Mark A. Peterson, senior fellow at the UCLA Center for Health Policy Research and a professor of public policy at the UCLA Luskin School of Public Affairs, recently appeared on KQED’s public affairs radio show “Forum,” to talk about what could happen to California health care programs as the Trump administration takes power.
The Republican party has signaled plans to overhaul the federal Medicaid program, which provides health care for low-income people, and which could result in billions of dollars in cuts to California, where 14 million people receive Medi-Cal benefits. Trump policies could also have major implications for Covered California, the state’s health insurance marketplace, and for health care programs addressing homelessness and reproductive health.
In a conversation moderated by “Forum” co-host Alexis Madrigal, and that included state Mia Bonta, state assemblywoman and chair of the assembly health committee, Angela Hart, KFF Health News senior correspondent covering health care politics and policy in California and the West, Peterson provided insights into the what’s motivating the Republican ideas, past attempts to revamp health care, and what’s at stake this year, which we excerpt here.
Listen to the episode to hear what the panelists had to say about other topics, too, including the prospect of single-payer coverage in California, reproductive health, and abortion access.
On why have Republicans wanted to overhaul Medicaid
“Well [the Republicans’] argument is that the Medicaid program is extremely inefficient, that it requires things that are not productive to health. There should be more opportunity for state innovation, and in particular they go back to the argument that in 1965 when the Medicaid program was enacted along with Medicare. It was intended for very poor people who simply had no means of their own to provide for their care. They argue now, particularly under the Affordable Care Act and the Medicaid expansion, that health care coverage paid for by the taxpayer is going to a lot of people who should be able to take care of themselves on their own.”
What changes to Medicaid could look like
“Well, the long-standing approach of Republicans in Congress — that Trump signed onto during the ‘Repeal and Replace’ activities of 2017 that failed — was to turn the Medicaid program from an entitlement, in which states and individuals got the funding as they needed it for the coverage they were guaranteed under the program, to a block grant. [That’s] a budgeted amount of money each year that would be sent to the states based on a formula, however much demand for health care either rose or declined. So, it’d be a very sharp reduction in spending, a lot more flexibility, but flexibility with very little in the way of resources to provide care.
“Now, I want to emphasize that when Republicans and Trump came in in 2017 and tried to do that, it failed dramatically with larger margins in the House and the Senate than they have now, or particularly the House. So it’s not as if this will be a particularly easy thing for them to do, particularly with the size of the Republican majority in the House in this next Congress and facing a midterm election in 2026.”
California’s Medi-Cal program operates differently from other Medicaid programs through waivers that have allowed the state to expand coverage to address social determinants of health
“We do know [there’s a] tremendous amount of research in the past couple decades about the role of the social determinants of health and the reality is that the delivery of health care is a rescue operation. That’s what we do when people become ill. Well, what if we can prevent people from becoming ill in the first place? Which would be both enhancement for their lives and their economic productivity. It would also mean we’d be spending less on health care.
“Let’s keep in mind that in the United States we spend twice as much per capita on health care than any country in the world even though we don’t cover everybody in our insurance system. And I just want to say a little bit about the waivers. Not only will California not be able to expand under Medi-Cal with new waivers, the waivers we have for CalAim do expire. So, even before we talk about major changes in the Medicaid program nationally that would have an impact on California — we are already talking about major losses for the state just by knowing that those waivers will not be renewed.”