Resistance State: California in the Age of Trump
Between Sacramento and Washington D.C. sits the rest of the country, and a chasm. On immigration and taxes, guns and healthcare, cannabis and climate change, California is the federal government’s equal and opposite reaction. One year into President Trump’s first term, the push and pull continues—playing out under the Capitol dome, in the courts and on Twitter.
Ready for another year? Follow along here.
Since the Trump administration said in January that states could require Medicaid recipients to work if they want to continue receiving the benefit, three states have signed on: Kentucky, Indiana and Arkansas. Many others are considering it.
California, of course, is walking a different path. State Sen. Ed Hernandez (D-West Covina) is floating a bill to ban work requirements for Medi-Cal recipients. Medicaid is the national health care program for the poor; the California version of it is Medi-Cal.
Hernandez called the federal work-requirement idea “backwards” when introducing his bill. “Now is the time to focus all efforts on covering more people,” he said, “not less.”
Proponents of the work requirement say it can save money and make recipients accountable for receiving benefits. The whole point of requiring work for non-disabled adults, according to federal guidance, is to promote recipients’ well-being and increase their self-sufficiency.
Critics argue it won’t reach any of those goals and, in fact, might actually cost states money. Erecting a work wall, they say, also would discourage people from getting Medicaid and drop many people who need it.
“I’m not sure why adding a work requirement would promote well-being,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research. “The reality is, the great majority of Medicaid recipients are children or seniors—or they’re part of working families. We can’t assume people who get Medicaid are just sitting on their hands.”
In California, most of the working-age poor on Medi-Cal already do have jobs. According to a California HealthCare Foundation report based on 2016 data, children and seniors make up the vast majority of Medi-Cal recipients. Only about a third are working-age, non-disabled adults.
The majority of those adults, 62% of them, work. Among those not working, almost all (82%) were ill, caring for an ailing family member or going to school.
Who’s left? The report said 324,000 Californians who didn’t work and were eligible to work were receiving Medi-Cal benefits. That’s about 2.4% of the 13.5 million on Medi-Cal.
If a work requirement would lift those people out of poverty and off Medi-Cal, that would save the state money, right?
That’s a pipe dream, according to Anthony Wright, executive director of the Sacramento-based Health Access, a nonprofit health advocacy group. Wright said a work requirement won’t make jobs appear.
The real way the work-for-Medicaid plan saves money is by cutting back on the number of people who receive benefits, he said. Imposing a lot more paperwork and eligibility requirements would do the trick, he said.
“This will have an impact because of the paperwork and administrative barriers being put up to get coverage. People will fall off coverage as a result,” Wright said. “That’s the hidden agenda.
“Those [work-for-Medicaid] rules would marginalize Medi-Cal as a welfare program, rather than see it as a safety net for all of us,” he said.
The Hernandez bill doesn’t defy federal guidance the same way California’s cannabis and sanctuary laws do—adoption of a Medicaid work requirement is a choice. But it sends a message.
Hernandez has said he’s hoping other states might follow California’s lead. And resistance did crop up in Minnesota, where one legislator sent a message similar to California’s:
Democratic Sen. Tony Lourey recently proposed an amendment to a Republican-backed work-for-Medicaid measure in Minnesota, one that the GOP-controlled Legislature there quickly voted down. It would have required that lawmakers lose their state-funded health care benefits unless they work with some of the people affected by the legislation.
That is, the amendment said legislators must put in some time at, say, the county human services agency when the Legislature was not in session, or they’d lose their state health coverage.
The California bill already has passed the Senate Health committee, which Hernandez chairs, and has been given priority status by the influential Latino caucus. It has no organized opposition and is expected to sail through the Legislature.
California’s sanctuary law—by limiting how much state and local law enforcement could cooperate with federal immigration agents—engaged in a we-won’t-hold-‘em policy that outraged the Trump administration. Now its federal border patrol agents reportedly have upped the ante.
Those agents have begun refusing to turn over suspects wanted by California law enforcement agencies for crimes such as sexual assault and drug possession, instead either charging them with immigration-related federal crimes or simply deporting them, according to a story in the Los Angeles Times.
This latest escalation of the power struggle between the Trump administration and California worries some immigration advocates and legal experts.
“It does seem to be a tit for tat,” said Jean Reisz of the University of Southern California’s Gould School of Law. “And that doesn’t serve anyone well.”
Jon Rodney of the California Immigrant Policy Center, a nonprofit advocacy group in Sacramento, had stronger words: “This move underscores the deeply hypocritical, manipulative and deceptive nature of the federal government’s deportation force.”
At the root of Reisz’ concern is not just the escalation of rhetoric, or any political maneuvering that might be going on. The law is written for its victims, she said, who may not feel they got justice if the accused is sent back home.
“It’s illegal to leave the country if there’s a pending criminal case against you,” Reisz said. Reportedly, convicted felons who were accused of serious crimes such as sex offenses were deported rather than turned over to California police.
The details about these particular deportations isn’t clear—the Times affected Southern California sheriff’s departments declined to comment, saying federal authorities hadn’t provided them enough information to identify which suspects they had refused to transfer.
Some police officers and sheriffs from conservative cities and counties have lambasted California’s sanctuary policy and called for it to be overturned.
Both the state’s sanctuary law and the apparent federal retaliation against it mark a departure from the cooperation that once existed between California police and sheriffs and immigration agents.
We have another lawsuit.
With a new filing this morning, California Attorney General Xavier Becerra brought the state’s total number of legal challenges against the Trump administration to 33. That’s two lawsuits per month since the president assumed office.
The question at issue this time: did the Environmental Protection Agency violate federal procedures when it reversed an Obama-era rule requiring agricultural companies to train their workers about the hazards of pesticides? This is the eighth case brought against the agency or its administrator, Scott Pruitt.
Track all of California’s lawsuits against the Trump administration here.
California already has taken its first shot at countering the Trump administration’s plan to deny funding for reproductive health services to any organization that provides abortions or makes referrals for the procedure.
This week California led a coalition of 19 states and the District of Columbia in backing a Planned Parenthood motion for an injunction to halt the federal plan. The states’ brief was filed in the U.S. District Court for the District of Columbia.
The Trump administration today is expected to release the details of its proposal to change the requirements for the funds, known as Title X money, effectively taking it away from groups like Planned Parenthood and instead awarding it to groups advocating natural family-planning methods and abstinence-only education.
According to California Attorney General Xavier Becerra, California receives about $20.4 million a year in Title X money, which helps provide family-planning and other reproductive health services to roughly 1 million low-income Californians.
“Medical care is a matter between a woman and her doctor, not the President or the Vice President,” Becerra said in a March 18 statement.
According to reports from the New York-based nonprofit Guttmacher Institute, a research and policy group, roughly half of the pregnancies in the U.S. are unintended. The rate of unintended pregnancies would jump by 66% without publicly funded contraceptive services, a Guttmacher report said—and unplanned pregnancy rates for teens would be 73% higher.
The Institute said Planned Parenthood is the source of birth control for about a third of all low-income women who get it through the Title X program.
“Title X is not abortion care,” said Jennifer Conti, a Stanford physician who provides abortions. “One of the things even my close friends and relatives don’t understand is that Title X funds have never been used to provide abortion care. This seems like a punitive rule for groups like Planned Parenthood.”
Conti said what rankles her most about the proposed rule is the restriction on discussing where patients can get an abortion.
“This new rule would force us to lie to our patients,” she said. “Not that we couldn’t discuss abortion—but not being able to discuss how to carry out an abortion or where to get it, I think that puts patients’ lives in danger.”