H.R. 1 Cuts to Medi-Cal Impact Californians in Every Legislative District

Access to health care and food assistance are critical for every Californian to survive. But due to the Republican megabill H.R. 1, signed into law in 2025, millions of Californians are likely to lose access to these invaluable programs that help them meet their basic needs.

H.R. 1 includes the largest cuts in U.S. history to food assistance and health care programs, among other critical services. Medi-Cal — California’s Medicaid program — provides free or low-cost health care to nearly 15 million Californians. According to the Department of Health Care Services, federal cuts to Medicaid are estimated to cost  “tens of billions of dollars” in lost federal funding to Medi-Cal every year and could cause up to 2 million Californians to lose their health care.

These cuts, together with additional cuts to CalFresh, threaten to destabilize California’s health care system, worsen health outcomes, increase costs, and exacerbate food insecurity in every legislative district in the state.

The tables below show how many residents in each of California’s legislative districts benefit from Medi-Cal. These cuts will have wide-reaching impacts in every community across the state that state leaders should consider as they deliberate the 2026-27 state budget and other policy priorities.

Medi-Cal, California’s Medicaid program, provides free or low-cost coverage to more than one in three Californians, including children, pregnant individuals, seniors, and people with disabilities. It plays a central role in keeping people healthy and supporting jobs, businesses, and the broader economy.

In recent state budget discussions, Medi-Cal has been framed as a main driver of the state’s structural budget shortfall, and policymakers are considering additional cuts after already reducing support for the program last year. But this framing overlooks a fundamental issue and Californians’ health needs. California’s structural shortfall reflects a mismatch between the public investments that people want and need and the resources necessary to support them. This problem would be better addressed by closing gaps in the state’s tax base, not cutting vital services like health care.

Medi-Cal Spending Reflects Broader Health Care Trends

Medi-Cal spending reflects system-wide trends that affect the entire health care system — not just Medicaid. A major driver is rising health care prices. Across the country, hospitals and physicians are raising prices for care and pharmacies are charging more for prescription drugs. As prices increase, delivering care becomes more expensive, which raises overall health care spending.

In addition to rising prices, the California Legislative Analyst’s Office recently outlined other cost factors impacting Medi-Cal spending, including:

• Demographic changes. More seniors and people with disabilities are accessing needed care, and because they often have more complex health needs, average spending per person is higher.
• Increased use of services. More people are receiving care in high-cost settings, such as hospital stays, and using a range of services.
• Higher prescription drug spending. The growing use of high-cost medications has been a significant contributor to recent spending increases.
• Policy choices to expand access. State investments have helped more Californians get care, improving health and financial stability.

Rising Medi-Cal spending, in part, reflects a state meeting the needs of its residents by helping more people get care they were previously unable to access. California’s uninsured rate has dropped significantly over the past decade, reflecting meaningful gains in access to care. Fewer Californians are delaying treatment, rationing prescription medications, or going without care they need because they cannot afford it.

But these gains are now under threat from harmful federal policy decisions. Republicans in Congress and the Trump administration enacted H.R. 1, which cut nearly $1 trillion from Medicaid over the next decade. While these cuts do not change the underlying cost of care, they increase pressure on the state budget by shifting a greater share of those costs to California.

Cutting Medi-Cal Is Counterproductive

Cutting Medi-Cal won’t solve long-term budget challenges, and it can make them worse. Reducing Medi-Cal enrollment or scaling back benefits harms people’s health while also weakening a major economic engine that supports jobs, health care providers, and local economies across the state.

When people lose health coverage, they are more likely to delay or forgo treatment. As a result, small health issues can become serious and expensive to treat. Over time, this adds new pressures to the state budget due to increased emergency care or uncompensated care.

Cuts to Medi-Cal also affect local economies. Reducing enrollment or covered services means less funding flowing into communities. Each year, Medi-Cal dollars support health care workers, hospitals, pharmacies, and many other parts of the health care system. When fewer people are covered or fewer services are reimbursed, providers bring in less revenue, which can lead to job losses and slower economic activity across the state.

While Medi-Cal cuts may offer short-term budget relief, they do not address the underlying drivers of cost growth and they come with significant trade-offs, including:

• Reduced access to care or fewer covered services.
• Higher out-of-pocket costs for Californians.
• Increased strain on health care providers and safety-net systems.
• Job losses and reduced economic activity in communities across the state.

California’s Structural Deficit Reflects Insufficient Resources to Meet Californians’ Growing Needs

At its core, the structural budget deficit reflects a mismatch between the ongoing resources raised by the state’s tax system and the public investments that are necessary to meet Californians’ needs. But cutting vital spending is not the solution because:

• Recent investments to address people’s essential needs have improved Californians’ quality of life.
• Californians continue to have significant unmet needs, and now federal cuts threaten to upend recent progress addressing them.
• California wastes billions of dollars each year on tax breaks for corporations and high-income households that take vital resources away from community needs.
• Inequities in our state’s tax system deprive the state of resources that could be better used to improve Californians’ quality of life.

Policymakers Should Focus on Sustainable Solutions

Addressing California’s budget challenges requires solutions that reflect the full scope of the problem. Increasing revenue is the most immediate way policymakers can close large, ongoing shortfalls. Other approaches can reduce costs and improve the system, but they may take time to generate savings. Rather than reducing Californians’ access to health coverage focusing on cuts to Medi-Cal, policymakers should:

• Address underlying health care cost growth. Policymakers can build on efforts like the Office of Health Care Affordability to slow cost growth across the entire health system.
• Strengthen preventive and primary care. Investing in prevention keeps people healthier while reducing avoidable health care spending.
• Improve system efficiency. Reducing administrative barriers and improving care coordination can help ensure resources are used effectively.
• Identify sustainable and equitable revenue sources. Aligning state revenues with the cost of meeting Californians’ needs is critical to supporting long-term fiscal stability.

State leaders should prioritize immediate revenue solutions to stabilize the budget while also pursuing systemic changes that will improve affordability and sustainability over time. Protecting access to health care is essential to both the well-being of Californians and the state’s long-term economic stability.

When all Californians — regardless of race, age, disability, or immigration status — have access to affordable and comprehensive health care, the entire state benefits through overall improved health and well-being, stronger communities, and reduced long-term costs.

California had made significant advances toward providing health care for all, but recent federal and state cuts to health care access and eligibility threaten to leave millions without coverage. Additionally, as part of his 2026-27 budget, the governor is proposing additional cuts that will restrict immigrants’ access to comprehensive, affordable health care. State leaders should restore and maintain access to Medi-Cal — California’s Medicaid program — for all Californians regardless of immigration status so that everyone can have the care they need to survive.

Preventive Care Is More Affordable Than Emergency Care, Universal Coverage Can Save California Money

Routine check-ups, screenings, and other preventive services help catch and address health issues before they become serious and more expensive to treat, research shows. For example, managing high blood pressure with medication and regular doctor visits is less costly than treating a stroke or heart failure. Investing in prevention keeps people healthier, improves their quality of life, and prevents bigger health issues later in life. Preventive health care also helps reduce emergency department visit rates, resulting in better care for all hospital patients.

When people lack health coverage, they may be forced to delay or forego care until their health worsens. For example, research shows that people who do not have health coverage are less likely to receive treatment for chronic health conditions and more likely to report a poor health status. This can worsen health conditions, which are more expensive to treat and, in turn, raise costs for hospitals, health care providers, and the state. People delaying care until health issues worsen costs California’s health care system billions of dollars every year, likely outweighing the costs of providing care to all. Those dollars could be better spent on funding health care for those who lack essential coverage.

Providing People with Comprehensive Health Coverage Leads to Better Health and Community Well-Being

In 2016, California expanded Medi-Cal to cover all children up to age 18, regardless of immigration status. Data show that this expansion meaningfully improved children’s health. The proportion of non-citizen children who reported being in excellent health after the expansion increased by 10 percentage points. This suggests that increasing access to health care improves health status.

In addition to improved health, when people have access to health care, they are more likely to avoid medical debt and contribute fully to their families, workplaces, and communities. This helps strengthen the public health system, keeps the community safer, helps ensure a healthy and strong workforce, and lowers poverty in the state. New research shows that California’s health care programs help keep people out of poverty by providing critical health care and could also help reduce poverty for families.

The Health Care System Works Better When Everyone — Including Immigrants — Is Covered

When more people have access to care, the entire health system and state benefits. A growing body of research links Medicaid expansion with reduced mortality rates. Current efforts to strip many immigrants of their health coverage undermines the health care system as a whole and cuts off access to essential services to people who are vital members of the state and its communities and make meaningful contributions to the state’s robust economy.

Undocumented Californians paid nearly $8.5 billion in state and local taxes in 2022, despite being excluded from most public benefits. Denying many immigrants access to health care while the state benefits from their labor and tax payments is inequitable and harms the overall health care system.

Providing health care to all is a worthwhile investment that will significantly improve the lives of all Californians. If current cuts remain in place, state leaders will prioritize short-term savings at the expense of long-term gains in the state’s overall social and financial well-being.  Ensuring broad access to Medi-Cal improves lives, protects public health, is good for the economy, and builds a healthier California for everyone.

Adriana Ramos-Yamamoto contributed to this publication.