spending cut

Ever since Elijah Maldonado was born at just 29 months, he has needed specialty treatments that his family could afford only with publicly funded healthcare.

Diagnosed with cerebral palsy as an infant, he spent his first three months at a public hospital where the family lives in Orange County.

Now 7, Elijah receives physical and speech therapy among a host of other services paid for through Medicaid. He relies on a wheelchair funded by the government. An assistant paid for with taxpayer dollars makes sure he’s safe on the bus ride to and from school.

Each month, he receives a $957 disability check that helps to cover his and his family’s living expenses.

Josephine Rios wipes her grandson Elijah’s face.

(Juliana Yamada / Los Angeles Times)

Still learning to speak on his own, he uses a Proloquo speech app on an iPad provided by his school to tell his family when he’s hungry, needs to use the restroom or wants to play with his favorite toys.

“It’s his voice — his lifeline,” his aunt and primary caretaker Cassandra Gonzalez says of the app. Her compensation for his in-home care comes from taxpayer dollars too.

Now that lifeline — and much of the government assistance Elijah receives — is at risk of going away.

With hundreds of billions of dollars worth of cuts to Medicaid and food aid kicking in this fall thanks to the passage of the Republican-backed “One Big Beautiful Bill Act” — on top of earlier cuts imposed by Elon Musk’s Department of Government Efficiency — a host of federally funded healthcare and nutrition programs that serve low-income Americans will be scaled back, revamped with expanded work requirements and other restrictions or canceled altogether if individual states can’t find alternate funding sources.

The budget reduces federal spending on Medicaid alone by about $1 trillion over the next 10 years nationwide, with initial reductions taking effect in the coming weeks.

Gov. Gavin Newsom responded by accusing the Trump administration of “ripping care from cancer patients, meals from children and money from working families — just to give tax breaks to the ultra-rich.”

L.A. public health officials called the cuts devastating for a county where nearly 40% of the population is enrolled in Medi-Cal, the state’s Medicaid program. L.A. County’s Department of Health Services, which oversees four public hospitals and about two dozen clinics, projects a budget reduction amounting to $750 million a year, and federal funding for the Department of Public Health, which inspects food, provides substance-use treatment and tracks disease outbreaks, will drop by an estimated $200 million a year. Spending cuts have prompted hiring freezes and projections of ballooning budget deficits, county health officials said.

Spending reductions, combined with recent changes to the Affordable Care Act and Medicare, could leave an additional 1.7 million people in California uninsured by 2034, according to an analysis by the nonprofit healthcare research organization KFF.

Cuts to the Supplemental Nutrition Assistance Program (SNAP), colloquially known as “food stamps,” will exceed $280 billion over the next decade, according to projections from the Congressional Budget Office.

It’s not just that the cuts to these programs are massive by historical standards.

The new rules and restrictions are confusing and states have been given little guidance from the federal agencies that oversee health and nutrition programs on how, or even when, to implement them, experts at the Center on Budget Policy and Priorities wrote in a recent report.

What’s clear, the CBPP said, is that millions of children, older adults, people with disabilities and veterans stand to lose not just Medicaid coverage but federal aid to access the type of healthy foods that could prevent illness and chronic conditions.

More than 5 million California households receive food aid through the state’s CalFresh program and 97% percent of them will see their benefits either slashed or eliminated because of federal spending cuts, changes to eligibility requirements or financial constraints at the state level, according to an analysis by the nonpartisan California Budget Policy Center.

Elijah plays with toy cars outside his aunt’s home in Tustin.

(Juliana Yamada / Los Angeles Times)

In Orange County, where Elijah’s family lives, public health officials were already reeling from federal spending cuts in the months before the budget bill passed, said Dr. Veronica Kelley, director of the OC Health Care Agency. For example, there was the $13.2-million cut to funding for family planning services in the county, and the $4-million reduction in funding to Women, Infants and Children nutrition (WIC).

The agency has worked to prevent mass layoffs by moving public-health workers in canceled programs to other departments or leaving some positions unfilled in order to save jobs elsewhere, and it has sought out nonprofit social service organizations and philanthropies to either take over programs or help fund them, Kelley said.

Now, Kelley is preparing for possible cuts to programs to combat obesity, maintain community gardens, help seniors make better healthcare decisions and reduce the use of tobacco. The agency also has to figure out how to make up for a $4.8-million reduction in federal funds for the county’s SNAP program that takes effect on Wednesday — another casualty of the federal spending bill.

The measures that the agency has leaned on to get through the year are not sustainable, Kelley said. “We can only do that for so long,” she said. “It’s chaotic. In terms of healthcare, it’s devastating… It feels like we’re taking so many steps backward.”

The looming cuts and changes have also set off alarm bells at Kaiser Permanente, California’s largest private healthcare provider with 9.5 million members statewide, 1.1 million of whom are enrolled in Medi-Cal, the state’s Medicaid program.

“Without the ability to pay, newly uninsured people will find themselves having to delay care, leading to more serious and complex health conditions, increasing the use of emergency services and more intensive medical services,” Kaiser Permanente Southern California Regional spokeswoman Candice Lee said in a statement to The Times.

“This will affect all of us as the cost of this uncompensated care leads hospitals and care providers to charge paying customers more to cover their costs. Some hospitals and providers, especially those in rural and underserved areas, will be unable to make up for these unreimbursed costs, and will be financially threatened by these changes.”

Standing in front of her sister Cassandra’s town home in Tustin, a quiet suburban city of 80,000 about 10 miles south of Disneyland, Elijah’s mother, Samantha Rios; grandmother Josephine Rios; and Aunt Cassandra are filled with worry.

Elijah points to a command on his Proloquo speech app, which he uses to communicate his needs.

(Juliana Yamada / Los Angeles Times)

Josephine, a nursing assistant who works at a Kaiser hospital in Orange County, said she hears the panic in patients’ voices when they describe rushing to schedule needed medical procedures in anticipation of losing their Medicaid benefits.

Earlier this year, Josephine joined delegations of unionized California healthcare workers who traveled to Washington with the aim of pressing lawmakers to oppose spending cuts.

Rep. Young Kim, the Republican who represents the Rios family’s district in Congress, was receptive to the delegation’s pleas to vote no on the budget bill, Josephine recalls. The congresswoman ultimately voted for the bill, saying on her official webpage the legislation was good for Californians because it would relieve the tax burden on families, ensure that government dollars are used effectively and “strengthen Medicaid and SNAP for our most vulnerable citizens who truly need it.”

Elijah’s Aunt Cassandra and grandmother Josephine look over his shoulder as he watches a TV show.

(Juliana Yamada / Los Angeles Times)

Now, Josephine looked on as Elijah, seated in his wheelchair, played on his iPad and watched a Disney program on his phone. He can press a tab on the touchscreen to make the tablet say “My name’s Elijah” if he’s feeling unsafe away from home, another to tell his family he needs space when upset.

Watching Elijah enjoy himself, the women said they feel awkward broadcasting their woes to strangers when all they desire is what’s best for him. They don’t need the public’s pity.

The family wants lawmakers and the public to understand how seemingly abstract healthcare decisions involving billions of dollars, and made 2,000-plus miles away in Washington, have brought new financial turmoil to a family that’s already on the edge financially.

Samantha, a single mom, works full time to provide a home for Elijah and his two sisters, ages 10 and 8. A subscription to the Proloquo speech app alone would cost $300 a year out-of-pocket — more than she can afford on her shoestring budget.

Due to changes in household income requirements, Samantha had already lost Medicaid coverage for herself and her two girls, she said, as well as her SNAP food assistance, leaving her at a loss for how to fill the gap. She now pays about $760 a month to cover her daughters and herself through her employer-based health plan.

The cut to food aid has forced her to compensate by getting free vegetables, milk, eggs and chicken from the food pantry at a local school, a reality that she said she was at first too ashamed to disclose even to relatives.

Then came the bad news Samantha recently received about Elijah’s monthly Social Security Insurance for his disability. She was stunned to hear that because of stricter income cut-offs for that type of aid, Elijah would no longer receive those checks as of Oct. 1.

“Before, he was getting $957 a month — obviously that’s grocery money for me,” Samantha said. The money also went to buy baby wipes, as well as knee pads to help him move more comfortably on the floor when not using his wheelchair.

“I don’t get food stamps. I don’t get Medi-Cal for my girls. I don’t get any of that,” Samantha said. “As of Oct. 1, now I’ve got to figure out how am I going to pay my rent? How am I going to buy groceries?”

Luckily, the sisters said, the physical, speech and behavioral-health therapies that Elijah receives are safe — for now.

And the women know they can lean on each other in tough times. The sisters and Josephine all live within minutes of each other in Tustin, close enough for Samantha’s children to eat at someone’s home when their own cupboards are bare.

Every few months, Samantha said, Elijah experiences severe seizures that can last up to 90 minutes and require hospitalization.

Cassandra and Josephine like that they can run over to help if Elijah has a medical emergency. Another sister who lives farther away is on hand when needed too.

“What’s going to happen to other families who don’t have that support system?” Samantha said.

Given the potential for further cuts to programs that pay for home-based healthcare and assistants for people with disabilities, Cassandra wonders what will happen to her own family if she can no longer work as Elijah’s caregiver.

Where would the family get the money to pay a new caregiver who is qualified enough to work with a special-needs child who can speak a few words thanks to speech therapy but who cannot eat, walk or use the restroom without supervision? What if funding is eliminated for the assistant who travels with Elijah to school?

“People think that cutting Medi-Cal, cutting food stamps or whatever isn’t going to affect that many people,” Cassandra said. “It’s affecting my nephew and nieces. It’s affecting my sister. But it’s not just affecting her household. It’s affecting my household.”

“We’re not saying we’re going to Disneyland or going out to eat every day,” Cassandra said. “This is just living. We can’t even live at this point, with things being cut.”

The women offered up principles they feel are in short supply lately in the discourse over the government’s role in public health — among them “morals” and “empathy.” Samantha adds one more word to the list.

“Humanity,” she says. “We lack it.”

WASHINGTON — The Senate is leaving Washington on Saturday night for its monthlong August recess without a deal to advance dozens of President Trump’s nominees, calling it quits after days of contentious bipartisan negotiations and Trump posting on social media that Senate Democratic leader Chuck Schumer can “GO TO HELL!”

Without a deal in hand, Republicans say they may try to change Senate rules when they return in September to speed up the pace of confirmations. Trump has been pressuring senators to move quickly as Democrats blocked more nominees than usual this year, denying any fast unanimous consent votes and forcing roll calls on each one, a lengthy process that can take several days per nominee.

“I think they’re desperately in need of change,” Senate Majority Leader John Thune (R-S.D.) said of Senate rules Saturday after negotiations with Schumer (D-N.Y.) and Trump broke down. “I think that the last six months have demonstrated that this process, nominations, is broken. And so I expect there will be some good robust conversations about that.”

The latest standoff comes as Democrats and Republicans have escalated their obstruction of the other party’s executive branch and judicial nominees over the last two decades, and as Senate leaders have incrementally changed Senate rules to speed up confirmations — and make them less bipartisan.

In 2013, Democrats changed Senate rules for lower court judicial nominees to remove the 60-vote threshold for confirmations as Republicans refused to consider any of President Obama’s judicial picks. In 2017, Republicans did the same for Supreme Court nominees as Democrats tried to block Trump’s nomination of Neil M. Gorsuch.

Trump has been pressuring Senate Republicans for weeks to cancel the August recess and grind through dozens of his nominations as Democrats have slowed the process. But Republicans hoped to make a deal with Democrats instead, and came close several times over the last few days as the two parties and the White House negotiated over moving a large tranche of nominees in exchange for reversing some of the Trump administration’s spending cuts on foreign aid, among other issues.

But it was clear that there would be no agreement when Trump attacked Schumer on social media Saturday evening and told senators to pack it up and go home.

“Tell Schumer, who is under tremendous political pressure from within his own party, the Radical Left Lunatics, to GO TO HELL!” Trump posted on his social media platform. “Do not accept the offer, go home and explain to your constituents what bad people the Democrats are, and what a great job the Republicans are doing, and have done, for our Country.”

Thune said afterward that there were “several different times” when the two sides thought they had a deal, but in the end “we didn’t close it out.”

It’s the first time in recent history that the minority party hasn’t allowed at least some quick confirmations. Thune has already kept the Senate in session for more days, and with longer hours, this year to try to confirm as many of Trump’s nominees as possible.

But Democrats had little desire to give in without the spending cut reversals or some other incentive, even though they too were eager to skip town after several long months of work and bitter partisan fights over legislation.

“We have never seen nominees as flawed, as compromised, as unqualified as we have right now,” Schumer said Saturday.

Jalonick and Cappelletti write for the Associated Press.

WASHINGTON — The House narrowly voted Thursday to cut about $9.4 billion in spending already approved by Congress as President Trump’s administration looks to follow through on work done by the Department of Government Efficiency when it was overseen by Elon Musk.

The package targets foreign aid programs and the Corp. for Public Broadcasting, which provides money for National Public Radio and the Public Broadcasting Service as well as thousands of public radio and television stations around the country. The vote was 214-212.

Republicans are characterizing the spending as wasteful and unnecessary, but Democrats say the rescissions are hurting the United States’ standing in the world and will lead to needless deaths.

“Cruelty is the point,” Democratic leader Hakeem Jeffries of New York said of the proposed spending cuts.

The Trump administration is employing a tool rarely used in recent years that allows the president to transmit a request to Congress to cancel previously appropriated funds. That triggers a 45-day clock in which the funds are frozen pending congressional action. If Congress fails to act within that period, then the spending stands.

“This rescissions package sends $9.4 billion back to the U.S. Treasury,” said Rep. Lisa McClain, House Republican Conference chair. “That’s $9.4 billion of savings that taxpayers won’t see wasted. It’s their money.”

The benefit for the administration of a formal rescissions request is that passage requires only a simple majority in the 100-member Senate instead of the 60 votes usually required to get spending bills through that chamber. So if they stay united, Republicans will be able to pass the measure without any Democratic votes.

Senate Majority Leader John Thune (R-S.D.) said the Senate would likely not take the bill up until July and after it has dealt with Trump’s big tax and immigration bill. He also said it’s possible the Senate could tweak the bill.

The administration is likening the first rescissions package to a test case and says more could be on the way if Congress goes along.

Republicans, sensitive to concerns that Trump’s sweeping tax and immigration bill would increase future federal deficits, are anxious to demonstrate spending discipline, though the cuts in the package amount to just a sliver of the spending approved by Congress each year. They are betting the cuts prove popular with constituents who align with Trump’s “America first” ideology as well as those who view NPR and PBS as having a liberal bias.

In all, the package contains 21 proposed rescissions. Approval would claw back about $900 million from $10 billion that Congress has approved for global health programs. That includes canceling $500 million for activities related to infectious diseases and child and maternal health and another $400 million to address the global HIV epidemic.

The Trump administration is also looking to cancel $800 million, or a quarter of the amount Congress approved, for a program that provides emergency shelter, water and sanitation, and family reunification for those forced to flee their own country.

About 45% of the savings sought by the White House would come from two programs designed to boost the economies, democratic institutions and civil societies in developing countries.

Democratic leadership, in urging their caucus to vote no, said that package would eliminate access to clean water for more than 3.6 million people and lead to millions more not having access to a school.

“Those Democrats saying that these rescissions will harm people in other countries are missing the point,” McClain said. “It’s about people in our country being put first.”

The Republican president has also asked lawmakers to rescind nearly $1.1 billion from the Corp. for Public Broadcasting, which represents the full amount it’s slated to receive during the next two budget years. About two-thirds of the money gets distributed to more than 1,500 locally owned public radio and television stations. Nearly half of those stations serve rural areas of the country.

The association representing local public television stations warns that many of them would be forced to close if the Republican measure passes. Those stations provide emergency alerts, free educational programming and high school sports coverage, and highlight hometown heroes.

Advocacy groups that serve the world’s poorest people are also sounding the alarm and urging lawmakers to vote no.

“We are already seeing women, children and families left without food, clean water and critical services after earlier aid cuts, and aid organizations can barely keep up with rising needs,” said Abby Maxman, president and chief executive of Oxfam America, a poverty-fighting organization.

Rep. Jim McGovern (D-Mass.) said the foreign aid is a tool that prevents conflict and promotes stability, but the measure before the House takes that tool away.

“These cuts will lead to the deaths of hundreds of thousands, devastating the most vulnerable in the world,” McGovern said.

“This bill is good for Russia and China and undertakers,” added Rep. Steve Cohen (D-Tenn.).

Republicans disparaged the foreign aid spending and sought to link it to programs they said DOGE had uncovered.

Rep. Chip Roy (R-Texas) said taxpayer dollars had gone to such things as targeting climate change, promoting pottery classes and strengthening diversity, equity and inclusion programs. Other Republicans cited similar examples they said DOGE had revealed.

“Yet, my friends on the other side of the aisle would like you to believe, seriously, that if you don’t use your taxpayer dollars to fund this absurd list of projects and thousands of others I didn’t even list, that somehow people will die and our global standing in the world will crumble,” Roy said. “Well, let’s just reject this now.”

Freking writes for the Associated Press.

The “One Big Beautiful Bill” is one big, ugly mess.

We’ve seen false advertising in naming laws before — the Democrats’ 2022 Inflation Reduction Act jumps to mind. Yet no legislation has been as misbranded as the Republican tax and spending cuts that President Trump, the branding aficionado himself, is pushing along a tortuous path in Congress.

Trump’s appeal to many Americans has always been his purported penchant for “telling it like it is.” But he’s doing the opposite by labeling as the “One Big Beautiful Bill” a behemoth that encompasses just about everything he can’t even try to do by unilateral executive orders — deeper tax cuts, more spending on the military and on his immigration crackdown and, yes, Medicaid cuts. His so-called beauty is a beast so frightening that ratings firm Moody’s saw the details last week, calculated the resulting debt and on Friday downgraded the United States’ sterling credit rating for the first time in more than 100 years. That likely means higher interest costs for the nation’s increased borrowing ahead.

And yet, in another example of the gaslighting at which Trump and his party are so adept, the White House and House Republican leaders dismissed the rebuke of their bill. Treasury Secretary Scott Bessent said it would spur economic growth — the old, discredited “tax cuts will pay for themselves” argument. Speaker Mike Johnson said the Moody’s downgrade just proved the urgent need to pass the big, beautiful bill with its “historic spending cuts.” Which only proved that Johnson didn’t read Moody’s rationale, explaining that spending cuts would be far exceeded by tax cuts, thereby reducing the government’s revenues and piling up more debt.

The Republican Party, which postures as the fiscally conservative of the two parties despite decades of evidence to the contrary, would add about $4 trillion in debt over the next 10 years if its bill becomes law, according to Moody’s. Other nonpartisan analyses — including from the Congressional Budget Office, the Committee for a Responsible Federal Budget and the Penn Wharton Budget Model of the University of Pennsylvania, similarly project additional debt in the $3-trillion-plus to $5-trillion range, more if the tax cuts are made permanent as Trump and Republicans want.

No surprise: Trump, after all, set a record for the most debt in a single presidential term: $8.4 trillion during Trump 1.0, nearly twice what accrued under his successor, President Biden. Most of Trump’s first-term red ink stemmed from his 2017 tax cuts and spending, which predated the COVID-19 pandemic and the government’s costly response.

“This bill does not add to the deficit,” White House Press Secretary Karoline Leavitt insisted to reporters on Monday, showing yet again why such a facile dissembler was chosen to speak for the habitually prevaricating president.

“That’s a joke,” Republican Rep. Thomas Massie of Kentucky responded.

Worse, it’s a lie.

And no surprise here, either, but Trump’s tariffs — another economic monstrosity that he’s declared “beautiful” — aren’t paying for this bill despite his claims. Yet the president repeated that falsehood on Tuesday (along with others), when he visited the Capitol to strong-arm Republican dissidents, including Massie, into supporting the measure ahead of a House vote. (Inside a closed caucus with House Republicans, the president reportedly called for Massie to be unseated; the Kentuckian remains opposed.)

“The economy is doing great, the stock market is higher now than when I came to office. And we’ve taken in hundreds of billions of dollars in tariff money,” Trump told reporters at the Capitol. Every point a lie.

(This week provided yet more evidence that he’s utterly wrong to keep insisting that foreign countries pay his tariffs, not American consumers. After Walmart, the largest U.S. retailer, said late last week that it would have to raise prices, Trump posted that it should “ ‘EAT THE TARIFFS.’ ” He added: “I’ll be watching, and so will your customers!!!” This after a Walmart exec said that “the magnitude of these increases is more than any retailer can absorb.”)

While details of the budget bill shift as Republican leaders dicker with their dissidents, here’s the ugly general outline, according to Penn Wharton:

Extending and expanding Trump’s 2017 tax cuts, which otherwise expire this year, would cost nearly $4.5 trillion over 10 years, $5.8 trillion if the cuts are permanent. (Mandating that tax cuts expire after a time, as Trump did in 2017, is an old budget gimmick to understate a bill’s cost. The politicians know they’ll just extend the tax breaks, as we’re seeing now.) The bill’s proposed spending increases for the military, immigration enforcement and deportations would cost about $600 billion more.

Spending cuts over 10 years, mostly to Medicaid as well as to Obamacare, food stamps and clean-energy programs, would save about $1.6 trillion. That offsets as little as one-quarter of the cost of Trump’s tax cuts and added spending.

Also, the bill is inequitable. The tax cuts would disproportionately favor corporations and wealthy Americans. Its spending cuts, however, would mostly cost lower- and some middle-income people who benefit from federal health and nutrition programs. Changes to Medicaid, including a work requirement (92% of recipients under 65 already work full or part-time, according to the health research organization KFF), and to Obamacare would leave up to 14 million people without health insurance.

Penn Wharton found that people with household income less than $51,000, for example, would see their after-tax income reduced if the bill becomes law, and the top 0.1% of income-earners would get hundreds of thousands of dollars more over the next 10 years. Beyond that time, Penn Wharton projected, “all future households are worse off” given the long-term impact of spiraling debt and a tattered safety net.

“Don’t f— around with Medicaid,” Trump told Republicans at the Capitol, according to numerous reports. How cynical, given that he was pressuring them to vote for a bill that would do just that.

All of which recalls an acronym that’s popular these days: FAFO.

@jackiekcalmes