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Leadership

In Practice: A Message from the President

From our recent electronic newsletter, The Member Connect:

Dear Colleagues,

With the passage of H.R. 1, the so-called “Big Beautiful Bill,” the implications for health care in this country are profound.

To summarize:

The bill enacts more than $1 trillion in Federal health care cuts over the next decade. It is estimated that 17 million individuals will lose their health insurance.

A recent CMA bulletin outlined the potential effects on California’s health care system:

  • Massive coverage losses: An estimated 2.5 million Medi-Cal enrollees and up to 2.6 million Covered California participants will lose coverage.
  • Less affordable care: The bill imposes new $35 copays per service on the Medicaid expansion population starting in 2028, a barrier to care for low-income patients. By allowing ACA premium tax credits to expire, nearly 2 million Californians face premium hikes of up to 66%, making coverage unaffordable for many.
  • Devastating provider cuts and payment caps: The bill slashes as much as $128 billion from California’s health care system over 10 years by cutting provider taxes and capping state-directed payments. These reductions are expected to lower hospital and physician payments and may force service reductions or closures.
  • Uncompensated care surge: With fewer patients insured, California hospitals and physicians could face $9.5 billion in new uncompensated care costs over the next decade.
  • Economic fallout: Health system contractions are projected to eliminate 217,000 California health care jobs, reduce economic output by $37 billion, and cut $1.7 billion from state and local tax revenues.
  • Burdensome new requirements: The law imposes 80-hour monthly work, school, or community service requirements on many adult Medicaid enrollees, with complex paperwork and reporting. This red tape could cause more than 4.8 million otherwise eligible adults to lose coverage nationwide.
  • Planned Parenthood defunding: One year of Medicaid defunding for Planned Parenthood would strip $305 million from California and threaten more than 80% of the state’s 1.2 million annual patient visits to its clinics.
  • Student loan cuts: The bill imposes several cuts to student loan programs, including a $200,000 cap on federal borrowing for medical school. This creates additional barriers for aspiring physicians and worsens our workforce shortages. (Note: The provision eliminating Public Service Loan Forgiveness for residency/internship hours was removed.)

I obtained the following data from the California Department of Health Care Access and Information (2023):

Hospitals

  • 45% of patients at Lompoc Valley Community Hospital are covered by Medi-Cal.
  • 40% of patients at Marian Regional Medical Center are covered by Medi-Cal.
  • 25% of patients at Adventist Health Sierra Vista are covered by Medi-Cal.
  • 24% of patients at Adventist Health Twin Cities are covered by Medi-Cal.
  • 22% of patients at Cottage Hospital are covered by Medi-Cal.
  • 13% of patients at French Hospital are covered by Medi-Cal.

Safety-Net Clinics

  • 82% of patients at American Indian Health & Services are covered by Medi-Cal.
  • 70% of patients at the County of Santa Barbara Health Care Centers are covered by Medi-Cal.
  • 65% of patients at Santa Barbara Neighborhood Clinics are covered by Medi-Cal.

The changes to our health care system are both discouraging and deeply concerning. It is particularly frustrating that the primary recommended response has been to contact our elected officials—most of whom, in Santa Barbara and San Luis Obispo counties, have already expressed strong opposition to these changes. We are fortunate to live in a region where our representatives, both local and statewide, share our values and understand the impact this bill would have on our communities.

Unfortunately, much of the country (at least their elected representatives) does not share California’s approach to caring for its residents. Still, I urge you to continue reaching out to our legislators. Sharing real patient stories and the local impact of these policies gives them the tools to advocate more effectively on our behalf in Sacramento and Washington, D.C.

There’s no single answer for how to address this. But I am convinced that one of the strongest paths forward is through sustained advocacy from the California Medical Association and our national specialty organizations (ACP, AAFP, ACOG, AAP, etc.). Please stay engaged with these groups as they work to mitigate harm and push for needed changes.

Thank you for being a member of CCMA and CMA, and for your continued commitment to compassionate, high-quality patient care.

Please take care of yourselves.

Todd Engstrom, MD, FACP
President, Central Coast Medical Association

2025 Board of Directors

Executive Committee:
Todd Engstrom, MD, President
Christopher Quijano, DO, President-Elect
Timothy Auran, MD, Treasurer
Bradley Knox, MD, Secretary
Douglas Murphy, MD, Immediate Past President

Directors:
Kevin Casey, MD
Justin Chang, MD
Julie Fallon, MD
Priti Gagneja, MD
Samira Kayumi-Rashti, MD
Winifred Leung, MD
Nicole Stern, MD, MPH
Robert Turbow, MD, JD

CMA House of Delegates

Sharon Basham, MD
Kevin Casey, MD
Todd Engstrom, MD
Julie Fallon, MD
Priti Gagneja, MD
Maya Heinert, MD, MBA
Samira Kayumi-Rashti, MD
Jason Krupp, MD
Christopher Lumsdaine, MD
Douglas Murphy, MD
Christopher Quijano, DO
Jane Varner, MD

CMA President Elect

René Bravo, MD

CMA Trustee, District V

Jennifer Hone, MD

American Medical Association Delegate

Jennifer Hone, MD