GOP'S HEALTH CUTS LOOM

Counties aren't sure how they'll pay for the care of millions of newly uninsured.

- CHRISTINE MAI-DUC AND CLAUDIA BOYD-BARRETT

OFFICIALS in Placer and other counties are bracing for health insurance cuts.

In 2013, before the Affordable Care Act helped millions get health insurance, California's Placer County provided limited healthcare to some 3,400 uninsured residents who couldn't afford to see a doctor.

For several years, that number has been zero in the predominantly white, largely rural county stretching from Sacramento's eastern suburbs to the shores of Lake Tahoe.

The trend could be short-lived.

County health officials there and across the country are bracing for an estimated 10 million newly uninsured patients over the next decade in the wake of Republicans' One Big Beautiful Bill Act.

The act, which President Trump signed into law this summer, is expected to reduce Medicaid spending by more than $900 billion over that period.

"This is the moment where a lot of hard decisions have to be made about who gets care and who doesn't," said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at UCLA. "The number of people who are going to lose coverage is large, and a lot of the systems that were in place to provide care to those individuals have either gone away or diminished."

It's an especially thorny challenge for states such as California and New Mexico, where counties are legally required to help their poorest residents through what are known as indigent care programs. Under Obamacare, both states were able to expand Medicaid to include more low-income residents, alleviating counties of patient loads and redirecting much of their funding for the patchwork of local programs that provided bare-bones services.

Placer County, which estimates that 16,000 residents could lose healthcare coverage by 2028, quit operating its own clinics nearly a decade ago.