{"id":12032,"date":"2026-03-16T09:00:00","date_gmt":"2026-03-16T09:00:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=12032"},"modified":"2026-03-16T09:00:00","modified_gmt":"2026-03-16T09:00:00","slug":"reckoning-with-state-and-federal-cuts-los-angeles-safety-net-clinics-push-for-a-new-tax","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=12032","title":{"rendered":"Reckoning With State and Federal Cuts, Los Angeles Safety-Net Clinics Push for a New Tax"},"content":{"rendered":"

LOS ANGELES \u2014 Mia Angulo, who is pregnant and due in May, is living in a tent with her boyfriend in the predominantly Latino neighborhood<\/a> of Boyle Heights.<\/p>\n

Lingering pain from a car crash two months ago, on top of an already hardscrabble life, has Angulo worried about her pregnancy. So, she was relieved when a mobile street medicine van from St. John\u2019s Community Health pulled up near her encampment last month.<\/p>\n

\u201cThank God that we have them,\u201d she said.<\/p>\n

St. John\u2019s<\/a>, which operates 28 clinics, mostly in L.A. County, is part of the nation\u2019s network of nonprofit community clinics that care for the poorest Americans. Around 80% of its 144,000 patients, including Angulo, have Medi-Cal, California\u2019s version of the Medicaid program for people with low incomes or disabilities.<\/p>\n

But federal cuts to Medicaid spending under the Republican-passed One Big Beautiful Bill Act<\/a>, compounded by fiscal belt-tightening<\/a> in Sacramento, could cost St. John\u2019s up to one-third of its $240 million annual revenue, requiring cuts to services that might include street medicine, said Jim Mangia, the president and CEO.<\/p>\n

Smaller, more cash-strapped clinics in L.A. County could face harsher consequences, including closure, if the lost funding is not replaced.<\/p>\n

That\u2019s why Mangia, along with a coalition of community clinics, health care workers, and advocates, is pushing for a five-year, half-cent sales tax<\/a> in the nation\u2019s most populous county to help backfill the projected loss of federal and state dollars. St. John\u2019s has contributed at least $2 million to the campaign so far.<\/p>\n

Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County, said there aren\u2019t a lot of options to save the health care system from disaster.<\/p>\n

\u201cOur backs are up against the wall,\u201d she said. \u201cThis has the potential to be a game changer. It will be an absolutely significant offset to the losses.\u201d<\/p>\n

The L.A. County Board of Supervisors approved the proposal<\/a> last month for inclusion on the June 2 primary ballot, over the objection of some cities within the county. Their leaders argued the tax would put a strain on consumers and business owners. Most of an estimated $1 billion<\/a> in annual revenue generated would be used to protect safety-net health care at community clinics, hospitals, and schools.<\/p>\n

Scrambling To Stay Afloat<\/strong><\/p>\n

Nationally, the GOP budget law is expected to cut federal Medicaid spending by $911 billion<\/a> over 10 years, and it could lead to an increase of over 14 million<\/a> in the number of people left uninsured. The L.A. ballot proposal is among many local and state initiatives nationwide, as clinics, hospitals, health care workers, advocates, and legislators scramble for new money to help offset the spending cuts.<\/p>\n

In Michigan, where the federal law is projected to cost the state $32 billion over 10 years<\/a>, Democratic Gov. Gretchen Whitmer\u2019s office has proposed new or increased taxes<\/a> on tobacco, vape products, online gambling, sports betting, and digital advertising, which it projects would raise hundreds of millions of dollars annually.<\/p>\n

In Rhode Island, a group of state legislators hopes to ease some of the pain caused by the federal cuts with a package of bills<\/a> that includes a tax on digital ads and a 3% surcharge on taxable incomes above roughly $640,000.<\/p>\n

\u201cThe goal is not to replace the revenue; it\u2019s to mitigate the damage,\u201d said Democratic state Rep. Brandon Potter, one of the legislators involved.<\/p>\n

In Washington, Democratic state Rep. Shaun Scott recently introduced legislation to address the loss of federal dollars with a 5% payroll tax<\/a> on large companies, applied to employee salaries exceeding $125,000 a year.<\/p>\n

In California, the GOP law will slash the federal contribution<\/a> to Medi-Cal by an estimated $30 billion<\/a> a year, or 25%. Enrollment in Medi-Cal could drop by 3 million<\/a> by 2028 as a result of the federal and state spending cuts, according to an analysis by the UCLA Center for Health Policy Research and the University of California-Berkeley Labor Center.<\/p>\n

In July, California will slash Medi-Cal payments that community clinics receive for certain services provided to patients with \u201cunsatisfactory\u201d immigration status by about $1 billion a year<\/a>. Those patients include permanent residents in the country for less than five years, refugees, asylees, and other lawfully present people.<\/p>\n

Bracing for a \u2018New Reality\u2019?<\/strong><\/p>\n

Advocates and health care experts say finding new revenue is the only way to avoid a crisis in California\u2019s health care system.<\/p>\n

\u201cAre we going to let the gaps created by federal policies and state budget cuts leave millions of people uninsured?\u201d said Laurel Lucia, deputy executive director of programs at the UC Berkeley Labor Center. \u201cI think a lot of that question comes down to revenues.\u201d<\/p>\n

Some medical professionals say that new revenue is needed in the short term but that the country needs to address its notoriously expensive health care system.<\/p>\n

\u201cThis new reality is that we have to do our work with less money going into the future,\u201d said Hector Flores, president-elect<\/a> of the Los Angeles County Medical Association. \u201cSo, this is an opportunity for us to look at how we can do things better.\u201d<\/p>\n

In the meantime, efforts to raise taxes for health care abound.<\/p>\n

Voters in Santa Clara County, home to Silicon Valley, last November approved a five-year 0.625% sales tax increase<\/a> to offset federal Medicaid cuts. A similar measure<\/a> will be on the June ballot in Contra Costa County.<\/p>\n

The best-known initiative, and a hotly contested one, is a union-sponsored ballot proposal in California for a one-time 5% tax<\/a> on the state\u2019s more than 200 billionaires<\/a>. Democratic Gov. Gavin Newsom strongly opposes it; Sen. Bernie Sanders (I-Vt.) stumped for it in California recently and has promised to introduce<\/a> a national version in Congress.<\/p>\n

Proponents of the temporary wealth tax say it would raise $100 billion<\/a>, which would mostly be used to backfill lost federal and state dollars in Medi-Cal and other safety-net programs. Proponents are trying to collect nearly 875,000 signatures needed to get it on the November ballot.<\/p>\n

\u201cWe are on the precipice of a collapse of our health care system. So the most fortunate among us pay a modest tax that will hold us over and allow us to figure out a long-term solution,\u201d said Suzanne Jimenez, chief of staff for Service Employees International Union-United Healthcare Workers West, the measure\u2019s chief sponsor. \u201cThey would still be incredibly wealthy after that.\u201d<\/p>\n

Billionaires Push Back<\/strong><\/p>\n

The plan has stirred considerable controversy, not just in the Golden State but nationwide, and has generated strong resistance from billionaires<\/a> and others.<\/p>\n

Critics argue the measure could prompt billionaires to leave California, putting a damper on innovation, jobs, and tax receipts. And, some warn, the measure could end up in a legal quagmire, as those deemed liable to pony up challenge it on multiple fronts.<\/p>\n

\u201cIf this passed, you would expect it to be tied up in court for some time,\u201d said Jared Walczak, a visiting fellow at the California Tax Foundation. \u201cIt is fairly plausible that no revenue could come in for a number of years, if there\u2019s ever any revenue at all.\u201d<\/p>\n

The prospect of such complications has led some health care advocates to focus instead on local initiatives that could start generating revenue more quickly, such as the proposed sales tax in L.A. County.<\/p>\n

That one has critics too, including leaders of multiple cities within the county who pleaded with supervisors<\/a> to reject a proposal they argued would add to the affordability worries of consumers and put a strain on businesses.<\/p>\n

Kathryn Barger, a Republican and the only L.A. County supervisor to oppose putting the measure on the June ballot, said in a statement that the proposed tax would make the county \u201cless affordable for families and less appealing for consumers to shop and businesses to operate.\u201d<\/p>\n

But supporters say safety-net health care is already feeling the impact of diminished funding. Last month, for example, L.A. County\u2019s Department of Public Health announced it was closing seven clinics<\/a> due to $50 million in federal, state, and local funding cuts.<\/p>\n

Medi-Cal enrollees are worried, too. \u201cWe get a lot of calls from panicked patients afraid they\u2019re going to lose their Medi-Cal. Dozens of calls a day, hundreds of calls a week,\u201d said St. John\u2019s Mangia.<\/p>\n

\u201cWe tell them that we\u2019re working on a solution and hopefully we\u2019ll have that solution come June.\u201d<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>","protected":false},"excerpt":{"rendered":"

LOS ANGELES \u2014 Mia Angulo, who is pregnant and due in May, is living in a tent with her boyfriend in the predominantly Latino neighborhood of Boyle Heights. Lingering pain from a car crash two months ago, on top of an already hardscrabble life, has Angulo worried about her pregnancy. So, she was relieved when…<\/p>\n","protected":false},"author":0,"featured_media":12033,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-12032","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12032"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=12032"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12032\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/12033"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=12032"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=12032"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=12032"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}