In a tough budget year, Trump’s policies just exacerbate the problems.

Assemblymember Dawn Addis, D-Morro Bay, serves on the Assembly Budget Committee. It's not a fun job in lean budget years like this one, with the state staring down a $12 billion deficit – due in no small part, she points out, to President Donald Trump's economic and tariff policies.

Beyond that, Addis chairs the subcommittee on health, a particularly thorny area in times like these, when the federal government is looking to slash funding for Medicaid (known as Medi-Cal in California), to the tune of $880 billion in the so-called Big, Beautiful Bill.

Federal funding accounts for roughly 58 percent of Medi-Cal revenue in California. About 15 million people, or one-third of Californians, are enrolled in Medi-Cal for their health insurance. Last year, more than $2 billion in Medi-Cal (combined state and federal dollars) were spent in Monterey County – dollars covering medical expenses for patients, and dollars helping medical providers and hospitals cover their costs.

Given all that, it is a no-brainer to make commitments to constituents about maintaining California's health infrastructure. Speaking to a delegation of local elected officials visiting the Capitol on April 9, Addis spoke about the health subcommittee. "We're not going to make hard decisions on the backs of our most vulnerable communities," she said, then added: "There could be hard decisions coming."

Those hard decisions are now here. The governor's deadline to sign a budget bill is June 30, and the Legislature has until June 15 to pass it.

The pressure is on, particularly regarding health care.

About 20 protesters under the banner of Health4All and organized by the California Pan-Ethnic Health Network gathered in Salinas on Thursday, June 5 outside of Assembly Speaker Robert Rivas' district office. Their message was clear: Reject Gov. Gavin Newsom's proposed budget on issues of health.

Francisco Rodriguez, CEO of the Monterey Bay Central Labor Council, emphasized prior commitments made by local lawmakers – Addis of Morro Bay and Rivas of Hollister – as evidence they were already on the Health4All team's side. "They are pro-immigrant and pro-worker and want everyone to have access to affordable health care. We want them to know we are in their corner."

A few days later, on Monday, June 9, a delegation of about 120 leaders with COPA (Communities Organized for Relational Power in Action) visited Sacramento for a rally and meetings with lawmakers. Ana Luz Acevedo-Cabrera of Marina is a COPA leader through her church, Our Lady of Refuge in Castroville, and her day included meeting with Addis' staff.

While the COPA team was holding a press conference outside, legislators were hashing out a plan inside that addressed some of COPA's demands, including bringing the monthly premium down for undocumented immigrants on Medi-Cal (in the governor's proposed budget) from $100 to $30; there would be no premiums for those ages 60 and older. A freeze on new enrollments would be deferred until July 1, 2027. The legislative proposal restores dental coverage to Medi-Cal.

Acevedo-Cabrera is encouraged, but wants to see more progress. "If they could come down from $100 to $30, then they can come down from $30 to zero," she says. "That [premium] is a huge vulnerability – this is a very vulnerable population. It's very un-Californian."

Addis doesn't disagree – she's proud of California's health coverage. While she has tough words for Newsom's budget proposal ("incredibly draconian") she says the real lurking fear is Trump. "The agreement threads the needle, with the caveat that we don't know what we're facing down with Trump," Addis says. "What's happening at the federal level could crush our health care system."

Beyond the dollars, there could be work requirements and changes to the formula for how Medi-Cal is reimbursed by the feds. Addis worries broadly about damage to a health care system in a state where a remarkable 94 percent of the population is now insured.

Proposed federal changes would shrink that number. Fewer people with health insurance means more deferred care. More deferred care means more emergency room visits – a backward move that is bad for all of us.

SARA RUBIN is the Weekly's editor. Reach her at [email protected]