Medicaid

The more I think about Proposition 40, the billionaire tax that will go before California voters in November, the angrier I get.

I’m angry at President Trump. His cruel slashing of Medicaid threatens the health of millions of Californians, may lead to the loss of hundreds of thousands of medical jobs and is the stated reason behind Proposition 40, which would levy a one-time 5% tax on billionaires. Trump invoked government deficits, but this was really his latest attack against people he sees as losers and thus expendable — people of color, the undocumented and especially the poor. “Evil” isn’t mean enough a word to describe this.

I’m upset at what Proposition 40 proposes to do. It’s a temporary stopgap that doesn’t reverse Trump’s Medicaid cuts and won’t solve the fundamental problems facing healthcare, or all the other things that make life in California so expensive. Plus, since when has a tax happened just once?

Proposition 30 was supposed to be a temporary tax increase for Californians who earn more than $250,000 a year in the name of propping up K-12 schools and community colleges. Passed in 2012, it was supposed to expire in 2019. Instead, voters extended it to 2030 — and our public schools are in more dire need than ever.

If Proposition 40 succeeds, you know every advocacy group from Yreka to San Ysidro will propose one-time taxes in the name of rescuing something or other. But relying on new taxes, or strengthening old ones, only shows that people are out of ideas — a dangerous scenario for democracy.

I’m enraged at billionaires. In the past, California’s captains of industry — your Dohenys, Gettys, Huntingtons and so many more — at least pretended to care about the rest of society by funding charities, the arts and other things meant to better the masses. Not this generation. Their avarice, their gleeful supplication before a tyrant like Trump, their obsession with breaking things and not caring about the consequences and their indifference to how the rest of us live have made billionaires a deserved scapegoat, about as popular as a diaper rash.

I’m furious at Proposition 40’s supporters. For a generation, California’s left has treated the rich as a goose that keeps laying golden, taxable eggs, making the state budget too reliant on a sliver of the population. Gov. Gavin Newsom’s budget summary this year estimated that the top 1% of Californians paid about 45% of the state’s personal income taxes from 2002 through 2023. What Proposition 40 supporters don’t get is that you can only smack a goose so much to give more until it bites back, which is what California billionaires are increasingly doing by throwing their cash around to defeat any political candidate exuding a whiff of progressivism.

Mark Zuckerberg and Lauren Sanchez attend the inauguration of President Trump Jan. 20, 2025, in Washington.

(Kenny Holston-Pool / Getty Images)

I’m upset at Proposition 40’s opponents. Backing two other ballot initiatives that would neutralize Proposition 40 doesn’t amount to a convincing argument against it. A point they do argue — that picking on billionaires will alienate them, push them out of California and tank the state’s budget — is at least plausible. But it’s not a winning argument in this era of populism on both the left and right, where voters seem to approve of cutting off your nose to spite the man.

I’m disgusted by Proposition 40’s architect. Service Employees International Union-United Healthcare Workers West President Dave Regan represents everything wrong with the union movement in California. He has made a mockery out of the proposition system by continually trotting out initiatives in the name of bettering the lives of blue-collar Californians. But as my colleague Taryn Luna reported last month, Regan doesn’t even believe in what he sells: He uses the threat of ballot measures to cut deals for his members, and his members alone. Way to use the rest of us as a bargaining chip, Dave.

I’m done with Newsom. He opposes Proposition 40 in the most Newsom-esque way possible. One of his arguments is that it will scare away billionaires from California — there he goes, carrying water for oligarchs again. His other argument is even more ludicrous — that Proposition 40 isn’t enough because there should be a permanent national tax on billionaires via changes to the tax code instead of a one-off. So Californians shouldn’t go after billionaires because you want to do it? Good luck explaining that logic to voters across the country if you run for president in 2028.

I’m mad at California Democratic Party leaders. Its executive board recently endorsed Proposition 40 despite the many loyal soldiers and allies who are opposed, including gubernatorial candidate Xavier Becerra, the California Teachers Assn. and Planned Parenthood. Other unions are expected to oppose Proposition 40 or sit out the campaign, setting up the party’s latest civil war in an election year when state Democrats need the fewest distractions. But that’s the party’s leadership for you — they’ve never met an internal crisis they didn’t make worse.

I’m revolted by the California Republican Party. It entered the second Trump administration with tailwinds behind its sails after a generation of statewide failures, installing a record number of Latino GOP legislators in Sacramento and grabbing enough voters of color to imagine a future in which they once again mattered. Instead, the party’s blind devotion to Trump has left it with the moral authority of a dandruff flake.

California’s Republican congressional delegation unanimously voted for Trump’s Medicaid cuts, even though rural parts of the state, which also happen to be deep red, will be severely affected. State GOP leaders either stayed silent or cheered as Trump volleyed other financial missiles against California, including canceling billions of dollars in clean energy initiatives solely because we’re a blue state. Proposition 40 supporters just need to say that Republicans oppose the ballot measure and Californians will line up to vote “yes” like In-N-Out fans idling to grab a Double-Double.

Not me. I’m angry, for sure: The fight over Proposition 40 will add nothing but rage to this election and a redwood grove’s worth of political mailers. The Medicaid cuts will worsen life for too many people. As odious as Trump and his side have been, Proposition 40 solves too little for too short a time, while potentially making things permanently worse.

Count me as a big, beautiful “no.”

In the latest salvo in the war between the Trump administration and California, Health and Human Services Secretary Robert F. Kennedy jr. said Tuesday that his agency withheld $867.5 million in Medicaid payments to the state over concerns about fraud.

Kennedy also said his agency defered $199 million in Medicaid payments to Minnesota over similar concerns.

“If Gov. Gavin Newsom or Gov. Tim Walz wants this funding released, all they have to do is provide basic documentation showing that these services are legitimate and not fraudulent,” Kennedy said at a news conference.

Just under half of the funds withheld from California were in connection with in-home health services.

Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, said California’s spending on in-home health services went up by more than double the national average over the last two fiscal years.

“That doesn’t make sense,” he said.

About a quarter of the funds withheld involved care provided to individuals with “unsatisfactory immigration status,” whose eligibility to be in the country and receive these services is in question, which Oz characterized as an “ongoing massive problem for California.”

The announcement by Kennedy and Oz on Tuesday comes two months after Vice President JD Vance announced that the administration would be deferring $1.3 billion in Medicaid payments over fraud concerns, largely connected to hospice services and in-home healthcare.

Newsom’s office, in a social media post, called the announcement a “recycled political stunt.”

“California isn’t being targeted because Trump has evidence of fraud,” the post said. “We are being targeted for political reasons — and because Dr. Oz doesn’t understand that we are *SAVING* taxpayers money by keeping seniors and people with disabilities out of far more expensive nursing homes!”

Newsom’s office also said that the state stands “ready to collaborate” with the Centers for Medicare and Medicaid Services “in good faith efforts to combat fraud.”

The office of California Atty. Gen. Rob Bonta said it is reviewing the deferral of payments and allegations of fraud.

“We have not hesitated to challenge unlawful actions by the Trump administration, and we will continue to act whenever Californians’ rights or access to critical services are threatened,” Bonta’s office said.

Despite Newsom’s claims that the accusations are political, the California state auditor has repeatedly flagged Medi-Cal eligibility discrepancies that have exposed the state to billions of dollars in questionable payments.

California Department of Healthcare Services spokesperson Anthony Cava noted, however, that a 2020 state audit of in-home care found “no program integrity concerns” and encouraged expansion of the program to reduce spending on institutional care.

Cava also pointed out that the federal government had previously approved California’s approach to in-home care.

Newsom and Oz have clashed before.

Newsom filed a civil rights complaint in January against Oz, after Oz posted a video to social media from Van Nuys in which he accused the “Russian Armenian mafia” of being a leading driver of $3.5 billion in fraud in hospice and home-care services.

Newsom said that Oz’s claims were “baseless and racist.”

The announcement by Kennedy and Oz on Tuesday is the latest effort by the Trump administration to crack down on suspected Medicaid fraud in numerous states across the country.

Planned Parenthood and two smaller regional abortion providers are resuming billing Medicaid for services other than abortion after being cut off for most of a year.

The defunding, which was mandated in President Trump’s big tax and policy law last year, has been blamed in the closure of multiple clinics as well as a reduction in the number of Planned Parenthood patients being screened for breast cancer or tested for sexually transmitted infections.

The Medicaid billing was allowed to resume last weekend.

The restored funding does not mean the battle over federal abortion policy has ended, and not all services that were cut will return.

Here’s what to know about the situation.

Planned Parenthood closed clinics and saw fewer patients

Many abortion providers, including Planned Parenthood affiliates, have struggled financially since the 2022 Supreme Court decision that overturned Roe v. Wade and allowed state abortion bans to be enforced. Clinics have closed in states with abortion bans and restrictions as well as those without.

Planned Parenthood says its affiliates have closed nearly 30 of its roughly 600 clinics over the past year, citing the funding change as a key reason.

Over that period, affiliates dispensed about 25% fewer packs of birth control pills and conducted about 20% fewer breast cancer exams than the previous year.

Many patients — especially in places where healthcare can be hard to access — may not have had care at all because of the defunding, the organization said.

Planned Parenthood Action Fund spokesperson Angela Vasquez-Giroux said the cuts have also led to limited abortion access in some places.

Planned Parenthood of Wisconsin halted abortions for about a month, then dropped its status as an “essential community provider” so it could resume seeking reimbursement. The Arizona affiliate paused offering many of its services to patients covered by Medicaid.

Two smaller providers were also impacted

The defunding provision also affected two other healthcare providers that met the criteria in the law because the were nonprofit family planning organizations that provided abortion and received more than $800,000 yearly in Medicaid reimbursements.

Their experiences were very different.

Maine Family Planning closed three primary care clinics that served about 1,000 patients in the largely rural state.

Evelyn Kieltyka, a senior vice president of program services, said that even with help, their former patients had to wait an average of four to six months to be established with new providers.

Meanwhile, the number of abortions the group provided held steady, she said. Maine is one of several states where state-funded Medicaid covers abortion.

Patients at Health Imperatives in Massachusetts may not have noticed the change, as no services were dropped.

The state government funded Medicaid reimbursements that the federal government stopped — something that Planned Parenthood says happened in some form in 14 states. On top of that, the clinic system received a grant from Melinda Gates’s foundation.

Some services are returning but others may not

Planned Parenthood’s Arizona affiliate has already announced expanded hours and more telehealth options linked to the ability to bill Medicaid again.

Some other services are not likely to be restored.

Kieltyka said Maine Family Planning isn’t planning to bring back its primary care practices again.

“When you close something down and you lose positions,” she said, “it’s very difficult to bring that back and build it back up again.”

And Michelle Quesada, vice president of communications, brand and marketing for the Planned Parenthood affiliate in Florida, said a closed clinic in Lakeland isn’t expected to reopen, partly out of concern that Congress or the Trump administration could cut Medicaid reimbursements for the organization again.

“There’s no telling with this uncertainty,” she said. “It’s like a yo-yo effect.”

Abortion opponents want to stop the Medicaid reimbursements again

The political battle isn’t over.

Abortion opponents are pushing Congress to adopt another defunding policy.

“They’ve defunded Big Abortion before,” Kelsey Pritchard, a spokesperson for Susan B. Anthony Pro-Life America, said Monday, “and they should do everything in their power to do it again.”

Planned Parenthood contends that most general election voters don’t want the organization to be defunded. Pritchard said that the Republican base does.

Mulvihill writes for the Associated Press.

New Jersey is launching a new fee on companies whose workers have Medicaid health coverage instead of being covered by their employers. Other states are considering it, too.

Democratic lawmakers and governors see it as a way to help pay for the joint federal and state insurance program that covers low-income residents as federal policy changes are expected to make the program more expensive for states and may lead to a reduction in the number of people with coverage.

Proponents also say it’s about fairness because employers benefit from having some lower-income workers with taxpayer-funded health coverage.

Business groups object. So do some liberal policy organizations.

New Jersey is putting the fee in place

New Jersey Gov. Mikie Sherrill signed a measure Tuesday night to charge employers that have at least 50 workers covered by Medicaid, and the state budget she approved earlier in the week counts on raising $145 million this year from the program.

Under the plan, companies will be billed for each employee and employees’ dependent receiving Medicaid, the joint state-federal insurance program.

The fees per person would start at $325 a year for companies with 50 to 249 Medicaid beneficiaries and top out at $725 annually for employers with at least 500 recipients.

A bill passed this week in California doesn’t impose a charge now, but it does direct the state administration to present lawmakers options for doing so next year.

Finishing the job would fall to the successor of Gov. Gavin Newsom, a Democrat who is leaving office in January. Democratic gubernatorial candidate Xavier Becerra has made an employer charge part of his election platform.

State Sen. John Laird, a Democrat who sponsored the California proposal, said the big tax and policy law President Trump signed a year ago was a major factor in the need for action because it could prompt the state to spend more on Medicaid to plug holes left by federal changes.

The nonpartisan Congressional Budget Office expects more than 10 million people will be uninsured because of the law by 2034. It requires some beneficiaries to work, be in school or volunteer — and requires even more to document whether they meet the requirements.

Most employees at the bigger companies would not be at risk of losing Medicaid coverage as long as they’re working at least 20 hours a week.

Laird also said there’s an equity issue involved.

“If you’re a small business person in California, you are quite likely paying for health insurance for your employees. And through your taxes, you’re paying for health insurance for some of the biggest employers in California,” he said. “And that’s not fair.”

Legislation with similar intents passed one legislative chamber in both Colorado and Oregon this year, but neither made it to law. A measure was also introduced in Washington.

Connecticut Gov. Ned Lamont, a Democrat who is seeking a third term in November’s election, has called for the same move there with the idea of making it a part of the state budget that would kick in two years from now.

Opposition comes from business and some liberal groups

It’s no surprise that business organizations have criticized the approach, which would add to their expenses.

“The fact remains that many job-creators are still going to be penalized for something they have no control over,” Christopher Emigholz, the chief government affairs officer at the New Jersey Business and Industry Assn., said in a statement. “If an employee declines an employer-provided health plan because they’d rather be on Medicaid, it is unfair to penalize the employer for that employee’s decision.”

Some left-leaning policy organizations also oppose the charges.

Gideon Lukens, who analyzes health policy at the left-leaning Center on Budget and Policy Priorities, said that while the idea may be well-intentioned, it could lead companies to employ fewer people from low-income household or single parents. He said companies could also consider the policy in decisions about whom to hire or lay off — and also on where to locate or how many workers to employ.

And, he said, it could make employees — or potential employees — less likely to enroll in Medicaid knowing it would make them less attractive to employers.

“Usually, when I see a tax on something it’s going to discourage whatever being taxed,” he said in an interview.

New Jersey’s legislation tries to address some of the concerns. It would exempt temporary, seasonal and part-time employees. It would also bar employment decisions based on a workers’ Medicaid status.

Charging companies whose workers are covered by Medicaid isn’t a new idea. At least two states have previously enacted it, and it’s been proposed in Congress.

Massachusetts lawmakers in 2017 adopted a charge on employers up to $750 per nondisabled worker who was covered through Medicaid or a state-subsidized health exchange plan. The program began in 2018 was not renewed when it expired the next year.

An even earlier policy in Maryland, in 2006, immediately affected only Walmart. An industry group challenged it in court and won, stopping the fees.

The latest generation of proposals may avoid that legal pitfall by not referencing those health plans in the legislation.

Mulvihill writes for the Associated Press.

NEW YORK — The Trump administration on Tuesday said it would freeze federal funding for New York’s Medicaid Fraud Control Unit, a state agency responsible for investigating and prosecuting fraud in the safety-net government healthcare program.

In a letter sent to New York officials, U.S. Department of Health and Human Services Inspector General Thomas March Bell accused the state of not securing enough criminal indictments and said millions of dollars in funding would be suspended through at least Sept. 30.

The move is the second suspension of a state Medicaid fraud unit this year by the Republican Trump administration, and part of a barrage of anti-fraud actions it has aggressively promoted in the healthcare sector. They have included the creation of a new task force, targeted investigations, funding deferrals and demands for revalidation of healthcare providers that have touched all states but are focused largely on Democratic ones.

The pulled funding also comes after the administration admitted a glaring error in figures meant to help justify a fraud inquiry into New York’s Medicaid program this year, a mistake critics said revealed a Trumpian tendency to attack first and verify the facts later.

New York Atty. Gen. Letitia James, a Democrat, immediately vowed to fight Tuesday’s funding freeze.

“During my time as Attorney General, my office has recovered over $627 million for Medicaid and was recognized by this very administration for leading the nation in anti-fraud efforts,” she wrote. “We are considering all legal options to stop this outrageous action.”

Letter accuses New York of low performance compared to other states

Bell’s letter to James and New York Medicare Fraud Control Unit Director Amy Held argues that the unit is moving too slowly on cases and amassing too few indictments and convictions for wrongdoing in the Medicaid system. It notes that compared with four similarly sized units in other states, it secured the lowest number of criminal fraud convictions between 2023 and 2025.

The letter acknowledges that one reason the state has fewer criminal convictions than others is that it made a deliberate choice to focus on “high impact, complex fraud cases” rather than smaller-scale individual cases, but says that trade-off didn’t produce sufficient results.

“Enough is enough,” Bell wrote. “The New York MFCU has failed to comply with the terms and conditions of its MFCU grant award.”

Bell said in the letter that the funding suspension could be lifted before Sept. 30 if New York takes corrective action, “showing it has remediated concerns that formed the basis for this suspension.” He said if the state doesn’t fix the problems, the freeze will continue.

New York officials dispute the Trump administration’s claims

New York’s attorney general’s office said in a statement that it has “long been recognized as a national leader in effectively investigating and prosecuting Medicaid fraud schemes,” including by the Health and Human Services inspector general’s office. A 2025 report from the office notes that New York is one of four states that made up half the total civil recoveries in that year.

A spokesperson for the attorney general’s office said most of the unit’s criminal convictions focus on company owners, executives and corporations that would return large amounts to Medicaid.

“This administration’s unprecedented attack on New York is another political distraction,” James said in a statement.

The funding cutoff follows a similar move in Hawaii. In early June, Bell told Hawaii officials that Medicaid fraud funding would be cut off there, saying that it had a three-year stretch without a Medicaid fraud indictment or conviction.

Joan Alker, executive director and co-founder of Georgetown University’s Center for Children and Families, said there’s an irony in the federal government cutting off money intended for prosecuting fraud when its stated goal is to do just that.

“If you want to fight fraud, don’t take away money from states’ fraud control units,” she said. “I chalk this up to more political theater to distract voters from historic Medicaid cuts before the midterms.”

Move follows months of federal warnings and deferrals

For months, the Trump administration has contended that states — especially some Democratic-led ones — have been lax about fraud in social safety-net programs, including Medicaid.

It has demanded that at least five states, four of them governed by Democrats, share information about how they identify, prevent and address Medicaid fraud.

The federal government has also withheld some Medicaid funding from Minnesota and California over fraud concerns. Minnesota Gov. Tim Walz, a Democrat who was Kamala Harris’ 2024 running mate, accused President Trump of making cuts because of retribution.

The fraud-busting efforts have also targeted Medicare programs. Dr. Mehmet Oz, who leads the federal Centers for Medicare and Medicaid Services, announced a six-month moratorium on new enrollments for providers of hospice and home care nationally.

Swenson and Mulvihill write for the Associated Press. Mulvihill reported from Haddonfield, N.J. AP writer Anthony Izaguirre contributed to this report.

The looming impact of federal Medicaid cuts has reignited a long-simmering, costly battle between California’s medical industry and one of its largest health worker unions.

SEIU-United Healthcare Workers West, with about 120,000 members, has put forward two ballot initiatives to cap the pay of medical executives and require community clinics to spend the bulk of their revenues on patient care.

The California Hospital Assn. has responded with its own ballot proposal that would make it tougher for unions to spend money on political initiatives in the future. It would require approval by a union’s rank-and-file membership for any spending of $1 million or more on statewide measures, or $100,000 or more on local ones.

The competing measures, which have drawn enough verified signatures to qualify for the November ballot, come at a time when the rising cost of healthcare is emerging as a top voter concern.

The Service Employees International Union affiliate has seized upon affordability angst to resurrect a proposal for a cap on healthcare executive compensation, which it has failed to achieve multiple times before. The proposed measure garnered more than 1 million petition signatures.

“This initiative reflects the serious crisis we face and that affordability is a real thing,” said Vikas Saini, president of the Lown Institute, a Massachusetts-based healthcare think tank. “I think it also reflects grassroots anger and a desire to do something.”

Mikey Vaughn, a certified nursing assistant at Cedars-Sinai Medical Center, said the hospital often lacks supplies and staffing levels that he and his colleagues need in order to do their jobs effectively and without undue stress, despite its reputation as the go-to place for the rich and famous.

“The executive pay initiative would, I hope, be used to hire staff and to actually provide better resources for our patients,” he said. Vaughn is also a member of SEIU-UHW’s executive board and political committee.

Thomas Priselac, then-president and CEO of Cedars-Sinai Medical Center, made $8.8 million in fiscal year 2024, according to the organization’s most recent available federal tax filing. Kaiser Permanente’s CEO, Gregory Adams, made nearly $13 million in 2024. Warner Thomas, head of Sutter Health, made just under $12 million.

Cedars-Sinai spokesperson Duke Helfand said the hospital would be unable to recruit and retain physicians, nurses, and specialists if the measure passed, dramatically impairing its ability to provide healthcare.

“Such a scenario would be disastrous not only for Cedars-Sinai but for hospitals across Los Angeles and California,” Helfand said.

The union wants to cap compensation at $450,000 a year for senior hospital and medical group executives, as well as other administrative and managerial staff. However, the initiative does not stipulate how dollars diverted from payroll must be spent.

The union has dubbed the latest proposal the Health Care Executive Compensation Act of 2026. A coalition of medical industry heavyweights opposing it — hospitals, physicians, and clinics, among others — has rebranded it the Health Care Endangerment Act.

Carmela Coyle, CEO of the hospital association, called the measure a cynical political ploy.

“It’s bad policy and it’s going to have bad consequences across California,” she said.

Glenn Melnick, a healthcare economist at the University of Southern California, said even if the initiative were fully implemented and pay cuts enacted, he doubts it would reduce the cost of healthcare for patients.

SEIU-UHW does not have an estimated total amount the initiative would claw back from pay packages that exceed the limit.

Opponents of the initiative note that it doesn’t just target executive pay; it would affect medical practitioners who are also managers. That could include chief medical officers and chief nursing officers, as well as heads of surgery, emergency rooms, oncology, obstetrics, cardiology and other specialties, they say.

It would be up to each hospital, health system and physician group to report which staff members exceed the cap and by how much.

Ultimately, who is subject to the pay cap “probably will have to be battled out in court,” Coyle said . “That’s why we are throwing everything we can at it.”

The second SEIU-UHW ballot initiative, on community clinics, is already in court. The California Primary Care Assn., which represents clinics, filed a federal lawsuit in April seeking to invalidate it before it reaches the November ballot.

The proposed measure would require federally designated community clinics to spend at least 90% of their revenues on activities directly related to their mission of providing care for low-income populations. If it were to pass, more than 90% of those clinic organizations would be on the hook for penalties totaling $1.7 billion in the first year alone and “would face similarly crippling penalties every year,” according to a report commissioned by the primary care association and conducted by the Berkeley Research Group, an international consulting company.

Louise McCarthy, president and CEO of the Community Clinic Assn. of Los Angeles County, said many pivotal services the clinics provide — such as translation and transportation — would likely not be counted toward the spending requirement.

“They are targeting a group of what they see as employers and we see as the safety net,” she said.

The lawsuit cites the harm to clinics and claims the proposed spending requirement would interfere with federal authority.

Renée Saldaña, a spokesperson for SEIU-UHW, characterized the lawsuit against the initiative as “a really desperate attempt by the clinic industry to try and avoid accountability.”

SEIU-UHW, proud of its political activism, is also behind a controversial billionaire tax proposal that would impose a one-time 5% levy on California residents with fortunes over $1 billion to backfill the funding gap created by federal cuts coming down the pike under Republicans’ One Big Beautiful Bill Act. The law, passed last July and signed by President Trump, is projected to squeeze nearly $1 trillion from the Medicaid health coverage program for low-income people by 2034, including as much as $30 billion annually in California.

The hospital association, the community clinic group and the California Medical Assn., which represents physicians, are neutral on the wealth tax proposal thus far. But Saldaña said all three of the union’s ballot proposals tie into an overarching strategy to counter the widening healthcare disparities caused by the federal law.

“We believe the primary concern of healthcare providers, including executives, should be to serve the community, heal patients, and not be in healthcare just to enrich themselves,” she said on the proposed pay cap.

Over the years, the union has submitted dozens of local and statewide ballot initiatives, including ones to cap the pay of hospital executives, regulate dialysis clinics, and raise the minimum wage of healthcare workers.

The hospital association calculates that SEIU-UHW has spent nearly $125 million on local and statewide initiatives since 2012. But healthcare industry groups have spent far more opposing them. The hospital association data shows that the union spent nearly $36 million on three ballot proposals to regulate the dialysis industry, but dialysis companies poured in $302 million to defeat them, according to state campaign finance records.

The union’s ongoing political efforts “threaten patient access to quality health care,” according to the hospital association’s ballot initiative, which could limit how much unions spend on future ballot measures.

Saldaña hinted at a possible lawsuit should that measure pass, saying “we don’t see the legal viability” of it. The proposal, she said, is an attempt “to silence the front-line healthcare workers.”

Ultimately, a ballot initiative won’t cure the ills that plague healthcare in the United States, said the Lown Institute’s Saini. What’s needed, he said, is “an evaluation and reimagination of healthcare.”

Wolfson writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.

June 1 (UPI) — The Trump administration unveiled a new rule Monday adding work requirements to Medicaid eligibility, attracting concern from patient groups and condemnation from Democrats.

Republicans instituted the requirement as part of President Donald Trump‘s massive tax cut and spending bill signed into law in July.

The Centers for Medicaid & Medicare Services said in a statement that the Interim Final Rule tying eligibility to an 80-hour-per-month work requirement promotes “economic stability, self-sufficiency and independence.”

“This rule helps Americans build skills and independence through work, education, job training or community service, creating new opportunities for themselves and their families,” CMS Administrator Mehmet Oz said in a statement.

Medicaid is a joint federal-state program helping those with limited income and resources pay their medical bills. The new rule will is the implementation of a Medicaid work requirement provision that Congress put into President Donald Trump’s so-called One Big Beautiful Bill.

Democrats had vocally opposed the measure before the Republican-controlled Congress passed it into law, arguing it would create bureaucratic obstacles to hinder the ability of those who need the coverage.

Sen. Ron Wyden, D-Ore., and the ranking member of the Senate Finance Committee, said Monday that the rule is “the dark heart of Republican plan to kick millions of working Americans and their children off their health insurance by placing a mountain of paperwork in front of them.”

“When these requirements go into effect at the beginning of next year, it’s going to be a complete train wreck for America, and not just for the Americans caught in the bureaucratic maze Republicans have created: every community will be left with worse healthcare,” he said in a statement.

The provision requires most adults ages 19 through 64 to “demonstrate work requirement activities,” including employment, participating in certain work programs or community service.

Those exempt include people who are pregnant or have recently given birth, parents and caretakers of children or those with disabilities, the disabled or medically frail and American Indians and Alaska Natives, among others.

States generally have until Jan. 1 to implement the new rule, according to a CMS fact sheet.

While Republicans and the White House have described the move as installing safeguards against fraud, medical groups are voicing concern that it will cut patients, including those fighting cancer, from coverage.

American Cancer Society Cancer Action Network President Lisa Lacasse said the requirements mean those with cancer or suffering from sides effects of the disease or treatment would have to prove that they can’t work, a task she said is likely too difficult and time-consuming for them.

The 80-hour requirement may also be too much even for those who are able to work, she said.

“Cancer patients who can still work — and many want to, for example, when they are well enough to work in between chemo rounds — will have to choose between losing their Medicaid coverage, working the required 80 hours per month or giving up working altogether to qualify for an exemption,” she said in a statement.

The social welfare advocacy group Protect Our Care lambasted Republicans for “weaponizing government bureaucracy against the American People” instead of using the government to lower medical costs or make care more accessible.

“They are betting that if they make the process confusing and exhausting enough, millions of people will fall through the cracks and lose the care they depend on to survive,” Protect Our Care President Brad Woodhouse said in a statement.

“Hospitals will suffer, providers will be pushed further to the brink and families across the country will pay the price while Republicans once again put wealthy donors and corporate greed ahead of the health and well-being of everyday Americans.”

NEW YORK — The proportion of Americans without health insurance held steady at around 8% of the population in 2025, according to new findings from the U.S. Centers for Disease Control and Prevention.

The national survey results, released Thursday, show the all-ages uninsured rate has stayed significantly down from where it was several years ago, but the ranks of the uninsured could soon expand as the Trump administration’s sweeping changes to the health landscape begin to take hold.

Massive changes to Medicaid, the government’s safety-net health program for low-income Americans, passed into law last year could result in 10 million more uninsured individuals over a decade, according to Congressional Budget Office estimates.

And the expiration this year of certain Affordable Care Act subsidies — which had offset premium costs — is also contributing to reduced participation in marketplace health programs. Around 5 million fewer people are expected to enroll in those plans in 2026 compared with 2025, according to the healthcare research nonprofit KFF.

The government has multiple programs for tracking Americans’ insurance status, which can give different numbers depending on factors like timing and question wording. Many researchers consider the U.S. Census Bureau to be “the official scorekeeper,” said David Howard, an Emory University health policy and management professor.

But the CDC survey results tracks closely with that, and they offer the first complete data for all of 2025 — the first year of President Trump’s second term in office.

The Trump administration has sought to expand access to low-premium catastrophic health insurance plans and lower drug prices for Americans who don’t have health insurance. It has also suggested that projected insurance enrollment declines indicate a drop-off of fraudulent and ineligible enrollees, rather than eligible Americans.

Although the share of insured and uninsured stayed roughly the same in 2025 as the year before, the number of uninsured grew by about 800,000 — 300,000 of them children. The growth of the overall U.S. population helps explain that.

The survey results also suggest a possible increased insured rate among Hispanic Americans. But that may in part reflect the effects of the Trump administration’s immigration crackdown, if uninsured members of that group left the country, Howard said.

Most Americans 65 and older have health insurance through the federal Medicare program. It’s different for younger Americans, many of whom are covered through a patchwork of public and private insurance programs.

The percentage of Americans under 65 who were uninsured rose in the 1980s, 1990s and early 2000s — from 12% in 1980 to more than 18% in 2010. It fell following passage of the Affordable Care Act in 2010, which expanded Medicaid programs and enacted measures to make affordable health insurance available to more people.

By 2016 it dropped nearly to 10%, before rising to 11 to 12% during Trump’s first administration, according to historical survey data from the CDC’s National Center for Health Statistics.

The COVID-19 pandemic saw the rate of uninsured fall again, as a result of government policies put in place to preserve coverage as people faced disruptions related to the pandemic. The rate hit an all-time low in 2023, falling below 9%.

It’s not clear yet how big the increase in uninsured Americans will be this year, but experts agree it will likely rise in the coming years as a result of changes to the Affordable Care Act and Medicaid.

“The decisions being made now — in Congress, state legislatures and state Medicaid agencies — will determine what happens next,” Nancy Brown, chief executive officer of the American Heart Association, said in a statement Thursday.

“Policymakers should act immediately to protect and expand access to affordable coverage, strengthen Medicaid and maintain pathways that make coverage and care accessible,” she said. “Without deliberate action, including reversing dramatic cuts to coverage, uninsured rates will continue to rise, putting quality health care further out of reach.”

Stobbe and Swenson write for the Associated Press.