On a hot, summer Thursday evening at Regional Medical Center’s cafeteria, over 100 community members jammed the room with one shared mission: to learn how HR 1, or the ‘Big, Beautiful HORRIBLE Bill,’ will affect residents of Santa Clara County, especially those who rely on Medicaid to access healthcare? County Leadership, County Executive James Williams and County Board Supervisor Betty Duong, made one thing evidently and abundantly clear — the passage of this federal budget has pushed our Public Healthcare system into crisis.
We are all going to be affected no matter what. However, County leaders, and community based organizations, including Working Partnerships USA, are committed to strengthening our county health system and organizing to protect our healthcare from Billionaire tax breaks.
5 takeaways from the townhalls
- The reckless cuts to Medicaid/Medi-Cal endanger our County’s public healthcare system — but Santa Clara County is working hard to ensure everyone receives the care they need, and as citizens, we have a voice.
Santa Clara County receives $3.7 billion in funding from the federal government, representing 30% of the County’s budget. With the passage of HR 1, the County is anticipating difficult conversations about how to mitigate this ginormous and unprecedented gap in funding. Medicaid, or known as Medi-Cal in California, is the largest source of federal revenue for Santa Clara County. As County Executive James Williams put it, “Medicaid is not a line item. It is a lifeline. It supports critical health care services that benefit everyone in our community.”
1 in every 4 residents in Santa Clara County are Medi-Cal enrollees, meaning that 25% of Santa Clara County residents will lose healthcare insurance and will resort to only going to hospital emergency room visits rather than ongoing preventative care. The public healthcare system will continuously provide care to residents, but this care will be unpaid for – resulting in tremendous amounts of debt and funding gaps for the county and its residents.
- Enroll in Medi-Cal before January 1, 2026 or enroll in the Primary Care Access Program (PCAP)
HR 1 is also forcing state governments to foot more of the bill for healthcare. California is preparing for these cuts by freezing enrollment for Medi-Cal on January 1, 2026. Determine if you are eligible on Covered California’s website and learn how to apply on the CA’s Department of Healthcare Services’ website. However, California and other states that have expanded Medicaid to undocumented patients reported being forced to hand over patient information to the federal government and the Department of Homeland Security (AP News). Only enroll if you believe it is the best fit for you and your family.
Santa Clara County also has the Primary Care Access Program (PCAP), a local low-cost healthcare insurance program for adults living in Santa Clara County. PCAP covers primary care, preventative care, pharmacy services, and some screening and diagnostic services. The program also covers emergency room visits at any of the County of Santa Clara hospitals including Regional Medical Center, Valley Medical Center, O’Connor Hospital, and St. Louise Regional Hospital.
- Cuts will hit in 2026
Cuts to healthcare access with Medicaid and subsidized groceries from SNAP will be taking into effect in 2026 as reported by the The New York Times.
Cuts will occur by forcing patients to undergo laborious re-enrollments and qualifying with work requirements. Medicaid work requirements that are going to take into effect on December 31, 2026 for most states, mandating that adults with children 14 or older must obtain work in order to qualify for aid. These changes are expected to increase premium’s prices, reduce enrollment, and cause insurers to withdraw from the market, making healthcare access inaccessible for many residents.
Additionally, Supplemental Nutrition Assistance Program (SNAP) or food stamp funding changes are also set to change starting in 2028. Similar to Medicaid’s work requirements, adults receiving SNAP benefits will also be required to work in exchange for assistance. These changes can create barriers to healthcare and food assistance, particularly for individuals with disabilities, insecure employment, and caregivers.
- EVERYONE will feel cuts – even those not on Medicaid
As the arduous paperwork for Medicaid benefits begin, the healthcare costs and ER ambulance wait times will go up. Residents will resort to only using the healthcare system when absolutely necessary, driving patients away from continuous ongoing care to one-time emergency room visits. Co-pays and hospital costs for everyone, even those with private healthcare insurance, will go up as companies and healthcare providers scramble to balance their budgets.
HR 1 exacerbates the already inequitable and health outcomes poor communities of color already face. Those most directly impacted by HR 1 the most are our low-income families. Mounting medical debt will drive patients into even deeper poverty and cuts to food assistance programs will lead to poorer health outcomes. Overall, this bill is exacerbating health inequity that already is pervasive in Santa Clara County and beyond.
- The County committed to the Defend our Care’s Demands:
The Defend our Care campaign asked the county at the end of their presentation to commit to five demands that will ensure transparency throughout the process of navigating these cuts. County leadership agreed to:
- Commit to Regular, Community-Based Public Forums on Healthcare Cuts and System Decisions
- Commit to Transparent Communication Through One County, One Future
- Partner with Community in State and Federal Advocacy
- Apply Equity Principles to Every Healthcare Budget Decision
- Commit to an Ongoing Partnership with Community in Reimagining Healthcare on the East Side
The fight for healthcare access is not over, we are compiling stories of patients who rely on Medi-Cal for their healthcare insurance. These stories will be used to continue to fight for healthcare access for everyone in California. Join our campaign to Defend our Care.
Additional Resources:
Federal Funding and the County’s Budget | County of Santa Clara | County of Santa Clara (we are updating this page given the passage of H.R. 1 and the passage of the County’s budget)
- Fact Sheet – Impact of Federal Funding Cuts on the County of Santa Clara’s Budget
- Santa Clara County receives $ 3.7 billion funding from the federal government for social services which equates to an approximate 30% of the County/s total year budget.
- Federal funding supports $2.9 billion for Medicare and Medicaid covered services, $400 million for social services programs such as CalFresh (SNAP) and CalWORKs (TANF), and $140 million programs related to public health, housing, transportation, and public safety. With the federal budget cuts, these social services can be a huge detriment to the lives of marginalized communities, most especially the low-income individuals and immigrant workers.
- Santa Clara Valley Healthcare, the second largest public hospital system in California, acquired 70% of the funding from the federal government.
- 13.6% of Santa Clara County’s population will be directly impacted by the federal budget cuts. 1 in 4 residents in Santa Clara County are Medi-Cal enrollees.
- 42% of the County’s Social Services Agency and ⅓ of the County’s Public Health Department are funded by the federal government.
- Video: Federally Funded Medi-Cal Health Insurance Protects the Community | County News Center | Office of Communications and Public Affairs | County of Santa Clara
- County Supervisors Approve $13.7 Billion Budget Protecting Core Safety Net Services Despite Federal Funding Uncertainty | County News Center | Office of Communications and Public Affairs | County of Santa Clara
- Statement from County Executive James R. Williams on the Passage of H.R. 1 | County News Center | Office of Communications and Public Affairs | County of Santa Clara
