Francisco on June 13, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Chan is not alone. According to federal data from the \u003ca href=\"https://www.gao.gov/financial-security-older-americans\">Government Accountability Office\u003c/a> (GAO), about half of households nationwide with a worker aged 55 or older had no retirement savings. And like her, more seniors are \u003ca href=\"https://www.gao.gov/blog/older-americans-are-working-longer-how-do-we-support-them\">staying in the workforce longer\u003c/a>, downsizing and depending more than ever on family and social services to meet essential needs.\u003c/p>\n\u003cp>But if you’re already approaching your 60s and don’t have much saved, what options are available for potentially changing that?\u003c/p>\n\u003cp>KQED reached out to financial advisers and groups that serve seniors to better understand what older adults with fewer savings in the Bay Area are doing to make retirement possible.\u003c/p>\n\u003ch2>In the Bay Area, inequalities before and after retirement\u003c/h2>\n\u003cp>Planning for retirement is even more difficult for low-income older adults — \u003ca href=\"https://www.gao.gov/assets/gao-23-105342.pdf\">only 15%\u003c/a> of this group report having anything saved at all.\u003c/p>\n\u003cp>The GAO also found that \u003ca href=\"https://www.gao.gov/assets/gao-23-105342.pdf\">lower-income workers are effectively shut out\u003c/a> from workplace retirement accounts, such as 401(k)s. By contrast, higher earners consistently have greater access to these kinds of accounts and usually receive larger employer contributions.\u003c/p>\n\u003cp>And the Bay Area’s high cost of living makes preparing for retirement even more complicated, said Vanessa Merlano Sittauer, director of Santa Clara County’s Department of Aging and Adult Services. “We need to talk about retirement [in] the greater context of what it’s like to live in a place like the Bay Area,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11986980\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11986980 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut.jpg\" alt=\"\" width=\"1920\" height=\"1446\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-800x603.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-1020x768.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-160x121.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/05/PXL_20240520_185856861_qut-1536x1157.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">People gathered at a rally on May 20, 2024, in support of a San Francisco proposal to expand funding for affordable housing for seniors and others with low incomes. \u003ccite>(Joe Fitzgerald Rodriguez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Sittauer points to data from the research publication \u003ca href=\"https://jointventure.org/images/stories/pdf/index2026-jvsv.pdf\">Silicon Valley Index\u003c/a> that shows that more that 40% of renters ages 18-64 across the South Bay and the Peninsula are severely rent burdened — meaning that at least half of their monthly income pays housing costs. For residents older than 65, that number climbs to 67%.\u003c/p>\n\u003cp>But if living in the Bay Area means spending more on housing — along with \u003ca href=\"https://www.kqed.org/news/12075761/when-child-care-costs-half-a-paycheck-bay-area-parents-must-choose-kids-or-career\">childcare\u003c/a>, \u003ca href=\"https://www.kqed.org/news/12081471/driving-in-the-bay-area-is-essential-for-many-its-only-gotten-more-expensive\">transportation\u003c/a>, \u003ca href=\"https://www.kqed.org/news/12082251/after-the-one-big-beautiful-bill-free-clinics-are-stepping-up\">healthcare\u003c/a> and almost everything else — younger people \u003ca href=\"https://www.reddit.com/r/AskSF/comments/1t5or0s/retirement_in_sf_as_a_lifelong_renter_whats_the\">are asking\u003c/a> if it’s even \u003cem>possible \u003c/em>to retire here when not much is left over at the end of every month.\u003c/p>\n\u003ch2>What does retirement planning with less time look like?\u003c/h2>\n\u003cp>Starting to plan for retirement in your 50s can feel overwhelming, said Matt Gellene, head of Specialized Consumer Client Solutions for Bank of America. “But the first and most important step is to be honest about your full financial picture,” he said.\u003c/p>\n\u003cp>“Take a full inventory: what you have saved, what you owe, what you expect from Social Security, and what you want retirement to look like,” he said.\u003c/p>\n\u003ch2>Plan out your spending — and debt payments\u003c/h2>\n\u003cp>Think carefully about the debt you have \u003cem>now\u003c/em>, Gellene said. “High-interest debt can erode retirement readiness faster than many people realize,” he said. “Paying down that debt in the years before retirement reduces the monthly income you’ll need to cover fixed costs once you stop working.”\u003c/p>\n\u003cp>Even setting a realistic monthly budget now that limits lifestyle expenses can help down the road. Many Bay Area public libraries offer \u003ca href=\"https://advisersgiveback.org/sf-library/\">free workshops with financial advisers\u003c/a> who can help you figure out what you can start cutting back on now.\u003c/p>\n\u003cfigure id=\"attachment_11946480\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946480 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-scaled-e1779405949186.jpg\" alt=\"A woman sits at her kitchen table and sifts through documents, looking concerned. Next to her is her opened laptop.\" width=\"2000\" height=\"1334\">\u003cfigcaption class=\"wp-caption-text\">According to federal data from the Government Accountability Office (GAO), about half of households nationwide with a worker aged 55 or older had no retirement savings. \u003ccite>(MoMo Productions/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>United Way Bay Area, known by many in the region for its\u003ca href=\"https://www.kqed.org/news/11909786/how-to-find-free-tax-help-near-you-and-prepare-everything-you-need-for-your-appointment\"> free tax filing services\u003c/a>, also runs a network of free financial coaching centers known as \u003ca href=\"https://uwba.org/what-we-do/sparkpoint-program/\">SparkPoint\u003c/a>.\u003c/p>\n\u003cp>There are centers in San Francisco, Alameda, Contra Costa, San Mateo and Marin counties, where financial coaches can help with making plans to achieve long-term goals like reducing debt and growing savings.\u003c/p>\n\u003ch2>Know your options if you need to continue working\u003c/h2>\n\u003cp>Seniors who feel they are not ready to leave the workforce but are looking for a job with more flexibility can also contact \u003ca href=\"https://www.selfhelpelderly.org/\">Self-Help for the Elderly\u003c/a>, a nonprofit organization that provides seniors in San Francisco, Santa Clara and San Mateo counties with housing, food and other social services.\u003c/p>\n\u003cp>“We train older workers as home health aides, housekeepers and restaurant workers,” CEO Anni Chung said. Seniors who are trained as housekeepers, for example, can work a few hours a week for several different clients. Multiple trainings for \u003ca href=\"https://www.selfhelpelderly.org/our-services/employment-services/job-placements-and-employment-training\">this older worker program\u003c/a> are held throughout the year.\u003c/p>\n\u003ch2>Remember healthcare costs\u003c/h2>\n\u003cp>Another huge retirement expense to consider is healthcare costs. Seniors with Medicare may still have to pay monthly premiums and deductibles, depending on what coverage plan they sign up for. Medicare Part A, which does not charge monthly premiums and covers major hospital bills, \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles\">still comes with deductibles\u003c/a> that beneficiaries pay if they are admitted to the hospital.\u003c/p>\n\u003cp>Other Medicare options can cover additional medical expenses, like lab tests and medication, but those plans come with monthly premiums. And researchers have found that out-of-pocket healthcare expenses increase significantly \u003ca href=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC3614143/\">for Medicare recipients\u003c/a> in the last years of life, and most individuals are considered \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2686318\">high-need, high-cost patients\u003c/a> prior to death.\u003c/p>\n\u003cfigure id=\"attachment_12058933\" class=\"wp-caption aligncenter\" style=\"max-width: 1829px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12058933 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed.jpg\" alt=\"\" width=\"1829\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed.jpg 1829w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed-160x117.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/125841436_qed-1536x1119.jpg 1536w\" sizes=\"auto, (max-width: 1829px) 100vw, 1829px\">\u003cfigcaption class=\"wp-caption-text\">Protestors carry signs as they demonstrate against proposed cuts to Medi-Cal and Medicare outside San Francisco city hall on Sept. 21, 2011, in San Francisco, California. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>You can start preparing for medical expenses now with a health savings account, or HSA. This kind of savings account “offers what we call triple tax savings,” said Gellene from Bank of America. “Your money goes in pre-tax, it can grow tax-free if you invest it and you can withdraw it tax-free for qualified medical expenses.”\u003c/p>\n\u003cp>And if you can save a little more in the next few years, there may still be some options to make what you have grow. If you have one, Gellene recommends maxing out your 401(k) — that is, contributing as much as the IRS allows you to — especially if your employer offers a match.\u003c/p>\n\u003cp>“That’s essentially free money, and you don’t want to leave any of it on the table,” he said.\u003c/p>\n\u003ch2>Think about where you’ll live\u003c/h2>\n\u003cp>At a recent \u003ca href=\"https://www.instagram.com/p/DWlMAlHFX9N/\">affordable housing fair\u003c/a> in San Francisco, several seniors had the same question for Anni Chung, from Self-Help for the Elderly. “Either their spouse or other family members have passed away, and they can’t keep up with the rent just on their own.”\u003c/p>\n\u003cp>When the biggest expense is housing, Chung and her team help seniors apply for affordable housing via \u003ca href=\"https://housing.sfgov.org/\">San Francisco’s Dahlia portal\u003c/a>, where eligible residents can enter different lotteries for affordable apartments or studios. The available units listed can sometimes be smaller than where seniors lived when they had a full-time job, Chung said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Some financial advisers shared with KQED that often, clients are able to bring their living expenses way down when they plan for retirement far from California. The state consistently ranks as one of the most expensive places for long-term care services. For example, the \u003ca href=\"https://assets.carescout.com/x/5c90319b6a/298701.pdf\">median monthly price\u003c/a> for a private room in a nursing home in California is about $15,000 — compared to roughly $10,000 in Ohio and $7,600 in Texas.\u003c/p>\n\u003cp>Another option for some seniors is moving in with their adult children. In many circumstances, this is an ideal arrangement for all parties. “They take care of each other, and it’s one big happy family,” Chung said. But even in these cases, she said it’s important to set up clear expectations about living together — especially if a family is already living in a smaller Bay Area apartment.\u003c/p>\n\u003cp>And even if actual cohabitation isn’t on the table, it’s still important to maintain family connections and support, Chung said. “If living with family is complicated, then the seniors would rather have their own place but still have a good relationship with the family,” she said.\u003c/p>\n\u003cp>If someone has little savings in the bank but was able to buy a home earlier in their life, they can also look into home-sharing programs like \u003ca href=\"https://frontporch.net/live/home-match/#request-info\">Home Match\u003c/a>. This program in San Francisco, Alameda, Contra Costa and Marin counties connects homeowners with folks looking to rent a room or an accessory dwelling unit on their property.\u003c/p>\n\u003cp>As they figure out next steps, Bay Area seniors should remember they can consult — and lean on — groups like Self-Help for the Elderly, Chung said. “We need our seniors. We don’t want to see them have to move,” she said.\u003c/p>\n\u003cp>“They worked hard here. They should enjoy their golden years here.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Lurie Eyes $34 Million to Cushion HR 1 Blows to Medi-Cal and CalFresh",
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"content": "\u003cp>As \u003ca href=\"https://www.kqed.org/news/12083922/calfresh-snap-new-work-requirements-rules-2026-hr1-eligibility-who-is-exempt-food-stamps\">CalFresh\u003c/a> recipients in San Francisco brace themselves for changes to their federal work and reporting requirements, effective June 1, Mayor Daniel Lurie plans to spend $34 million to help.\u003c/p>\n\u003cp>President Donald Trump’s H.R. 1, or his “One Big Beautiful Bill,” added new work \u003ca href=\"https://www.kqed.org/news/12083922/calfresh-snap-new-work-requirements-rules-2026-hr1-eligibility-who-is-exempt-food-stamps\">requirements\u003c/a> with stricter enforcement, which will impact roughly 21,000 CalFresh and over 40,000 Medi-Cal recipients in San Francisco.\u003c/p>\n\u003cp>The updated requirements for CalFresh recipients begin in June, with Medi-Cal’s changes slated for January. Recipients who are aged 18 to 64 — and who do not live with a child under the age of 14 — will have to prove that they are completing at least 20 hours of work a week to continue receiving food and healthcare.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The upcoming \u003ca href=\"https://www.kqed.org/news/12083922/calfresh-snap-new-work-requirements-rules-2026-hr1-eligibility-who-is-exempt-food-stamps\">restrictions\u003c/a> will only apply to new CalFresh and Medi-Cal applicants. Current recipients in California will only be subject to these rules once they recertify their benefits.\u003c/p>\n\u003cp>But Lurie, who is currently working to balance the budget, proposed a way to cushion the blows posed by a more stringent federal guideline — setting aside $34 million for retaining staff that would help San Franciscans navigate the new measures necessary to continue receiving federal aid.[aside postID=news_12083922 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/12/CalFreshGetty.jpg']“While federal cuts make it harder for San Franciscans to access healthcare and put food on the table, this budget will protect our city’s social safety net and help residents stay on the benefits they rely on,” Lurie said in a statement on Thursday. Trent Rhorer, executive director of the San Francisco Human Services Agency, described the federal bill as death by bureaucracy.\u003c/p>\n\u003cp>“They ascribed all of these new requirements as a way to reduce the number of people who successfully receive healthcare through Obamacare,” Rhorer said.\u003c/p>\n\u003cp>He called it “a sinister approach to undoing one of the most successful domestic policy changes in the last four decades.”\u003c/p>\n\u003cp>If passed, hiring for what Lurie estimated as over 150 staffers would not begin until July — once his budget passes through the Board of Supervisors. About half of those employees would work directly with clients to help them find jobs, navigate the paperwork processes and do monthly check-ins to confirm they’re working. The remainder will work as “employment training specialists” to help clients choose the right classes to level up their job skills.\u003c/p>\n\u003cp>Rhorer said that as his team works to protect the Medi-Cal and CalFresh recipients at risk of losing coverage, this additional staffing will be necessary in helping “mitigate the harm to clients that the authors of H.R. 1 actually intend to occur.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As \u003ca href=\"https://www.kqed.org/news/12083922/calfresh-snap-new-work-requirements-rules-2026-hr1-eligibility-who-is-exempt-food-stamps\">CalFresh\u003c/a> recipients in San Francisco brace themselves for changes to their federal work and reporting requirements, effective June 1, Mayor Daniel Lurie plans to spend $34 million to help.\u003c/p>\n\u003cp>President Donald Trump’s H.R. 1, or his “One Big Beautiful Bill,” added new work \u003ca href=\"https://www.kqed.org/news/12083922/calfresh-snap-new-work-requirements-rules-2026-hr1-eligibility-who-is-exempt-food-stamps\">requirements\u003c/a> with stricter enforcement, which will impact roughly 21,000 CalFresh and over 40,000 Medi-Cal recipients in San Francisco.\u003c/p>\n\u003cp>The updated requirements for CalFresh recipients begin in June, with Medi-Cal’s changes slated for January. Recipients who are aged 18 to 64 — and who do not live with a child under the age of 14 — will have to prove that they are completing at least 20 hours of work a week to continue receiving food and healthcare.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The upcoming \u003ca href=\"https://www.kqed.org/news/12083922/calfresh-snap-new-work-requirements-rules-2026-hr1-eligibility-who-is-exempt-food-stamps\">restrictions\u003c/a> will only apply to new CalFresh and Medi-Cal applicants. Current recipients in California will only be subject to these rules once they recertify their benefits.\u003c/p>\n\u003cp>But Lurie, who is currently working to balance the budget, proposed a way to cushion the blows posed by a more stringent federal guideline — setting aside $34 million for retaining staff that would help San Franciscans navigate the new measures necessary to continue receiving federal aid.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“While federal cuts make it harder for San Franciscans to access healthcare and put food on the table, this budget will protect our city’s social safety net and help residents stay on the benefits they rely on,” Lurie said in a statement on Thursday. Trent Rhorer, executive director of the San Francisco Human Services Agency, described the federal bill as death by bureaucracy.\u003c/p>\n\u003cp>“They ascribed all of these new requirements as a way to reduce the number of people who successfully receive healthcare through Obamacare,” Rhorer said.\u003c/p>\n\u003cp>He called it “a sinister approach to undoing one of the most successful domestic policy changes in the last four decades.”\u003c/p>\n\u003cp>If passed, hiring for what Lurie estimated as over 150 staffers would not begin until July — once his budget passes through the Board of Supervisors. About half of those employees would work directly with clients to help them find jobs, navigate the paperwork processes and do monthly check-ins to confirm they’re working. The remainder will work as “employment training specialists” to help clients choose the right classes to level up their job skills.\u003c/p>\n\u003cp>Rhorer said that as his team works to protect the Medi-Cal and CalFresh recipients at risk of losing coverage, this additional staffing will be necessary in helping “mitigate the harm to clients that the authors of H.R. 1 actually intend to occur.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "san-francisco-nurses-fight-for-kaiser-employee-terminated-over-daca-status",
"title": "San Francisco Nurses Fight for Kaiser Employee Terminated Over DACA Status",
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"content": "\u003cp>Dozens of nurses rallied outside \u003ca href=\"https://www.kqed.org/news/tag/kaiser\">Kaiser\u003c/a> San Francisco on Monday to advocate for a San Francisco nurse who is set to lose her job — after the federal government did not process her temporary legal status in time.\u003c/p>\n\u003cp>The surgical nurse, who has lived in the U.S. for most of her life and will remain anonymous due to safety concerns, immigrated from the Philippines when she was two years old. As an employee of Kaiser Permanente San Francisco Medical Center on Geary Boulevard, the nurse filed her DACA, or Deferred Action for Childhood Arrivals, renewal application on Dec.1 — exactly 135 days before her status was set to expire on April 15. Despite applying well within the recommended window, she said she has not heard back.\u003c/p>\n\u003cp>When her status lapsed, Kaiser placed her on 30 days of unpaid leave. That window closes on May 14. In response to her inquiries, Kaiser wrote that “It is your responsibility to keep your work authorization current,” according to \u003ca href=\"https://missionlocal.org/2026/05/kaiser-nurse-daca-renewal-delay-san-francisco/\">\u003cem>Mission Local\u003c/em>\u003c/a>, which first reported her case.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a statement, Kaiser said the organization was evaluating potential solutions. \u003c/p>\n\u003cp>“We have been working directly with our employee to support her through this as best we can. We have been working with the union as well, and appreciate their advocacy on behalf of our employee. We are currently evaluating what potential solutions are available,” a spokesperson said in a statement. \u003c/p>\n\u003cp>Outside of Kaiser on Monday, dozens of nurses chanted: “Defend DACA now,” calling on the hospital to extend the nurse’s unpaid leave. In a statement read aloud by fellow nurses at the rally, the soon-to-be-terminated nurse wrote: “I feel devastated and torn to pieces to be in a position where the fault lies with the innocent.”\u003c/p>\n\u003cp>“So, I ask Kaiser to extend my leave, because I want to thrive, too,” it said.\u003c/p>\n\u003cp>Hers is not an isolated case. According to the Migration Policy Institute, an estimated 500,000 immigrants currently hold DACA status, and many have been caught in a surge of federal processing delays — a trend that advocates told KQED accelerated this year.\u003c/p>\n\u003cfigure id=\"attachment_12083226\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12083226\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1334\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED-1536x1025.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Diana Alfaro, a registered nurse, rallies against Kaiser’s plans to terminate a DACA recipient registered nurse outside of Kaiser Permanente on Geary Street in San Francisco on May 11, 2026. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The East Bay Sanctuary Covenant, which serves more than 1,000 active DACA clients, said that over half of renewal requests filed since November 2025 remain pending.\u003c/p>\n\u003cp>Lisa Hoffman, the organization’s co-executive director, said delays of 150 days or more are now common.\u003c/p>\n\u003cp>“This is just the latest attack,” Hoffman said. “It feels like DACA is being chipped away at piece by piece every day.”\u003c/p>\n\u003cp>Sydney Simpson, a registered nurse at Kaiser San Francisco, said the hospital’s decision is both morally and practically wrong.[aside postID=news_12082440 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240408-FCIDublin-018-BL_qut-1020x680.jpg']“To replace a nurse with her level of expertise is extremely painful for the organization — it’s expensive, it hurts our morale as nurses and it hurts patient quality of care,” Simpson said. “It seems like a really easy decision, but for whatever reason, they are holding their ground.”\u003c/p>\n\u003cp>Nurses pointed to a stark contrast with the University of California health system. Maureen Dugan, a UCSF registered nurse, said at Monday’s rally that the UC’s union contract explicitly protects DACA nurses from termination during renewal delays — and guarantees recall rights if they are temporarily let go.\u003c/p>\n\u003cp>“UC is committed to supporting DACA staff,” Dugan said. “We won that language in our last contract negotiations.”\u003c/p>\n\u003cp>Last week, a coalition of Bay Area immigrant rights groups — including Justice Action Center, East Bay Sanctuary Covenant, the Immigration Institute of the Bay Area and Cornell Law School’s Path2Papers — filed a Freedom of Information Act request, demanding the Trump administration release data on how it is processing DACA renewals and what, if any, policy changes are driving the delays.\u003c/p>\n\u003cp>Advocates say DACA recipients are now making major life decisions — about their jobs, their housing, their families — without knowing when or whether their renewals will come through.\u003c/p>\n\u003cp>Vanessa Rivas-Bernardy, a staff attorney at Justice Action Center, said the delays reflect a program under sustained administrative pressure.\u003c/p>\n\u003cfigure id=\"attachment_12083229\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12083229\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Supervisor Connie Chan rallies against Kaiser’s plans to terminate a DACA recipient registered nurse outside of Kaiser Permanente on Geary Street in San Francisco on May 11, 2026. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“DACA recipients have been living in two-year increments — all their decisions, their whole lives are in these two-year chunks,” Rivas-Bernardy said. “This is just an exacerbation of that uncertainty and risk, but it’s been completely ramping up in recent months in a way we really haven’t seen before.”\u003c/p>\n\u003cp>If the government does not respond to the FOIA request within 20 calendar days, Rivas-Bernardy said the coalition is prepared to file a federal lawsuit to compel disclosure.\u003c/p>\n\u003cp>San Francisco Supervisor Connie Chan attended Monday’s rally and called on Kaiser to change course.\u003c/p>\n\u003cp>“Our nurses — DACA or otherwise — should not be punished for the Trump administration’s incompetence,” Chan said.\u003c/p>\n\u003cp>In her written statement, the nurse said she is still holding on to hope.\u003c/p>\n\u003cp>“I know I am worthy, good enough, an exceptional nurse and member of this society,” she wrote. “I am a DACA recipient — a dreamer.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dozens of nurses rallied outside \u003ca href=\"https://www.kqed.org/news/tag/kaiser\">Kaiser\u003c/a> San Francisco on Monday to advocate for a San Francisco nurse who is set to lose her job — after the federal government did not process her temporary legal status in time.\u003c/p>\n\u003cp>The surgical nurse, who has lived in the U.S. for most of her life and will remain anonymous due to safety concerns, immigrated from the Philippines when she was two years old. As an employee of Kaiser Permanente San Francisco Medical Center on Geary Boulevard, the nurse filed her DACA, or Deferred Action for Childhood Arrivals, renewal application on Dec.1 — exactly 135 days before her status was set to expire on April 15. Despite applying well within the recommended window, she said she has not heard back.\u003c/p>\n\u003cp>When her status lapsed, Kaiser placed her on 30 days of unpaid leave. That window closes on May 14. In response to her inquiries, Kaiser wrote that “It is your responsibility to keep your work authorization current,” according to \u003ca href=\"https://missionlocal.org/2026/05/kaiser-nurse-daca-renewal-delay-san-francisco/\">\u003cem>Mission Local\u003c/em>\u003c/a>, which first reported her case.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a statement, Kaiser said the organization was evaluating potential solutions. \u003c/p>\n\u003cp>“We have been working directly with our employee to support her through this as best we can. We have been working with the union as well, and appreciate their advocacy on behalf of our employee. We are currently evaluating what potential solutions are available,” a spokesperson said in a statement. \u003c/p>\n\u003cp>Outside of Kaiser on Monday, dozens of nurses chanted: “Defend DACA now,” calling on the hospital to extend the nurse’s unpaid leave. In a statement read aloud by fellow nurses at the rally, the soon-to-be-terminated nurse wrote: “I feel devastated and torn to pieces to be in a position where the fault lies with the innocent.”\u003c/p>\n\u003cp>“So, I ask Kaiser to extend my leave, because I want to thrive, too,” it said.\u003c/p>\n\u003cp>Hers is not an isolated case. According to the Migration Policy Institute, an estimated 500,000 immigrants currently hold DACA status, and many have been caught in a surge of federal processing delays — a trend that advocates told KQED accelerated this year.\u003c/p>\n\u003cfigure id=\"attachment_12083226\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12083226\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1334\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00122_TV-KQED-1536x1025.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Diana Alfaro, a registered nurse, rallies against Kaiser’s plans to terminate a DACA recipient registered nurse outside of Kaiser Permanente on Geary Street in San Francisco on May 11, 2026. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The East Bay Sanctuary Covenant, which serves more than 1,000 active DACA clients, said that over half of renewal requests filed since November 2025 remain pending.\u003c/p>\n\u003cp>Lisa Hoffman, the organization’s co-executive director, said delays of 150 days or more are now common.\u003c/p>\n\u003cp>“This is just the latest attack,” Hoffman said. “It feels like DACA is being chipped away at piece by piece every day.”\u003c/p>\n\u003cp>Sydney Simpson, a registered nurse at Kaiser San Francisco, said the hospital’s decision is both morally and practically wrong.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“To replace a nurse with her level of expertise is extremely painful for the organization — it’s expensive, it hurts our morale as nurses and it hurts patient quality of care,” Simpson said. “It seems like a really easy decision, but for whatever reason, they are holding their ground.”\u003c/p>\n\u003cp>Nurses pointed to a stark contrast with the University of California health system. Maureen Dugan, a UCSF registered nurse, said at Monday’s rally that the UC’s union contract explicitly protects DACA nurses from termination during renewal delays — and guarantees recall rights if they are temporarily let go.\u003c/p>\n\u003cp>“UC is committed to supporting DACA staff,” Dugan said. “We won that language in our last contract negotiations.”\u003c/p>\n\u003cp>Last week, a coalition of Bay Area immigrant rights groups — including Justice Action Center, East Bay Sanctuary Covenant, the Immigration Institute of the Bay Area and Cornell Law School’s Path2Papers — filed a Freedom of Information Act request, demanding the Trump administration release data on how it is processing DACA renewals and what, if any, policy changes are driving the delays.\u003c/p>\n\u003cp>Advocates say DACA recipients are now making major life decisions — about their jobs, their housing, their families — without knowing when or whether their renewals will come through.\u003c/p>\n\u003cp>Vanessa Rivas-Bernardy, a staff attorney at Justice Action Center, said the delays reflect a program under sustained administrative pressure.\u003c/p>\n\u003cfigure id=\"attachment_12083229\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12083229\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/05/260511-KAISERDACA00360_TV-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Supervisor Connie Chan rallies against Kaiser’s plans to terminate a DACA recipient registered nurse outside of Kaiser Permanente on Geary Street in San Francisco on May 11, 2026. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“DACA recipients have been living in two-year increments — all their decisions, their whole lives are in these two-year chunks,” Rivas-Bernardy said. “This is just an exacerbation of that uncertainty and risk, but it’s been completely ramping up in recent months in a way we really haven’t seen before.”\u003c/p>\n\u003cp>If the government does not respond to the FOIA request within 20 calendar days, Rivas-Bernardy said the coalition is prepared to file a federal lawsuit to compel disclosure.\u003c/p>\n\u003cp>San Francisco Supervisor Connie Chan attended Monday’s rally and called on Kaiser to change course.\u003c/p>\n\u003cp>“Our nurses — DACA or otherwise — should not be punished for the Trump administration’s incompetence,” Chan said.\u003c/p>\n\u003cp>In her written statement, the nurse said she is still holding on to hope.\u003c/p>\n\u003cp>“I know I am worthy, good enough, an exceptional nurse and member of this society,” she wrote. “I am a DACA recipient — a dreamer.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "santa-clara-county-facing-nearly-1-billion-budget-deficit-after-trump-cuts",
"title": "Santa Clara County Facing Nearly $1 Billion Budget Deficit After Trump Cuts",
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"headTitle": "Santa Clara County Facing Nearly $1 Billion Budget Deficit After Trump Cuts | KQED",
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"content": "\u003cp>\u003ca href=\"https://www.kqed.org/news/tag/santa-clara-county\">Santa Clara County\u003c/a> is proposing cutting several hundred positions and shuttering health clinics to help close a $787 million budget deficit, as it confronts sea changes in funding from both the federal and state governments.\u003c/p>\n\u003cp>“This is our fourth year in a row of budget reductions and the magnitude of the gap that we had to close this year is one of the largest that the county has faced in decades,” County Executive James Williams said of the $14.7 billion budget proposal.\u003c/p>\n\u003cp>He called it an “extraordinarily difficult budget to bring forward,” not just because of the challenges of bridging the gap, but because of residents’ increasing reliance on the county, complicated by the likelihood of further losses of federal revenue in coming years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“And all of that in a context where there is so much need in the community and the context where we know that there are tremendous pressures on safety net services for the most vulnerable families,” Williams said.\u003c/p>\n\u003cp>The county’s top brass recommended cutting 655 positions across its organization, with the brunt of that expected to be felt in the county’s large hospital system and its behavioral health departments.\u003c/p>\n\u003cp>The county said about 265 of those positions are currently filled, or roughly 40%, but Williams said he is hoping to avoid any layoffs.\u003c/p>\n\u003cfigure id=\"attachment_12080199\" class=\"wp-caption aligncenter\" style=\"max-width: 1980px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12080199\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216.jpg\" alt=\"\" width=\"1980\" height=\"1320\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216.jpg 1980w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1980px) 100vw, 1980px\">\u003cfigcaption class=\"wp-caption-text\">Santa Clara County Government Center in San Jose, California, on June 10, 2023. \u003ccite>(JHVEPhoto via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We will be attempting very vigorously to place all those individuals into other vacant positions across the county,” he said. What exactly happens to those employees would be based on what positions are offered to them, their labor contracts and their personal needs, Williams said.\u003c/p>\n\u003cp>County Supervisor Susan Ellenberg lauded those efforts given the county’s total workforce size of roughly 22,000 people, and hopes the county can support every worker.\u003c/p>\n\u003cp>“It’s rather extraordinary… to be able to find enough places to make budget cuts, look for increased revenue and be able to consolidate and increase efficiencies with such a relatively small number of employees being impacted,” she said. “Of course, for any single employee, that makes all the difference in the world…but we have been very successful in leveraging positions that are either vacant now or we know have upcoming retirements or other planned separations from the county.”[aside postID=news_12074467 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/SFLicensePlateReader-1020x675.jpg']The county is facing significant cuts to federal Medicaid and food assistance funding stemming from President Donald Trump’s H.R. 1 bill, which is expected to amount to more than $1 billion in annual revenue losses for Santa Clara County in the coming years.\u003c/p>\n\u003cp>The state has also this year shifted the requirements and funding model for mental health and behavioral health programs after the passage of Proposition 1 by voters in 2024, which Williams said “has really turned the fiscal world in behavioral health upside down.”\u003c/p>\n\u003cp>On top of federal and state funding challenges, the county, like many other organizations and households, has also seen rising costs for labor, goods, services and utilities, while property tax revenue has not kept pace.\u003c/p>\n\u003cp>The biggest way the county is coping with the cuts is through the emergency injection of $337 million expected to be provided by a new sales tax approved by 57% of voters last year, called Measure A. The measure increases sales tax across the county by five-eighths of a cent for every one dollar spent, and is in place for five years.\u003c/p>\n\u003cp>Williams and his staff recommended putting all of the Measure A money for the current budget year into Santa Clara Valley Healthcare, the county’s public hospital and clinic system, to help lessen the blow from Medicaid cuts enacted by Trump and the Republican-controlled Congress.\u003c/p>\n\u003cfigure id=\"attachment_12058486\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12058486\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Santa Clara Valley Medical Center stands on 751 South Bascom Avenue in San José on Sept. 29, 2025. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>County supervisors also previously approved nearly $200 million in budget cuts in February during the mid-year budget review, including cutting roughly 365 positions that were largely vacant and focused on the county’s healthcare system.\u003c/p>\n\u003cp>While planning for 655 cuts, the county is simultaneously considering adding 191 positions, especially in areas that are growing but aren’t reliant on federal funds, like parks and libraries, for a net cut of 464 positions, Williams said.\u003c/p>\n\u003cp>Two county-run behavioral health clinics are expected to be closed, but Williams said the services will be transitioned to other facilities or community organizations that provide services for the county already.\u003c/p>\n\u003cp>Ellenberg said the idea of consolidating clinics on its face doesn’t worry her too much, so long as people who need those services aren’t challenged to find them elsewhere nearby.\u003c/p>\n\u003cp>But she added that in general, the on-the-ground impacts from broad budget recommendations to alter contracts and leases and reduce positions is where she will focus as supervisors go through budget workshops and reviews next week.\u003c/p>\n\u003cp>“There are many aspects of it that are not yet clear to me, particularly around impact… I need to understand how that impacts particular populations, especially the very high-need and vulnerable residents that the county serves,” Ellenberg said.\u003c/p>\n\u003cfigure id=\"attachment_12044070\" class=\"wp-caption aligncenter\" style=\"max-width: 1999px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12044070\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed.jpg\" alt=\"\" width=\"1999\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed.jpg 1999w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1999px) 100vw, 1999px\">\u003cfigcaption class=\"wp-caption-text\">Santa Clara County Supervisor Susan Ellenberg, speaks during an event celebrating the opening of Vermont House, a new residential treatment facility in San José for people leaving jail with mental health needs. \u003ccite>(Joseph Geha/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Williams said the county has been aiming to preserve or expand services for those in most need across the county. He pointed to plans for new “satellite clinics in high-need communities,” as well as the planned opening of the county’s behavioral health pavilion on the campus of Santa Clara Valley Medical Center later this year.\u003c/p>\n\u003cp>The pavilion will include the first child and adolescent inpatient psychiatric unit in the South Bay, Williams said, and will be staffed by transferring positions from elsewhere in the county.\u003c/p>\n\u003cp>“We’re continuing to expand in critical areas and areas with significant community demand where there’s significant need. We haven’t taken our eye off the ball,” he said.\u003c/p>\n\u003cp>Williams said the county has “moved mountains” to preserve critical services in the face of unprecedented cuts, and said voters have stepped up at an important time. But he called directly on the governor and legislature to help counties across the state.\u003c/p>\n\u003cp>“We need to see a forceful, clear and unequivocal response at the state level to what’s happening with H.R. 1,” he said. “There’s no way our county or any other can do this alone.”\u003c/p>\n\u003cp>The county’s Board of Supervisors will hold three consecutive budget workshops May 11-13, and will hold three more sessions to adopt a final budget in mid-June.\u003c/p>\n\u003cp>The county is not the only government facing down budget deficits, as South Bay cities look for ways to close their gaps while maintaining critical services.\u003c/p>\n\u003cfigure id=\"attachment_11998675\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11998675\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1.jpg\" alt=\"The mayor of San Jose stands behind a podium. A poster breaking down the project budget is displayed next to the speaker.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">San José Mayor Matt Mahan speaks during a gathering in Santa Clara on Aug. 2, 2024, to announce a nearly $5.1 billion funding commitment from federal transit officials toward the VTA BART Silicon Valley Phase II extension project. \u003ccite>(Joseph Geha/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>San José, whose Mayor Matt Mahan heavily touted his work to spend more of the city’s affordable housing funds on more than 1,000 new interim shelter spaces for people who are homeless last year, is now working to cut $50 million out of its budget.\u003c/p>\n\u003cp>The city’s current proposal from City Manager Jennifer Maguire would cut support for interim housing operations by $1.25 million in the coming budget year and significantly reduce it by $14.2 million in the budget for 2027-2028, officials said this week.\u003c/p>\n\u003cp>Williams said the coming years for Santa Clara County could be even more difficult, and he is concerned about changes to the “social compact” in the country.\u003c/p>\n\u003cp>“We’re one United States, and there are deep interrelationships between federal, state and local governments that all operate together to help take care of communities across the country,” Williams said. “We’re witnessing a complete reordering of that fabric, not just fiscally, but in terms of policy and the politics of this whole country.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"https://www.kqed.org/news/tag/santa-clara-county\">Santa Clara County\u003c/a> is proposing cutting several hundred positions and shuttering health clinics to help close a $787 million budget deficit, as it confronts sea changes in funding from both the federal and state governments.\u003c/p>\n\u003cp>“This is our fourth year in a row of budget reductions and the magnitude of the gap that we had to close this year is one of the largest that the county has faced in decades,” County Executive James Williams said of the $14.7 billion budget proposal.\u003c/p>\n\u003cp>He called it an “extraordinarily difficult budget to bring forward,” not just because of the challenges of bridging the gap, but because of residents’ increasing reliance on the county, complicated by the likelihood of further losses of federal revenue in coming years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“And all of that in a context where there is so much need in the community and the context where we know that there are tremendous pressures on safety net services for the most vulnerable families,” Williams said.\u003c/p>\n\u003cp>The county’s top brass recommended cutting 655 positions across its organization, with the brunt of that expected to be felt in the county’s large hospital system and its behavioral health departments.\u003c/p>\n\u003cp>The county said about 265 of those positions are currently filled, or roughly 40%, but Williams said he is hoping to avoid any layoffs.\u003c/p>\n\u003cfigure id=\"attachment_12080199\" class=\"wp-caption aligncenter\" style=\"max-width: 1980px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12080199\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216.jpg\" alt=\"\" width=\"1980\" height=\"1320\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216.jpg 1980w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/GettyImages-1679222216-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1980px) 100vw, 1980px\">\u003cfigcaption class=\"wp-caption-text\">Santa Clara County Government Center in San Jose, California, on June 10, 2023. \u003ccite>(JHVEPhoto via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We will be attempting very vigorously to place all those individuals into other vacant positions across the county,” he said. What exactly happens to those employees would be based on what positions are offered to them, their labor contracts and their personal needs, Williams said.\u003c/p>\n\u003cp>County Supervisor Susan Ellenberg lauded those efforts given the county’s total workforce size of roughly 22,000 people, and hopes the county can support every worker.\u003c/p>\n\u003cp>“It’s rather extraordinary… to be able to find enough places to make budget cuts, look for increased revenue and be able to consolidate and increase efficiencies with such a relatively small number of employees being impacted,” she said. “Of course, for any single employee, that makes all the difference in the world…but we have been very successful in leveraging positions that are either vacant now or we know have upcoming retirements or other planned separations from the county.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The county is facing significant cuts to federal Medicaid and food assistance funding stemming from President Donald Trump’s H.R. 1 bill, which is expected to amount to more than $1 billion in annual revenue losses for Santa Clara County in the coming years.\u003c/p>\n\u003cp>The state has also this year shifted the requirements and funding model for mental health and behavioral health programs after the passage of Proposition 1 by voters in 2024, which Williams said “has really turned the fiscal world in behavioral health upside down.”\u003c/p>\n\u003cp>On top of federal and state funding challenges, the county, like many other organizations and households, has also seen rising costs for labor, goods, services and utilities, while property tax revenue has not kept pace.\u003c/p>\n\u003cp>The biggest way the county is coping with the cuts is through the emergency injection of $337 million expected to be provided by a new sales tax approved by 57% of voters last year, called Measure A. The measure increases sales tax across the county by five-eighths of a cent for every one dollar spent, and is in place for five years.\u003c/p>\n\u003cp>Williams and his staff recommended putting all of the Measure A money for the current budget year into Santa Clara Valley Healthcare, the county’s public hospital and clinic system, to help lessen the blow from Medicaid cuts enacted by Trump and the Republican-controlled Congress.\u003c/p>\n\u003cfigure id=\"attachment_12058486\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12058486\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/10/250924-ELECTION-SJ-MEASURE-A_00662_TV-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Santa Clara Valley Medical Center stands on 751 South Bascom Avenue in San José on Sept. 29, 2025. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>County supervisors also previously approved nearly $200 million in budget cuts in February during the mid-year budget review, including cutting roughly 365 positions that were largely vacant and focused on the county’s healthcare system.\u003c/p>\n\u003cp>While planning for 655 cuts, the county is simultaneously considering adding 191 positions, especially in areas that are growing but aren’t reliant on federal funds, like parks and libraries, for a net cut of 464 positions, Williams said.\u003c/p>\n\u003cp>Two county-run behavioral health clinics are expected to be closed, but Williams said the services will be transitioned to other facilities or community organizations that provide services for the county already.\u003c/p>\n\u003cp>Ellenberg said the idea of consolidating clinics on its face doesn’t worry her too much, so long as people who need those services aren’t challenged to find them elsewhere nearby.\u003c/p>\n\u003cp>But she added that in general, the on-the-ground impacts from broad budget recommendations to alter contracts and leases and reduce positions is where she will focus as supervisors go through budget workshops and reviews next week.\u003c/p>\n\u003cp>“There are many aspects of it that are not yet clear to me, particularly around impact… I need to understand how that impacts particular populations, especially the very high-need and vulnerable residents that the county serves,” Ellenberg said.\u003c/p>\n\u003cfigure id=\"attachment_12044070\" class=\"wp-caption aligncenter\" style=\"max-width: 1999px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12044070\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed.jpg\" alt=\"\" width=\"1999\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed.jpg 1999w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/06/250612-SCCVERMONT-JG-4_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1999px) 100vw, 1999px\">\u003cfigcaption class=\"wp-caption-text\">Santa Clara County Supervisor Susan Ellenberg, speaks during an event celebrating the opening of Vermont House, a new residential treatment facility in San José for people leaving jail with mental health needs. \u003ccite>(Joseph Geha/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Williams said the county has been aiming to preserve or expand services for those in most need across the county. He pointed to plans for new “satellite clinics in high-need communities,” as well as the planned opening of the county’s behavioral health pavilion on the campus of Santa Clara Valley Medical Center later this year.\u003c/p>\n\u003cp>The pavilion will include the first child and adolescent inpatient psychiatric unit in the South Bay, Williams said, and will be staffed by transferring positions from elsewhere in the county.\u003c/p>\n\u003cp>“We’re continuing to expand in critical areas and areas with significant community demand where there’s significant need. We haven’t taken our eye off the ball,” he said.\u003c/p>\n\u003cp>Williams said the county has “moved mountains” to preserve critical services in the face of unprecedented cuts, and said voters have stepped up at an important time. But he called directly on the governor and legislature to help counties across the state.\u003c/p>\n\u003cp>“We need to see a forceful, clear and unequivocal response at the state level to what’s happening with H.R. 1,” he said. “There’s no way our county or any other can do this alone.”\u003c/p>\n\u003cp>The county’s Board of Supervisors will hold three consecutive budget workshops May 11-13, and will hold three more sessions to adopt a final budget in mid-June.\u003c/p>\n\u003cp>The county is not the only government facing down budget deficits, as South Bay cities look for ways to close their gaps while maintaining critical services.\u003c/p>\n\u003cfigure id=\"attachment_11998675\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11998675\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1.jpg\" alt=\"The mayor of San Jose stands behind a podium. A poster breaking down the project budget is displayed next to the speaker.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240802-VTAFEDFUND-JG-1-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">San José Mayor Matt Mahan speaks during a gathering in Santa Clara on Aug. 2, 2024, to announce a nearly $5.1 billion funding commitment from federal transit officials toward the VTA BART Silicon Valley Phase II extension project. \u003ccite>(Joseph Geha/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>San José, whose Mayor Matt Mahan heavily touted his work to spend more of the city’s affordable housing funds on more than 1,000 new interim shelter spaces for people who are homeless last year, is now working to cut $50 million out of its budget.\u003c/p>\n\u003cp>The city’s current proposal from City Manager Jennifer Maguire would cut support for interim housing operations by $1.25 million in the coming budget year and significantly reduce it by $14.2 million in the budget for 2027-2028, officials said this week.\u003c/p>\n\u003cp>Williams said the coming years for Santa Clara County could be even more difficult, and he is concerned about changes to the “social compact” in the country.\u003c/p>\n\u003cp>“We’re one United States, and there are deep interrelationships between federal, state and local governments that all operate together to help take care of communities across the country,” Williams said. “We’re witnessing a complete reordering of that fabric, not just fiscally, but in terms of policy and the politics of this whole country.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "after-the-one-big-beautiful-bill-free-clinics-are-stepping-up",
"title": "After the One Big Beautiful Bill, Free Clinics Are Stepping Up",
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"headTitle": "After the One Big Beautiful Bill, Free Clinics Are Stepping Up | KQED",
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"content": "\u003cp>\u003cem>This story is part of \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>How We Get By\u003c/em>\u003c/a>\u003cem>, a KQED series exploring how people are coping with rising costs in the Bay Area and California. Find the \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>full series here\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\u003cp>For Marisol, it’s not strange to feel aches and pains all over her body when she comes home after work. She picks and packages fruit for farms in \u003ca href=\"https://www.kqed.org/news/tag/contra-costa-county\">Contra Costa County\u003c/a>. Even when temperatures rise over 100 degrees Fahrenheit, she’s out in the field collecting cherries, peaches, nectarines and apricots.\u003c/p>\n\u003cp>She knows it takes a toll on her body. “Sometimes you’re so exhausted that it feels like there’s something wrong with your body, and you don’t know if you’re actually sick or just tired,” she said in Spanish.\u003c/p>\n\u003cp>As an undocumented immigrant without employer-provided health insurance, actually finding out if she’s sick is a luxury. KQED is withholding her full name because publishing it could expose her to potential immigration enforcement. “I either pay my rent or I go to the doctor,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But in the summer of 2023 — when she began to feel several bumps on her breasts — she decided her health could no longer wait. She went to the one place she knew she could get care at no cost: \u003ca href=\"https://www.hijasdelcampo.org/\">Hijas del Campo\u003c/a>.\u003c/p>\n\u003cp>Every Tuesday afternoon, the Contra Costa County Department of Public Health parks \u003ca href=\"https://www.cchealth.org/get-care/for-people-without-health-coverage/health-care-for-the-homeless\">a mobile clinic\u003c/a> outside the nonprofit’s Brentwood offices. The clinic offers limited free care to residents like Marisol who qualify. It’s one of dozens of free clinics across the Bay Area that serve low-income and undocumented immigrants who don’t have access to healthcare.\u003c/p>\n\u003cfigure id=\"attachment_12078942\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12078942 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Marisol, a farmworker in Brentwood, sits outside the Hijas del Campo offices, an organization that connects agricultural workers and their families to free health services, food assistance and legal support on March 31, 2026, in Brentwood, California. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Free clinics across California are bracing for a surge of uninsured patients as provisions in President Donald Trump’s “\u003ca href=\"https://www.kqed.org/news/12073880/tax-credits-trump-2026-refund-tips-child-tax-credit-car-loan-interest-documents\">One Big Beautiful Bill\u003c/a>” take effect, eliminating federal subsidies for some Affordable Care Act plans and tightening Medicaid eligibility rules.\u003c/p>\n\u003cp>About 160,000 Californians have already \u003ca href=\"https://www.ppic.org/blog/many-californians-are-paying-more-for-health-insurance-from-covered-california/\">lost federal subsidies\u003c/a> that made their premiums cheaper and in the coming years, state officials \u003ca href=\"https://lao.ca.gov/reports/2026/5180/Changing_Landscape_Affects_Californias_Health_Care_System_050426.pdf\">estimate\u003c/a> that the number of Californians without health insurance — currently around 2 million — could double by 2030, leaving safety-net clinics to absorb the growing demand for care.\u003c/p>\n\u003cp>The White House has \u003ca href=\"https://www.whitehouse.gov/releases/2025/06/myth-vs-fact-the-one-big-beautiful-bill/\">defended\u003c/a> the OBBB, arguing that these changes will help eliminate “waste, fraud, and abuse” from the nation’s healthcare system. But doctors and volunteers who staff free clinics are already seeing people who have lost coverage and warn that a growing uninsured population could negatively impact care for all patients.\u003c/p>\n\u003ch2>How free care works\u003c/h2>\n\u003cp>Free clinics have existed for decades across the Bay Area, offering primary care to those without health insurance. Many serve suburban and rural communities far from the medical infrastructure of the region’s larger cities. But even in San Francisco, free clinics serve thousands each year.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.clinicbythebay.org/\">Clinic by the Bay\u003c/a> — located in San Francisco’s Excelsior District, one of the most \u003ca href=\"https://www.sfchronicle.com/sf/article/demographic-map-san-francisco-21310100.php\">ethnically diverse neighborhoods\u003c/a> in the city — sees many patients who are experiencing a transition that left them uninsured, often a layoff, aging out of their parents’ insurance or migrating to the United States.\u003c/p>\n\u003cfigure id=\"attachment_12079790\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079790\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Katelyn McMeekin-Jackson, executive director of Clinic by the Bay, poses for a portrait inside the clinic in San Francisco on March 5, 2026. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“And there’s people who are working but cannot afford their healthcare premiums, so they have decided to go without health insurance,” said Katelyn McMeekin-Jackson, executive director of Clinic by the Bay. She knows many patients by their first name, greeting them warmly when they come through the front door.\u003c/p>\n\u003cp>There are only a few requirements to get care there, McMeekin-Jackson said. A new patient must share a copy of an ID, proof of income and confirm they do not have health insurance.\u003c/p>\n\u003cp>More than 200 volunteers — many of them retired doctors, resident physicians and medical students — help the clinic offer primary and ongoing care for those living with chronic conditions, like diabetes.\u003c/p>\n\u003cfigure id=\"attachment_12079789\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079789\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Volunteer Melissa Castillo, left, and executive director Katelyn McMeekin-Jackson walk through a hallway inside Clinic by the Bay in San Francisco on March 5, 2026. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When a patient needs a service that’s not available in-house, staff work with the clinic’s extended network of physicians who are willing to donate their time. Companies like LabCorp also provide a limited number of free screenings, and skilled nursing homes regularly donate surplus medication.\u003c/p>\n\u003cp>“A big part of the puzzle is figuring out how we can get around the limitations to get free care,” McMeekin-Jackson said, adding that over the past year, volunteer numbers increased by about 30% to keep pace with the growing number of patients.\u003c/p>\n\u003cp>“We’re anticipating that patient numbers will grow as premiums increase,” she said. “And there are Medi-Cal changes projected in the future.”\u003c/p>\n\u003ch2>Finding the limits\u003c/h2>\n\u003cp>As Congress raced to finalize the details of the OBBB last summer, lawmakers \u003ca href=\"https://www.wsj.com/politics/policy/trump-wsj-poll-tax-bill-support-ee51c67e\">sought to balance\u003c/a> the price tag of other Trump policy priorities — reshaping the \u003ca href=\"https://www.kqed.org/news/12073880/tax-credits-trump-2026-refund-tips-child-tax-credit-car-loan-interest-documents\">nation’s tax system\u003c/a> and supercharging immigration enforcement — by freeing up funding elsewhere.\u003c/p>\n\u003cp>Republicans moved to end the subsidies that lowered the costs of healthcare premiums for millions of people nationwide who bought their plan through an Affordable Care Act marketplace, which includes Covered California.\u003c/p>\n\u003cfigure id=\"attachment_12079787\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079787\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">The Jewish Community Free Clinic building is seen on March 2, 2026, in Santa Rosa. The clinic provides free healthcare services to uninsured patients. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2024, the federal government spent nearly $14 billion \u003ca href=\"https://www.kff.org/medicaid/what-does-the-federal-government-spend-on-health-care/#Appendix-Table-3\">on subsidies\u003c/a>, which helped millions of Americans \u003ca href=\"https://www.pewresearch.org/short-reads/2026/01/22/what-the-data-says-about-affordable-care-act-health-insurance-exchanges/\">enroll in a plan\u003c/a>. According to the \u003ca href=\"https://www.kff.org/affordable-care-act/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/#:~:text=The%20enhanced%20subsidies%20in%20the%20Inflation%20Reduction%20Act%20reduce%20net%20premium%20costs%20by%2044%25%2C%20on%20average%2C%20for%20enrollees%20receiving%20premium%20tax%20credits%2C%20though%20the%20amount%20of%20savings%20varies%20by%20person.\">Kaiser Family Foundation\u003c/a>, a San Francisco-based public health research nonprofit, the subsidies lowered the annual premium payment in 2024 from about $1,600 to $900 — a difference of about 44%.\u003c/p>\n\u003cp>On Jan. 1, the majority of Covered California enrollees saw their \u003ca href=\"https://www.ppic.org/blog/many-californians-are-paying-more-for-health-insurance-from-covered-california/\">premiums rise\u003c/a> as the federal government pulled back subsidies. But people making above 400% of the federal poverty level — roughly $62,000 for a single person — began paying the full monthly premium for their health insurance. In the Bay Area, some residents \u003ca href=\"https://www.kqed.org/forum/2010101912612/how-are-you-coping-with-increased-health-insurance-premiums\">have shared\u003c/a> that their premiums have gone up by over 150%.\u003c/p>\n\u003cp>“We’re getting a lot of calls from people who lost their plan because they couldn’t pay these outrageous new premiums,” said Donna Waldman, the executive director of the Santa Rosa-based \u003ca href=\"https://www.jewishfreeclinic.org/\">Jewish Community Free Clinic\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_12079785\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079785\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Donna Waldman, executive director and one of the founders of the Jewish Community Free Clinic, listens during a conversation inside the clinic on March 2, 2026, in Santa Rosa. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Waldman, along with a handful of doctors and nurses, started the clinic in 2001. The majority of patients are immigrant farmworkers who power Sonoma County’s multimillion-dollar wine industry. Many are seeing a doctor for the first time in years and are coming in for a one-time check-in — a situation that the clinic is well-equipped for, Waldman said.\u003c/p>\n\u003cp>“We are not set up to do chronic disease maintenance,” she said. “Our system’s not set up to have you come back every three or four months to get your blood pressure checked — that’s not our type of practice.”\u003c/p>\n\u003cp>Higher premiums are not just forcing people to drop their plan, but also discouraging those who could qualify for a Covered California plan from signing up.\u003c/p>\n\u003cfigure id=\"attachment_12079786\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079786\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Rivka Vaughs, who works at the front desk and assists with grant writing, sits in the waiting area of the Jewish Community Free Clinic on March 2, 2026, in Santa Rosa. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In Sonoma County, new enrollment this year \u003ca href=\"https://www.pressdemocrat.com/2026/02/28/new-affordable-care-act-enrollment-declines-by-33-in-north-bay/\">decreased by 33%\u003c/a>, with officials reporting a \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2026/02/26/as-enhanced-federal-subsidies-expire-covered-california-ends-open-enrollment-with-state-subsidies-keeping-renewals-steady-for-now-and-new-signups-down/#:~:text=California%20allocated%20%24190%20million%20from,of%20the%20federal%20poverty%20level.\">similar drop statewide\u003c/a>. And according to \u003ca href=\"https://lao.ca.gov/reports/2026/5180/Changing_Landscape_Affects_Californias_Health_Care_System_050426.pdf\">some researchers\u003c/a>, the first people to drop their Covered California plans are usually younger, healthier individuals who use fewer benefits. Those enrollees help lower the costs of care for everyone else. But with fewer healthier people in the marketplace, premiums could rise even higher.\u003c/p>\n\u003cp>When folks call in after dropping their plan, Waldman said the clinic can see them in the meantime, but they also work with the patient to see if they qualify for care at a \u003ca href=\"https://findahealthcenter.hrsa.gov/\">federally qualified health center\u003c/a> — which serve patients on a sliding fee scale, but are subject to income limits and \u003ca href=\"https://www.hhs.gov/press-room/prwora-hhs-bans-illegal-aliens-accessing-taxpayer-funded-programs.html\">potential immigration rules\u003c/a> from the Trump administration.\u003c/p>\n\u003cp>“We have nothing to lose monetarily from the federal government,” Waldman said. “Free clinics play a really important role in the resiliency of the community right now because we are independent organizations.”\u003c/p>\n\u003ch2>‘Influenza doesn’t know if you have insurance or not’\u003c/h2>\n\u003cp>The OBBB’s next big shock to healthcare is expected at the end of this year. By Dec. 31, states must implement stricter eligibility requirements for patients enrolled in Medicaid — known as Medi-Cal in California, which provides free or low-cost care to roughly 15 million lower-income residents.\u003c/p>\n\u003cp>In 2010, the Obama administration expanded Medicaid eligibility to include adults aged 19-64 with incomes below 138% of the federal poverty level. In the decade that followed, \u003ca href=\"https://www.ppic.org/blog/medi-cal-has-expanded-health-coverage-in-california/\">Medi-Cal enrollment soared\u003c/a>, with the biggest increase in that newly-eligible group.\u003c/p>\n\u003cfigure id=\"attachment_12079783\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079783\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A hallway inside the San Francisco Free Clinic in the Richmond District on Feb. 27, 2026. The clinic provides free primary care and specialty services to patients without health insurance. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Under the OBBB, Medi-Cal recipients will need to renew their eligibility every six months, instead of annually, and those who are able-bodied and without dependents have to either work, go to school or do community service for at least 80 hours each month.\u003c/p>\n\u003cp>State officials \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2025/05/newsom-medicaid-impacts-memo.pdf\">estimated\u003c/a> the new requirements would result in up to 3.4 million Californians losing their Medi-Cal coverage. And because federal funding for Medi-Cal is dependent on how many people are enrolled, the state could lose over $30 billion.\u003c/p>\n\u003cp>That’s unfortunate, said Ashley Tsang, medical director for the San Francisco Free Clinic, because more people on Medi-Cal means fewer people who are uninsured.[aside postID=news_12078480 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/AffordabilitySeriesIntro_Lede.jpg']“We were hoping that there were going to be fewer people uninsured as Medi-Cal covered more people,” Tsang said. “At some point, our numbers would have actually dropped.”\u003c/p>\n\u003cp>The clinic currently sees around 1,500 uninsured patients each year with the help of a few dozen physicians and medical students. Tsang — who helps run the Richmond District clinic along with her husband and fellow physician Ian Nelligan — said the team hasn’t yet needed to expand service hours, but that’s something they are thinking about given the political situation.\u003c/p>\n\u003cp>“COVID-19 taught us that [infectious diseases don’t] know if you have insurance or not, and people will end up at the emergency department one way or the other,” she said. “We all end up paying for patients who have no health insurance.”\u003c/p>\n\u003cp>A \u003ca href=\"https://lao.ca.gov/reports/2026/5180/Changing_Landscape_Affects_Californias_Health_Care_System_050426.pdf\">recent report\u003c/a> from the state Legislative Analyst’s Office predicts that care providers — including private and public hospitals that treat patients with coverage — may feel greater financial pressure as the uninsured population grows in the coming years.\u003c/p>\n\u003cp>Many providers, the report finds, “will still provide some care to these populations without receiving reimbursement,” and as these expenses go up, they may negotiate higher rates with private insurance plans.\u003c/p>\n\u003ch2>Pushing back on closed doors\u003c/h2>\n\u003cp>White House officials have argued that other parts of the OBBB — like larger tax deductibles and expanded flexible spending accounts — will make it easier for individuals to pay for health insurance.\u003c/p>\n\u003cp>But the administration has made clear the changes will limit access to low-cost care for one group of people in particular: undocumented immigrants. Blocking this group from Medicaid is necessary “to preserve it for hardworking Americans who need it,” press secretary Karoline Leavitt said before the bill’s passage.\u003c/p>\n\u003cp>The OBBB reduced federal funds that helped states provide emergency Medicaid coverage to undocumented immigrants — a \u003ca href=\"https://www.whitehouse.gov/wp-content/uploads/2025/10/WFTCA-Illegal-Immigrant-Healthcare-Memo-FINAL.pdf\">White House memo\u003c/a> went as far as calling this move “closing the California loophole.”\u003c/p>\n\u003cfigure id=\"attachment_12078937\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12078937\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Pro-farmworker posters adorn the walls inside the Hijas del Campo workspace. The group helps coordinate services including food distribution, healthcare access and legal aid for farmworkers and their families, on March 31, 2026, in Brentwood, California. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This change — along with other expected healthcare cuts from the federal government — prompted state lawmakers last year to \u003ca href=\"https://calmatters.org/politics/2025/06/california-budget-newsom-democrats/\">block new Medi-Cal enrollment\u003c/a> for undocumented immigrants aged 19 and older.\u003c/p>\n\u003cp>That means Marisol can no longer sign up for Medi-Cal, leaving her with only the mobile clinic outside Hijas del Campo for care.\u003c/p>\n\u003cp>“This is an injustice,” the farmworker said. “Our work is very intense, and it’s what brings food to people’s tables. But this work is not valued.”\u003c/p>\n\u003cfigure id=\"attachment_12078938\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12078938\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Dorina Salgado-Moraida, co-founder of Hijas del Campo, stands beside a Contra Costa Health Department mobile clinic used to provide free and low-cost medical services to farmworkers and underserved residents, on March 31, 2026, in Brentwood, California. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When she first felt those bumps on her breasts in 2023, a doctor at the clinic confirmed she had a tumor — but a benign one that was treated thanks to the county program. Marisol still comes to the mobile clinic for follow-ups.\u003c/p>\n\u003cp>“People are still going to be sick,” said Hijas del Campo co-founder Dorina Salgado-Moraida, who pointed out that there are thousands of undocumented immigrants in other parts of the state who will be left with no options for care.\u003c/p>\n\u003cp>“We had some learnings from the pandemic, but then at the same time, we didn’t really learn much,” she said. “We didn’t put systems in place to protect those who are the most essential.”\u003c/p>\n\u003cp>\u003cem>Editor’s Note: This story was updated to clarify medical terminology. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "After the passage of the One Big Beautiful Bill, many Californians no longer have access to healthcare because of higher premiums or their immigration status. Free clinics are rushing to fill the gaps in coverage.",
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"title": "After the One Big Beautiful Bill, Free Clinics Are Stepping Up | KQED",
"description": "After the passage of the One Big Beautiful Bill, many Californians no longer have access to healthcare because of higher premiums or their immigration status. Free clinics are rushing to fill the gaps in coverage.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story is part of \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>How We Get By\u003c/em>\u003c/a>\u003cem>, a KQED series exploring how people are coping with rising costs in the Bay Area and California. Find the \u003c/em>\u003ca href=\"https://www.kqed.org/affordability\">\u003cem>full series here\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\u003cp>For Marisol, it’s not strange to feel aches and pains all over her body when she comes home after work. She picks and packages fruit for farms in \u003ca href=\"https://www.kqed.org/news/tag/contra-costa-county\">Contra Costa County\u003c/a>. Even when temperatures rise over 100 degrees Fahrenheit, she’s out in the field collecting cherries, peaches, nectarines and apricots.\u003c/p>\n\u003cp>She knows it takes a toll on her body. “Sometimes you’re so exhausted that it feels like there’s something wrong with your body, and you don’t know if you’re actually sick or just tired,” she said in Spanish.\u003c/p>\n\u003cp>As an undocumented immigrant without employer-provided health insurance, actually finding out if she’s sick is a luxury. KQED is withholding her full name because publishing it could expose her to potential immigration enforcement. “I either pay my rent or I go to the doctor,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But in the summer of 2023 — when she began to feel several bumps on her breasts — she decided her health could no longer wait. She went to the one place she knew she could get care at no cost: \u003ca href=\"https://www.hijasdelcampo.org/\">Hijas del Campo\u003c/a>.\u003c/p>\n\u003cp>Every Tuesday afternoon, the Contra Costa County Department of Public Health parks \u003ca href=\"https://www.cchealth.org/get-care/for-people-without-health-coverage/health-care-for-the-homeless\">a mobile clinic\u003c/a> outside the nonprofit’s Brentwood offices. The clinic offers limited free care to residents like Marisol who qualify. It’s one of dozens of free clinics across the Bay Area that serve low-income and undocumented immigrants who don’t have access to healthcare.\u003c/p>\n\u003cfigure id=\"attachment_12078942\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12078942 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_016_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Marisol, a farmworker in Brentwood, sits outside the Hijas del Campo offices, an organization that connects agricultural workers and their families to free health services, food assistance and legal support on March 31, 2026, in Brentwood, California. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Free clinics across California are bracing for a surge of uninsured patients as provisions in President Donald Trump’s “\u003ca href=\"https://www.kqed.org/news/12073880/tax-credits-trump-2026-refund-tips-child-tax-credit-car-loan-interest-documents\">One Big Beautiful Bill\u003c/a>” take effect, eliminating federal subsidies for some Affordable Care Act plans and tightening Medicaid eligibility rules.\u003c/p>\n\u003cp>About 160,000 Californians have already \u003ca href=\"https://www.ppic.org/blog/many-californians-are-paying-more-for-health-insurance-from-covered-california/\">lost federal subsidies\u003c/a> that made their premiums cheaper and in the coming years, state officials \u003ca href=\"https://lao.ca.gov/reports/2026/5180/Changing_Landscape_Affects_Californias_Health_Care_System_050426.pdf\">estimate\u003c/a> that the number of Californians without health insurance — currently around 2 million — could double by 2030, leaving safety-net clinics to absorb the growing demand for care.\u003c/p>\n\u003cp>The White House has \u003ca href=\"https://www.whitehouse.gov/releases/2025/06/myth-vs-fact-the-one-big-beautiful-bill/\">defended\u003c/a> the OBBB, arguing that these changes will help eliminate “waste, fraud, and abuse” from the nation’s healthcare system. But doctors and volunteers who staff free clinics are already seeing people who have lost coverage and warn that a growing uninsured population could negatively impact care for all patients.\u003c/p>\n\u003ch2>How free care works\u003c/h2>\n\u003cp>Free clinics have existed for decades across the Bay Area, offering primary care to those without health insurance. Many serve suburban and rural communities far from the medical infrastructure of the region’s larger cities. But even in San Francisco, free clinics serve thousands each year.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.clinicbythebay.org/\">Clinic by the Bay\u003c/a> — located in San Francisco’s Excelsior District, one of the most \u003ca href=\"https://www.sfchronicle.com/sf/article/demographic-map-san-francisco-21310100.php\">ethnically diverse neighborhoods\u003c/a> in the city — sees many patients who are experiencing a transition that left them uninsured, often a layoff, aging out of their parents’ insurance or migrating to the United States.\u003c/p>\n\u003cfigure id=\"attachment_12079790\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079790\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_017-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Katelyn McMeekin-Jackson, executive director of Clinic by the Bay, poses for a portrait inside the clinic in San Francisco on March 5, 2026. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“And there’s people who are working but cannot afford their healthcare premiums, so they have decided to go without health insurance,” said Katelyn McMeekin-Jackson, executive director of Clinic by the Bay. She knows many patients by their first name, greeting them warmly when they come through the front door.\u003c/p>\n\u003cp>There are only a few requirements to get care there, McMeekin-Jackson said. A new patient must share a copy of an ID, proof of income and confirm they do not have health insurance.\u003c/p>\n\u003cp>More than 200 volunteers — many of them retired doctors, resident physicians and medical students — help the clinic offer primary and ongoing care for those living with chronic conditions, like diabetes.\u003c/p>\n\u003cfigure id=\"attachment_12079789\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079789\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/030526_FREECLINICS-_GH_016-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Volunteer Melissa Castillo, left, and executive director Katelyn McMeekin-Jackson walk through a hallway inside Clinic by the Bay in San Francisco on March 5, 2026. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When a patient needs a service that’s not available in-house, staff work with the clinic’s extended network of physicians who are willing to donate their time. Companies like LabCorp also provide a limited number of free screenings, and skilled nursing homes regularly donate surplus medication.\u003c/p>\n\u003cp>“A big part of the puzzle is figuring out how we can get around the limitations to get free care,” McMeekin-Jackson said, adding that over the past year, volunteer numbers increased by about 30% to keep pace with the growing number of patients.\u003c/p>\n\u003cp>“We’re anticipating that patient numbers will grow as premiums increase,” she said. “And there are Medi-Cal changes projected in the future.”\u003c/p>\n\u003ch2>Finding the limits\u003c/h2>\n\u003cp>As Congress raced to finalize the details of the OBBB last summer, lawmakers \u003ca href=\"https://www.wsj.com/politics/policy/trump-wsj-poll-tax-bill-support-ee51c67e\">sought to balance\u003c/a> the price tag of other Trump policy priorities — reshaping the \u003ca href=\"https://www.kqed.org/news/12073880/tax-credits-trump-2026-refund-tips-child-tax-credit-car-loan-interest-documents\">nation’s tax system\u003c/a> and supercharging immigration enforcement — by freeing up funding elsewhere.\u003c/p>\n\u003cp>Republicans moved to end the subsidies that lowered the costs of healthcare premiums for millions of people nationwide who bought their plan through an Affordable Care Act marketplace, which includes Covered California.\u003c/p>\n\u003cfigure id=\"attachment_12079787\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079787\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_037-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">The Jewish Community Free Clinic building is seen on March 2, 2026, in Santa Rosa. The clinic provides free healthcare services to uninsured patients. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2024, the federal government spent nearly $14 billion \u003ca href=\"https://www.kff.org/medicaid/what-does-the-federal-government-spend-on-health-care/#Appendix-Table-3\">on subsidies\u003c/a>, which helped millions of Americans \u003ca href=\"https://www.pewresearch.org/short-reads/2026/01/22/what-the-data-says-about-affordable-care-act-health-insurance-exchanges/\">enroll in a plan\u003c/a>. According to the \u003ca href=\"https://www.kff.org/affordable-care-act/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/#:~:text=The%20enhanced%20subsidies%20in%20the%20Inflation%20Reduction%20Act%20reduce%20net%20premium%20costs%20by%2044%25%2C%20on%20average%2C%20for%20enrollees%20receiving%20premium%20tax%20credits%2C%20though%20the%20amount%20of%20savings%20varies%20by%20person.\">Kaiser Family Foundation\u003c/a>, a San Francisco-based public health research nonprofit, the subsidies lowered the annual premium payment in 2024 from about $1,600 to $900 — a difference of about 44%.\u003c/p>\n\u003cp>On Jan. 1, the majority of Covered California enrollees saw their \u003ca href=\"https://www.ppic.org/blog/many-californians-are-paying-more-for-health-insurance-from-covered-california/\">premiums rise\u003c/a> as the federal government pulled back subsidies. But people making above 400% of the federal poverty level — roughly $62,000 for a single person — began paying the full monthly premium for their health insurance. In the Bay Area, some residents \u003ca href=\"https://www.kqed.org/forum/2010101912612/how-are-you-coping-with-increased-health-insurance-premiums\">have shared\u003c/a> that their premiums have gone up by over 150%.\u003c/p>\n\u003cp>“We’re getting a lot of calls from people who lost their plan because they couldn’t pay these outrageous new premiums,” said Donna Waldman, the executive director of the Santa Rosa-based \u003ca href=\"https://www.jewishfreeclinic.org/\">Jewish Community Free Clinic\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_12079785\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079785\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_027-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Donna Waldman, executive director and one of the founders of the Jewish Community Free Clinic, listens during a conversation inside the clinic on March 2, 2026, in Santa Rosa. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Waldman, along with a handful of doctors and nurses, started the clinic in 2001. The majority of patients are immigrant farmworkers who power Sonoma County’s multimillion-dollar wine industry. Many are seeing a doctor for the first time in years and are coming in for a one-time check-in — a situation that the clinic is well-equipped for, Waldman said.\u003c/p>\n\u003cp>“We are not set up to do chronic disease maintenance,” she said. “Our system’s not set up to have you come back every three or four months to get your blood pressure checked — that’s not our type of practice.”\u003c/p>\n\u003cp>Higher premiums are not just forcing people to drop their plan, but also discouraging those who could qualify for a Covered California plan from signing up.\u003c/p>\n\u003cfigure id=\"attachment_12079786\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079786\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_029-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Rivka Vaughs, who works at the front desk and assists with grant writing, sits in the waiting area of the Jewish Community Free Clinic on March 2, 2026, in Santa Rosa. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In Sonoma County, new enrollment this year \u003ca href=\"https://www.pressdemocrat.com/2026/02/28/new-affordable-care-act-enrollment-declines-by-33-in-north-bay/\">decreased by 33%\u003c/a>, with officials reporting a \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2026/02/26/as-enhanced-federal-subsidies-expire-covered-california-ends-open-enrollment-with-state-subsidies-keeping-renewals-steady-for-now-and-new-signups-down/#:~:text=California%20allocated%20%24190%20million%20from,of%20the%20federal%20poverty%20level.\">similar drop statewide\u003c/a>. And according to \u003ca href=\"https://lao.ca.gov/reports/2026/5180/Changing_Landscape_Affects_Californias_Health_Care_System_050426.pdf\">some researchers\u003c/a>, the first people to drop their Covered California plans are usually younger, healthier individuals who use fewer benefits. Those enrollees help lower the costs of care for everyone else. But with fewer healthier people in the marketplace, premiums could rise even higher.\u003c/p>\n\u003cp>When folks call in after dropping their plan, Waldman said the clinic can see them in the meantime, but they also work with the patient to see if they qualify for care at a \u003ca href=\"https://findahealthcenter.hrsa.gov/\">federally qualified health center\u003c/a> — which serve patients on a sliding fee scale, but are subject to income limits and \u003ca href=\"https://www.hhs.gov/press-room/prwora-hhs-bans-illegal-aliens-accessing-taxpayer-funded-programs.html\">potential immigration rules\u003c/a> from the Trump administration.\u003c/p>\n\u003cp>“We have nothing to lose monetarily from the federal government,” Waldman said. “Free clinics play a really important role in the resiliency of the community right now because we are independent organizations.”\u003c/p>\n\u003ch2>‘Influenza doesn’t know if you have insurance or not’\u003c/h2>\n\u003cp>The OBBB’s next big shock to healthcare is expected at the end of this year. By Dec. 31, states must implement stricter eligibility requirements for patients enrolled in Medicaid — known as Medi-Cal in California, which provides free or low-cost care to roughly 15 million lower-income residents.\u003c/p>\n\u003cp>In 2010, the Obama administration expanded Medicaid eligibility to include adults aged 19-64 with incomes below 138% of the federal poverty level. In the decade that followed, \u003ca href=\"https://www.ppic.org/blog/medi-cal-has-expanded-health-coverage-in-california/\">Medi-Cal enrollment soared\u003c/a>, with the biggest increase in that newly-eligible group.\u003c/p>\n\u003cfigure id=\"attachment_12079783\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12079783\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/022726_FREE-CLINICS-_GH_009-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A hallway inside the San Francisco Free Clinic in the Richmond District on Feb. 27, 2026. The clinic provides free primary care and specialty services to patients without health insurance. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Under the OBBB, Medi-Cal recipients will need to renew their eligibility every six months, instead of annually, and those who are able-bodied and without dependents have to either work, go to school or do community service for at least 80 hours each month.\u003c/p>\n\u003cp>State officials \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2025/05/newsom-medicaid-impacts-memo.pdf\">estimated\u003c/a> the new requirements would result in up to 3.4 million Californians losing their Medi-Cal coverage. And because federal funding for Medi-Cal is dependent on how many people are enrolled, the state could lose over $30 billion.\u003c/p>\n\u003cp>That’s unfortunate, said Ashley Tsang, medical director for the San Francisco Free Clinic, because more people on Medi-Cal means fewer people who are uninsured.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“We were hoping that there were going to be fewer people uninsured as Medi-Cal covered more people,” Tsang said. “At some point, our numbers would have actually dropped.”\u003c/p>\n\u003cp>The clinic currently sees around 1,500 uninsured patients each year with the help of a few dozen physicians and medical students. Tsang — who helps run the Richmond District clinic along with her husband and fellow physician Ian Nelligan — said the team hasn’t yet needed to expand service hours, but that’s something they are thinking about given the political situation.\u003c/p>\n\u003cp>“COVID-19 taught us that [infectious diseases don’t] know if you have insurance or not, and people will end up at the emergency department one way or the other,” she said. “We all end up paying for patients who have no health insurance.”\u003c/p>\n\u003cp>A \u003ca href=\"https://lao.ca.gov/reports/2026/5180/Changing_Landscape_Affects_Californias_Health_Care_System_050426.pdf\">recent report\u003c/a> from the state Legislative Analyst’s Office predicts that care providers — including private and public hospitals that treat patients with coverage — may feel greater financial pressure as the uninsured population grows in the coming years.\u003c/p>\n\u003cp>Many providers, the report finds, “will still provide some care to these populations without receiving reimbursement,” and as these expenses go up, they may negotiate higher rates with private insurance plans.\u003c/p>\n\u003ch2>Pushing back on closed doors\u003c/h2>\n\u003cp>White House officials have argued that other parts of the OBBB — like larger tax deductibles and expanded flexible spending accounts — will make it easier for individuals to pay for health insurance.\u003c/p>\n\u003cp>But the administration has made clear the changes will limit access to low-cost care for one group of people in particular: undocumented immigrants. Blocking this group from Medicaid is necessary “to preserve it for hardworking Americans who need it,” press secretary Karoline Leavitt said before the bill’s passage.\u003c/p>\n\u003cp>The OBBB reduced federal funds that helped states provide emergency Medicaid coverage to undocumented immigrants — a \u003ca href=\"https://www.whitehouse.gov/wp-content/uploads/2025/10/WFTCA-Illegal-Immigrant-Healthcare-Memo-FINAL.pdf\">White House memo\u003c/a> went as far as calling this move “closing the California loophole.”\u003c/p>\n\u003cfigure id=\"attachment_12078937\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12078937\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_001_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Pro-farmworker posters adorn the walls inside the Hijas del Campo workspace. The group helps coordinate services including food distribution, healthcare access and legal aid for farmworkers and their families, on March 31, 2026, in Brentwood, California. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This change — along with other expected healthcare cuts from the federal government — prompted state lawmakers last year to \u003ca href=\"https://calmatters.org/politics/2025/06/california-budget-newsom-democrats/\">block new Medi-Cal enrollment\u003c/a> for undocumented immigrants aged 19 and older.\u003c/p>\n\u003cp>That means Marisol can no longer sign up for Medi-Cal, leaving her with only the mobile clinic outside Hijas del Campo for care.\u003c/p>\n\u003cp>“This is an injustice,” the farmworker said. “Our work is very intense, and it’s what brings food to people’s tables. But this work is not valued.”\u003c/p>\n\u003cfigure id=\"attachment_12078938\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12078938\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/04/033126Free-Clinics-Brentwood_GH_008_qed-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Dorina Salgado-Moraida, co-founder of Hijas del Campo, stands beside a Contra Costa Health Department mobile clinic used to provide free and low-cost medical services to farmworkers and underserved residents, on March 31, 2026, in Brentwood, California. \u003ccite>(Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When she first felt those bumps on her breasts in 2023, a doctor at the clinic confirmed she had a tumor — but a benign one that was treated thanks to the county program. Marisol still comes to the mobile clinic for follow-ups.\u003c/p>\n\u003cp>“People are still going to be sick,” said Hijas del Campo co-founder Dorina Salgado-Moraida, who pointed out that there are thousands of undocumented immigrants in other parts of the state who will be left with no options for care.\u003c/p>\n\u003cp>“We had some learnings from the pandemic, but then at the same time, we didn’t really learn much,” she said. “We didn’t put systems in place to protect those who are the most essential.”\u003c/p>\n\u003cp>\u003cem>Editor’s Note: This story was updated to clarify medical terminology. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"order": 1
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
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"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
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"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"meta": {
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
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"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
"meta": {
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
"subscribe": {
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"npr": "https://www.npr.org/podcasts/432309616/perspectives",
"rss": "https://ww2.kqed.org/perspectives/category/perspectives/feed/",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"
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},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/M4f5",
"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
"tuneIn": "https://tunein.com/podcasts/Business--Economics-Podcasts/Planet-Money-p164680/",
"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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