healthcare

SACRAMENTO — A corporate tax policy that costs California billions in lost tax revenue each year could be coming to an end as the state struggles to backfill federal cuts and resolve a looming budget deficit.

The proposed legislation, Assembly Bill 1790, would repeal the so-called “water’s edge” tax break, a filing option that allows multinational corporations to exclude the income of their foreign subsidiaries from state taxation.

“The tax bills of the wealthiest, most powerful corporations in the world are at all-time lows,” Assemblymember Damon Connolly (D-San Rafael), one of the primary sponsors of the bill, told The Times. “Meanwhile, we’re struggling to fund programs that feed children — I think everyone understands that now is the time for long-term budget solutions.”

Republican Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, said the bill to repeal water’s edge won’t receive support from GOP lawmakers. He said the legislation would lead to double taxation, meaning the same income would be taxed twice by different countries, and compared taxing corporations’ foreign profits to enacting tariffs.

“California already has the reputation of being not particularly business friendly,” said Niello (R-Fair Oaks). “This would really just compound that.”

A spokesperson for Gov. Gavin Newsom did not respond to a request for comment about the governor’s views on the proposal. Newsom, however, has largely shunned new tax increase proposals.

Legislation to increase taxes requires a two-thirds approval vote instead of a simple majority. Democrats in California hold a supermajority in both the Assembly and Senate, meaning the bill could still pass without Republican support, but it would require backing from the progressive and moderate wings of the party.

Kayla Kitson, a senior analyst at the California Budget and Policy Center, said the measure has a decent chance of winning support among moderate Democrats due to the state’s budgetary woes.

“The stakes are really high this year,” she said. “With any tax policy, it’s certainly hard to get folks beyond the progressive community on board, but there are a lot of discussions happening behind closed doors given the challenges that the state knows it’s going to have to deal with in the next few years.”

When filing taxes, a multinational corporation in the United States can currently choose between two methods. Worldwide reporting takes into account all of the corporation’s global profits or losses, while the water’s edge option allows the U.S.-based parent company to exclude the income of foreign subsidiaries. This can help corporations that own profitable foreign companies pay less taxes in the United States.

California is scrambling for solutions as the state is facing an estimated $18-billion budget deficit and fallout from federal cuts that slashed healthcare. A Republican-backed tax and spending bill signed last year by President Trump shifted federal funding away from safety net programs and toward tax cuts and immigration enforcement.

Carl Davis, a research director for the Institute on Taxation and Economic Policy, said the idea is picking up momentum nationwide, with states like Maryland, Minnesota and New Hampshire also considering a repeal in recent years, due to a growing awareness about profit shifting — a loophole in the water’s edge tax break that some corporations use to reduce their tax burdens by shifting profits made in a high-tax country into tax havens.

“Folks are outraged when they hear that these companies are pretending that they are earning their profits in the Caymans or in Switzerland and are skipping out on paying U.S. taxes as a result,” he said. “That feels insulting to a lot of people who are paying the taxes they owe every day.”

During an informational hearing at the Legislature last month, Rowan Isaaks, an economist with the nonpartisan Legislative Analyst’s Office, said the state does not know the extent to which corporations use profit shifting, which makes it impossible to determine exactly how much revenue California would gain by eliminating the water’s edge tax exemption. But he estimated it would bring in “single digit billions” for the state each year.

“While there would be revenue gains, the Legislature also faces a trade-off between broadening the tax base but also managing additional uncertainty,” said Isaaks, explaining it could increase budget volatility because foreign income is more sensitive to global economic conditions.

Issaks added that the Legislative Analyst’s Office has found no strong evidence that companies would flee California if the water’s edge tax break was repealed.

Jennifer Barton, director of the legislative services bureau for the California Franchise Tax Board, told legislators that mandating worldwide reporting wouldn’t be difficult for the state from an administrative standpoint, only requiring some additional outreach or educational efforts.

California Tax Foundation visiting fellow Jared Walczak said that the water’s edge option exists for a reason and that it would be unfair to mandate worldwide reporting. “The vast majority of the activity abroad is true economic activity abroad,” he told lawmakers. “Companies don’t just exist in the United States; they have sales, they have manufacturing, they do things abroad.”

A survey last year from the nonpartisan Pew Research Center found 63% of adult Americans believe large corporations or businesses should pay more in taxes, while 19% want corporate taxes to be lower and 17% believe corporate tax policy should remain the same.

Tech companies appear to be particularly aggressive with profit shifting. Six U.S. multinational corporations — Apple, Cisco, EBay, Facebook, Google and Microsoft — may have underpaid their U.S. corporate income taxes by $277 billion over varying periods from 2009 through 2022, according to a report from the Center on Budget and Policy Priorities.

Repealing the water’s edge tax break isn’t the only tax-related proposal being considered as the state seeks to increase revenue. The Billionaire Tax Act is a controversial proposed state ballot initiative that would levy a one-time, 5% tax on the state’s billionaires to help offset federal cuts. Newsom is among its critics.

Davis believes it will continue to be a hot topic regardless of the bill’s outcome this year.

“There is very good reason to think this [repeal] is going to happen at some point,” he said. “This is a debate that is certainly not going away.”

SAN FRANCISCO — It was speed dating: Eight suitors with less than four minutes each, pitching the woo to thousands of Democratic Party faithful.

The race for California governor has been a low-boil, late-developing affair, noteworthy mostly for its lack of a whole lot that has been noteworthy.

That changed a bit on a sunny Saturday in San Francisco, the contest assuming a smidgen of campaign heat — chanting crowds, sign-waving supporters, call-and-response from the audience — as the state party held its annual convention in this bluest of cities.

Delegates had the chance to officially endorse a party favorite, providing a major lift in a contest with the distinct lack of any obvious front-runner. But with an overstuffed field of nine major Democratic contenders — San José Mayor Matt Mahan was said to have entered the contest too late for consideration — the vote proved to be a mere formality.

No candidate came remotely close to winning the required 60% support.

That left the contestants, sans Mahan, to offer their best distillation of the whys and wherefore of their campaigns, before one of the most important and influential audiences they will face between now and the June 2 primary.

There was, unsurprisingly, a great deal of Trump-bashing and much talk of affordability, or rather, the excruciating lack of it in this priciest of states.

The candidates vied to establish their relatability, that most valuable of campaign currencies, by describing their own hardscrabble experiences.

Former Los Angeles Mayor Antonio Villaraigosa — the first speaker, as drawn by lot — spoke of his upbringing in a home riven by alcoholism and domestic violence. State Supt. of Public Instruction Tony Thurmond described his childhood subsistence on food stamps, free school lunches and surplus government cheese.

Former state Controller Betty Yee told how she shared a bedroom with four siblings. Katie Porter, the single mom of three kids, said she knows what it’s like to push a grocery cart and fuel her minivan and watch helplessly as prices “go up and up” while dollars don’t stretch far enough.

Michele Reed of Los Angeles cheers at the state Democratic Party convention.

(Christina House/Los Angeles Times)

When it came to lambasting Trump, the competition was equally fierce.

“His attacks on our schools, our healthcare and his politics of fear and bullying has to stop now,” Villaraigosa said.

Rep. Eric Swalwell (D-Dublin) called him “the worst president ever” and boasted of the anti-Trump battles he’s fought in Congress and the courts. Xavier Becerra, a former California attorney general, spoke of his success suing the Trump administration.

Porter may have outdone them all, at least in the use of profanity and props, by holding up one of her famous whiteboards and urging the crowd to join her in a chant of its inscription: “F—- Trump.”

“Together,” the former Orange County congresswoman declared, “we’re going to kick Trump’s ass in November.”

Porter was also the most extravagant in her promises, pledging to deliver universal healthcare to California — a years-old Democratic ambition — free childcare, zero tuition at the state’s public universities and elimination of the state income tax for those earning less than $100,000.

Unstated was how, precisely, the cash-strapped state would pay for such a bounty.

Former Assemblyman Ian Calderon offered a more modest promise to provide free child care to families earning less than $100,000 annually and to break up PG&E, California’s largest utility, “and literally take California’s power back.” (Another improbability.)

Becerra, in short order, said he was “not running on inflated promises” but rather his record as a congressman, former attorney general and health secretary in President Biden’s cabinet.

Rachel Pickering, right, vice chair of the San Luis Obispo County Democratic Party, stands with others wearing pins supporting Democratic causes at the party’s state convention.

(Christina House/Los Angeles Times)

It was one of several jabs that could be heard if one listened closely enough. (No candidate called out any other by name.) “You’re not going to vote for a Democrat who voted for the border wall, are you?” Thurmond demanded, a jab at Porter who supported a major funding bill that included money for Trump’s pet project.

“You’re not going to vote for a Democrat who praises ICE, are you?” Thurmond asked, a poke at Swalwell, who thanked the department for its work last year in a case of domestic terrorism.

“You’re not going to vote for a Democrat who made money off ICE detention centers,” Thurmond went on, targeting Tom Steyer and his former investment firm, which had holdings in the private prison industry.

Yee seemed to take aim at Mahan and his rich Silicon Valley backers, suggesting grassroots Democrats “will not be pushed aside by the billionaire boys club that wants to rule California.”

The barb was part of a full-on assault on the state’s monied class, which includes Steyer, who made his fortune as a hedge fund manager.

In a bit of billionaire jujitsu, he sought to turn the attack around by saying his vast wealth — which has allowed him to richly fund his political endeavors — made him immune to the blandishments of plutocrats and corporate interests.

“Here’s the thing about big donors,” Steyer said. “If you take their money, you have to take their calls. And I don’t owe them a thing. In a world where politicians serve special interests, I can’t be bought.”

There were no breakout moments Saturday. Nothing was said or done in the roughly 35 minutes the candidates devoted to themselves that seemed likely to change the dynamic or trajectory of a race that remains stubbornly ill-defined and, to an unprecedented degree in modern times, wide open.

And there was certainly no sign any of the gubernatorial candidates plan to give up, bowing to concerns their large number could divide the Democratic vote and allow a pair of Republicans to slip through and emerge from California’s top-two primary.

But for at least a little while, within the confines of San Francisco’s Moscone Center, there was a glimmer of a life in a contest that has seemed largely inert. That seemed a portent of more to come as the June primary inches ever closer.

Hannatu Charles* carried her pregnancy to full term. She attended all antenatal sessions and was eager to meet her baby. 

In January, when she was due, she went into labour around 7 p.m. Unfortunately, the primary healthcare centre in Kirchinga, a community in Madagali local government area of Adamawa state in northeastern Nigeria, closes around 6 p.m. Her family immediately called one of the traditional birth attendants in the community.

Hannatu laboured for hours, yet her baby did not emerge despite the efforts of the traditional birth attendant. By 10 p.m., warning bells began to ring in her mind, as by that time, all doors in Kirchinga had been shut and all access routes deserted. 

“We decided to try to see if we could at least meet one person at the primary healthcare centre, so my husband and my neighbour took me there that night, but we didn’t meet any midwife or any healthcare staff,” she told HumAngle. 

The centre was closed. All the healthcare staff had gone and would only return the next morning. Night shifts no longer hold. These changes were made due to the scale of insecurity. 

Hannatu told HumAngle they returned home, where she continued to push, but despite her efforts, she was unable to deliver. The birth attendant noted that the baby was in breech position and, therefore, an experienced midwife or a gynaecologist was required. The only way they could access such care was by travelling to the Cottage Hospital in Gulak Local Government or the General Hospital in Michika Local Government, both many hours away. 

Hannatu said they would have made the journey that night on a regular day, but now,  it was too risky. Movement in Kirchinga was restricted after dark as Boko Haram terrorists roamed the area, especially at night. There was also no way to access vehicles or get a driver to take the,m as all routes were closed. 

She said she was willing to persevere until dawn when the roads would reopen, but by midnight, the pain intensified, and the midwife doubled her efforts. A stillborn was delivered. 

“I’m not the first to lose a child because of the security situation in this region,” Hannatu said as she talked about how insecurity destroys healthcare. “In fact, I’m lucky to be alive,” she added, stressing that several women and their babies had died.

According to Hannatu, the women who went into labour during the day in Kirchinga are considered lucky. 

The healthcare crisis 

Kyauta Ibrahim, a community health extension worker, spends her days at the primary school in Limankara, another community in the same Madagali that has, since the past decade, been repurposed as the community’s healthcare centre. Since residents began returning to Madagali in 2016 — two years after Boko Haram attacks displaced them — she and her colleagues have provided medical services from this makeshift facility.

“We are yet to move to the permanent site. We were asked to stay here to perform our duties,” she said. When the insurgents struck, they torched several structures, including the original primary healthcare centre where she worked.

For Limankara residents, this temporary facility remains the only nearby source of medical care. With few doctors remaining in the region, patients are often forced to travel long distances to better-equipped centres in Shuwa, Michika, or Gulak, particularly in emergencies.

Before the insurgency, the primary healthcare centre in Limankara served the local population and neighbouring communities such as Sakur and Lakundi, providing antenatal care, deliveries, and basic medical services. After peace was gradually restored in 2016, the state government converted one of the primary schools into a modest healthcare facility to meet the community’s needs.

A decade later, the school still functions as the healthcare centre. The situation worsened as medical doctors and other professionals began withdrawing, leaving indigenous community health extension workers to manage the facility. In 2016, most health centres in Madagali and Michika were closed because many professionals had either been killed or fled permanently.

As of 2019, the World Health Organisation’s Health Resources Availability Monitoring System (HeRAMS) highlighted that only 45 per cent of health centres in Adamawa were fully functional after 12 per cent had been destroyed and 34 per cent severely damaged by Boko Haram attacks. 

Kyauta told HumAngle that, aside from staff shortages, inadequate healthcare equipment continues to affect healthcare delivery in the area. The temporary primary healthcare centre now closes by late evening due to recurring Boko Haram attacks, leaving pregnant women and children most vulnerable.

“When a woman starts labour at night, she can’t even go to the primary healthcare centre and has to give birth at home,” she said. Complicated cases are referred to Shuwa, and if necessary, to the General Hospital in Michika or the Gulak cottage hospital, all of which are some distance away. 

Esther Markus, a mother of six from Wagga, another community in Madagali, travels six hours for a round trip to Gulak for medical care. Emergencies are further complicated by a 6 p.m. curfew. Traditional birth attendants handle routine deliveries, but high-risk cases, like breech births or sudden illness at night, go untreated until morning.

“Once it’s 6 p.m., we can’t take sick people to the hospital, so we leave them till the next day in the hands of God, and if the person dies, then we accept it,” said Hamidu Ahmadu, Limankara’s community leader.

Residents said security remains precarious. “A few days ago, the soldiers guarding us were attacked, so since then, they leave once it is 5 p.m. and head back to their headquarters in town. Our youths guard us all through the night,” Esther added. 

Hamidu told HumAngle that the community has a population of about 3,000. He acknowledged the efforts of some humanitarian organisations that have visited the area in the past to treat malnourished children and provide basic healthcare services to residents, but the gap remains. 

In 2024, the International Committee of the Red Cross (ICRC) resumed operations in Madagali after being unable to operate since 2018. The following year, the organisation provided basic healthcare and nutrition services to residents and also renovated the existing healthcare facility in Madagali town, which has become a haven for displaced persons in villages around the area. This has helped mitigate how insecurity affects healthcare in Madagali. 

Despite these humanitarian efforts to restore healthcare access in conflict-prone communities in Madagali, however, factors like the curfew, abductions, and the absence of medical professionals continue to limit access to services. 

Medical professionals are fleeing 

Kirchinga, the community in Madagali where Halima had the stillbirth, faces a similar plight. Although it has a functional primary healthcare centre, the lack of medical professionals severely affects service delivery.  

“Since the insecurity started, the doctors have stopped staying. They no longer live in the community but only show up from time to time,” said Bitrus Kwada, a Kirchinga resident.

Boko Haram terrorists have abducted, killed, or threatened several health and humanitarian workers in the northeastern region. In 2018, some medical workers were kidnapped and later killed in Borno. The following year, Boko Haram attacked Kirchinga and Shuwa communities, burning houses, shops, and clinics after killing three people. 

By 2020, Bitrus explained, healthcare workers, including doctors, who once lived in Kirchinga had either been transferred or fled, leaving them only occasionally available and unable to respond to emergencies.

“We suffer when it comes to emergency treatment at night,” Bitrus stated.  

Over the years, several women with complicated pregnancies have died during childbirth, along with their babies, due to the absence of doctors and surgeons. 

Blessing Dingami, another resident of Kirchinga, told HumAngle that before the insurgency started in 2014, the primary healthcare centre in the community was staffed by a medical doctor, two nurses, and another healthcare provider who ran the facility round the clock, with support from community health extension workers.

Following the attacks, the centre collapsed, forcing the professionals to flee. Although the government has since renovated it, community health extension workers now manage the facility, and the quality of services has declined.

Even though movement in Kirchinga is unrestricted until 10 p.m., accessing medical care is increasingly difficult. “There was a time when people from our community were involved in a ghastly accident at night, and we rushed them to the centre, but there was no professional to handle their case,” Blessing recounted. 

She noted that the healthcare centre no longer provides scanning, surgery, and other services it previously offered. Residents now have to travel for over half an hour to Shuwa and sometimes to Gulak, where there is a cottage hospital.

In Wagga Lawan, another community in Madagali, the primary healthcare centre was destroyed during Boko Haram attacks in 2014 but was recently rebuilt and commissioned by the state government.

Despite the renovation, many Madagali residents remain unable or afraid to use the facility. People from Wagga Mongoro, Thidakwa, and even Limankara travel there, yet fear of kidnapping, its remote location, and the surrounding bushes keep many away, particularly at night.

“The centre is located on the outskirts of the town, and bushes surround it, so people are afraid to go there for services, especially at night, due to fear of kidnapping,” said Cyril Ezra, a resident. Travel to the facility takes over an hour by bike. 

In 2025, Boko Haram attacked Wagga Mongoro, killing four people, injuring many others, and razing property—underscoring why many remain hesitant to use even the newly rebuilt facility.

Uncertainty 

Peace Ijanada Simon, a midwife at Shuwa’s primary healthcare centre, said the facility is overburdened with deliveries and emergencies from surrounding communities, as theirs lack night services. Although staff work night shifts, service is inconsistent due to recent kidnappings and a lack of reliable electricity. 

“There is no power supply. We use torchlights for most deliveries. If we can’t handle it, we refer immediately to Gulak or Michika,” she said.

In Kirchinga, locals have lost hope for the return of professional healthcare workers. “From 2014 to today, we’ve been facing security challenges because Boko Haram can attack at any time and destroy our things. Some of our people have been killed. Two years back, the situation changed into kidnappings,” he said. 

Bitrus explained that the terrorists mostly show up at night when locals are sleeping and carry out these abductions. “Ransoms have been paid, and some have been released. We have soldiers here, but I don’t think they are taking strong action,” he added.

Maradi, a community near Kirchinga, was attacked on Jan. 23. One resident who resisted capture was killed in his home, while a hunter who confronted the attackers that night was also killed, and another person was abducted that night. 

“We don’t sleep. From midnight, we stay awake till 3 a.m. because that’s the time they normally come. We have to stay conscious,” he said.