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If President-elect Donald Trump goes forward with Project 2025, California could lose out on at least $300 million a year in funding for abortions, family planning and contraception for millions of low-income residents.  

Project 2025, a right-wing blueprint for the next president, targeted the state with an ultimatum that would require California to start reporting abortion data to the Centers for Disease Control or risk losing critical Medicaid funding. 

Despite Trump’s attempts to distance himself from the plan during the campaign, at least 140 of his allies produced the report and he’s appointing key figures from the project to his administration. As California leaders rush to shield the state from a Trump agenda, preserving reproductive freedoms stands as a top priority. 

Newsom called a special session for next month to “Trump-proof” California, and he’s hiring lawyers to prepare for Day 1 of the Trump presidency. 

“Whether it be our fundamental civil rights, reproductive freedom, or climate action – we refuse to turn back the clock and allow our values and laws to be attacked,” Newsom said in a statement.

When CalMatters first reported on the ultimatum in September, the California Department of Health Care Services didn’t provide specific figures detailing how much the state receives in federal reimbursements for reproductive healthcare provided through Medi-Cal. The department now says the federal government reimbursed California about $310.7 million for reproductive healthcare last year, according to California Department of Health Care Services figures. In the previous year, the state received $334.5 million. That funding supports Medi-Cal, the single largest payer of maternity care in the country. Medi-Cal covers about 14.2 million Californians.  All told, the federal government reimbursed the state $90.9 billion for Medi-Cal last year.

Under Project 2025, all 50 states would be mandated to report detailed abortion-related data to the federal government, including information such as the reason for the abortion, the fetus’ gestational age, the birthing parent’s state of residence, whether the procedure was surgical or medication-induced, and more.

Currently, California, Maryland, and New Hampshire do not require abortion providers to share patient data with the federal government. Shortly after the overturning of Roe v. Wade, the California Department of Public Health said that it does not report abortion data federally because it is not legally obligated to do so. States that do collect abortion data typically use it for public health analyses, which can help identify gaps in care and improve access to services.

Newsom’s office did not provide details on the projected costs of lawyering up, but said the  governor plans for legislation to give additional resources to the California Department of Justice and other state agencies. 

These resources are intended “to pursue robust affirmative litigation against any unlawful actions by the incoming Trump Administration, as well as defend against federal lawsuits aimed at undermining California’s laws and policies,” the governor’s office said. “The funding will support the ability to immediately file litigation and seek injunctive relief against unlawful federal actions.”

Trump tapped two individuals associated with Project 2025 for roles in his administration. Brendan Carr, who authored Project 2025’s section on the Federal Communications Commission, will lead the agency.  

Tom Homan, an immigration hawk who’s listed in Project 2025’s credits as having assisted in developing and writing the playbook, will serve as the border czar, overseeing immigration policies and implementing mass deportation strategies. The spot is not an official cabinet position.

To lead the Department of Health and Human Services, Trump tapped Robert F. Kennedy Jr., an environmental lawyer who previously fought California over vaccine mandates. . The department controls oversight of Medicaid spending and plays a critical role in abortion reporting by setting federal guidelines and enforcing privacy protections under HIPAA. 

Kennedy does not appear to have endorsed Project 2025. His stance on abortion has been notably inconsistent over time. In May, he expressed support for unrestricted abortion access, stating he opposed any government restrictions, “even if it’s full term.” 

However, he later revised his position, advocating for legal abortion up to the point of fetal viability, the stage at which a fetus can potentially survive outside the womb. 

Roger Severino, who served as the Department of Health and Human Services’ director of the Office for Civil Rights under Trump, authored Project 2025’s abortion surveillance plan. He is now the vice president of domestic policy at the Heritage Foundation, the conservative think tank behind Project 2025. He declined an interview request.

Severino’s vision for remaking the department is a cornerstone of Project 2025’s effort to impose stricter federal oversight on abortion practices, particularly targeting states like California, which offers greater access to abortion services than most other states. 

“Because liberal states have now become sanctuaries for abortion tourism, [the Department of Health and Human Services] should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method,” reads the chapter on abortion reporting. 

The potential fallout isn’t limited to California. Experts have warned that other states with progressive abortion policies may face similar funding threats, amplifying the national debate over reproductive rights under Trump’s second term.

After Election Day, Newsom traveled to Washington, D.C. for meetings with the Biden administration and congressional leaders to “discuss strategies for safeguarding healthcare access,” said Anthony Cava, a spokesperson for the California Department of Health Care Services.

Cava would not elaborate on those strategies. He said the department “cannot speculate on the future of these programs under a new federal administration, but the Newsom administration is working to protect the health and well-being of all Californians.”

California has long positioned itself as a national leader in reproductive rights, actively opposing federal restrictions on abortion access. The state’s proactive policies, such as safeguarding providers who serve out-of-state patients, stand in stark contrast to the goals of Project 2025. As policymakers and advocates brace for how Trump plans to “Make California Great Again,” they’re treating Project 2025 as a looming possibility.

Planned Parenthood, one of California’s leading providers of reproductive healthcare services for low-income communities, said the organization is preparing for “a variety of scenarios.” 

Shelby McMichael, a spokesperson for Planned Parenthood Affiliates of California, said “while specifics remain under wraps,” the group is prioritizing expanding California’s abortion provider workforce, increasing investments in abortion funds and infrastructure as well as analyzing data to “improve abortion care access and education.”

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Five years ago, hundreds of people crowded the halls of the state Capitol protesting legislation that sought to tighten California’s vaccine rules. Outside, music blasted something about a revolution and people carried signs that read “Vaccine mandates violate bodily autonomy.”

From the sea of red-clad protesters emerged a familiar face idolized by the anti-vaccine activists: Robert F. Kennedy Jr.  

He was the guest of honor in one of the biggest public health showdowns the state has seen in recent years. Ultimately, he and his followers lost — the Legislature passed a law to clamp down on fraudulent or inappropriate medical exemptions for required childhood vaccines.

Today, Kennedy finds himself on a bigger stage with potentially far more influence and power. President-elect Donald Trump has nominated the former environmental lawyer turned controversial vaccine critic to oversee the nation’s health policy as secretary of Health and Human Services.

He has been known to make false, and at times dangerous, claims about medicine and public health. Perhaps most infamously he linked vaccines to autism — a claim that has been debunked over and over again. 

Now with Kennedy in the running to lead the federal health department, health leaders and advocates in California and across the country are voicing their concerns and preparing to combat a potential wave of medical disinformation.

Having a vaccine skeptic at the helm of the U.S. Health and Human Services agency, some say, could lead to more Americans refusing to be vaccinated and potentially put lives at risk. It could also embolden the anti-vaccine movement in California. 

Dr. Richard Pan, a pediatrician who as a state senator authored the 2019 medical exemption law and a separate law that eliminated personal belief exemptions for childhood vaccines, said having a health secretary who casts doubt on vaccines is “a danger” and “disturbing.”

“I imagine we’re going to see a lot more direct attacks on individual scientists, individual people. I’m anticipating that I’m probably gonna be hoisted somewhere by those guys as well. I don’t think RFK Jr. has forgotten about me yet,” he said. 

Pan said he’s met Kennedy twice when Kennedy traveled to Sacramento to oppose his bills.

Carrying those laws made Pan the subject of harassment and attacks, and at one point an anti-vaccine activist shoved him while Pan was walking in a Sacramento street. At protests, anti-vaccine activists plastered Pan’s face on posters with the word “LIAR” in red letters.

Now, people who rallied against his vaccine bills are celebrating Kennedy’s potential spot on Trump’s cabinet, and calling for “justice” via social media posts.

In one of their last quarrels, Pan publicly called for Kennedy to be banned from social media platforms when Kennedy promoted COVID disinformation. In response, Kennedy told the Sacramento Bee that Pan’s request for censorship was anti-American. 

More recently, Kennedy has taken a more measured approach when responding to questions about vaccines. Following Trump’s win he told NBC News that he isn’t looking to take vaccines off the market, but rather is advocating for informed choice.

“If vaccines are working for somebody, I’m not going to take them away,” he said.

What can RFK Jr. do as health secretary?

If Kennedy is confirmed as head of Health and Human Services, he would oversee a $1.7 trillion budget and about a dozen agencies. He would be responsible for managing pandemic preparedness, and would be in charge of issues ranging from health insurance to food safety.

Experts say that any controversial changes would likely be met with litigation that could slow or derail Kennedy’s proposals. Still, there are several ways anti-vaccine sentiment in the federal government could undermine public health gains in states.

For example, school immunization mandates are issued by states and while the federal government cannot directly change those, it could decide to withhold public health funding, such as grants sent to states to help fund vaccination efforts, said Dorit Reiss, a professor at UC Law San Francisco. 

As health secretary, Kennedy would also have the power to appoint members of an advisory committee that makes recommendations on immunization practices to the U.S. Centers for Disease Control and Prevention.

Reiss added that the health secretary also has the power to expedite or limit access to new vaccines, which would become especially important in the case of another pandemic.

It is the secretary of Health and Human Services who declares a public health emergency and issues emergency use authorization for unapproved vaccines. When COVID shots were first made available to the public in December 2020, they were allowed under this emergency designation. The U.S. Food and Drug Administration fully approved the vaccine for people 16 and older nine months later. 

A secretary hostile to vaccines could block or remove the emergency use  authorization. That means the vaccine manufacturer “would have to either apply for full approval at the moment or not sell the vaccine,” Reiss said. 

Kennedy told NBC that he wouldn’t have “directly blocked” the emergency use of COVID-19 vaccines had he been secretary at the time, but rather would have made sure that “we have the best science.” 

Yet at the height of the pandemic, Kennedy helped fuel mistrust of the coronavirus vaccine. In 2021, he called it the “deadliest vaccine ever made” in opposition to a Louisiana proposal that would have required school children to be vaccinated against the virus. 

California vaccine mandates

In 2010, the California Legislature passed a law that added a booster of the pertussis vaccine, which protects against whooping cough, to the immunization schedule for teens to attend school. Catherine Flores Martin, the executive director of California Immunization Coalition, a nonprofit that advocates for vaccines, remembers when lawmakers were considering this bill, roughly about 18 people or so showed up in opposition, she said. 

Fast-forward to 2015 and 2019, opposition to vaccine legislation evolved into mass protests of hundreds of people. “It’s gotten wild,” Flores Martin said. 

“The vast majority of parents still vaccinate their children,” she said. “We hear a lot about hesitancy, but hesitancy doesn’t convert into not vaccinating.” 

In the 2021-22 school year, 94% of California’s kindergarteners had received the required vaccines, the state’s public health department reported.

But Flores Martin acknowledges that it has become more challenging to pass vaccine legislation as opposition has become louder in California. She attributes this in part to the growing role of misinformation shared on social media platforms.

State public health officials did not respond to an interview request by deadline.

The year 2014 was notable in public health for a couple of reasons. That year whooping cough infections peaked, with more than 11,000 cases reported in the state, the most ever. Also, in December of that year, a measles outbreak at Disneyland contributed to the highest number of measles cases reported in the U.S. in two decades. Most of the cases were among unvaccinated children. The outbreak resulted in hospitalizations but no deaths were reported.

In California, the vaccine that protects against measles, mumps and rubella is among the required doses for kids to attend school. So is the polio vaccine and the Hepatitis B vaccine, among others. It was this measles outbreak that led the Legislature in 2015 to remove personal belief and religious exemptions for required shots.

Then in 2019, lawmakers came back and approved a second law that allowed the state’s Department of Public Health to review and revoke inappropriate medical exemptions. Medical exemptions have to be made by a physician and are reserved for small groups of people, such as those who are allergic to vaccine ingredients.

Following the 2019 law, ​​the rate of kindergarteners with medical exemptions decreased to the lowest levels since 2015-16, according to the state’s public health department. However, research shows that because of disruption in routine doctor visits during the pandemic, the number of kindergarteners who were not up to date on their immunizations ticked up. 

Health advocates and experts say that it is now more important than ever to instill confidence in vaccines and proven public health measures. Flores Martin said doctors and health advocates will have to band together and push vaccine education to maintain high immunization rates. The messaging matters, she said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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An Alameda County child with mild upper respiratory symptoms tested positive for bird flu, state public health officials announced today. The potential infection is the first known case in California that does not appear to have originated from contact with infected cattle.

State health officials are waiting for the Centers for Disease Control and Prevention to confirm the test result.

Public health investigators suspect the infection may have originated from wild birds, which are the main carriers of bird flu, according to a statement from the California Department of Public Health. The agency did not disclose information describing the child’s interactions with wildlife.

The child displayed mild respiratory symptoms and tested positive for multiple viruses, according to Austin Wingate, a spokesperson for the Alameda County health department. 

Doctors did not initially suspect bird flu. Officials detected it through routine influenza subtyping, Wingate said. Family members tested negative for bird flu, but they had other viruses. 

Officials are working to notify and test close contacts of the child, which include individuals at a daycare the child attended.

“We want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious – and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said state Public Health Officer Dr. Tomás Aragón said in a statement.

Aragón emphasized the risk to the general public remains low. People can become infected through close contact with infected animals, according to the CDC. Dairy and poultry workers and people who work with wildlife face the greatest risk of contracting the virus.

Some infectious disease experts are concerned about what this case could signal about the wider bird flu outbreak sweeping the country, which started in 2022.

“We’re seeing the numbers go up, the number of infected farms, the number of farm workers, we now have this child. All of these signs to me suggest that things are going in the wrong direction, not the right direction,” said Sam Scarpino, an epidemiologist with Northeastern University in Boston who is not involved in the California disease investigation.

Cases spreading in Central Valley dairies

The case comes as California grapples with the country’s largest bird flu outbreak among cattle and farmworkers. There are 26 confirmed human cases of bird flu primarily in the Central Valley where the virus has swept through 335 herds, according to state health and agriculture officials. Workers in the dairy industry have contracted the virus through close contact with infected cows.

The state health department has distributed more than 3 million pieces of personal protective equipment to farmworkers. It has also secured 5,000 doses of the seasonal flu vaccine for farmworkers from the CDC.

The federal government has a small stockpile of bird flu vaccines, but they have not been distributed. Instead, health officials encourage people to get vaccinated for influenza, COVID-19 and respiratory syncytial virus to help prevent co-infections like the child had.

“We want to make sure in general that we promote people getting up to date on vaccines and protecting themselves from seasonal illness, from seasonal flu,” said Dr. Erica Pan, the state’s top epidemiologist, in a previous interview with CalMatters.

Scarpino said California has done a good job of testing farmworkers compared to other states where sick cattle have infected humans, contributing to its relatively high number of confirmed cases, but surveillance efforts across the board need to be increased. 

As seasonal flu rates increase, it will become harder for public health laboratories to detect rare viruses, such as H5N1, the bird flu, Scarpino said.

Bird flu present in California sewage

The bird flu virus has appeared in 17 wastewater systems in California, according to the Centers for Disease Control and Prevention. Positive detections appear primarily in Northern California including in Alameda, San Francisco, Sonoma, Contra Costa and Sacramento. Wastewater surveillance cannot determine the source of the virus, but infections among wild waterfowl can contribute to its presence.

Maurice Pitesky, a researcher at UC Davis who studies bird flu in waterfowl, said it’s rare for the virus to jump from birds to humans, but it has happened before. The virus is endemic among wild birds, Pitesky said, and has also been detected in other mammals in California, including bobcats, skunks and mountain lions.

“As the virus further evolves within a mammalian host — whether it’s dairy cows, or felines, or all the species that it has affected — it will continue to adapt,” Pitesky said. “As it adapts more and more it has more potential to cause even more problems.”

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The last time Donald Trump was president, his health care policies chipped away at the Affordable Care Act and helped eliminate federal abortion rights, leaving states to fill the gaps. In his second term, experts predict Trump’s agenda to be similar and warn that health care will get more expensive and harder to access for millions of people. 

Congressional Republicans, newly empowered by Trump’s victory and the Senate moving to GOP control, have made it clear that they intend to try to implement long-standing conservative goals that include decreasing government spending on health care and further dismantling abortion rights, which are currently protected in about half of the country, including California.

Newly nominated Health Secretary Robert F. Kennedy Jr. has also pushed erroneous claims about vaccine hazards and exaggerated the risks of water fluoridation that could have ripple effects across state public health efforts. 

The Democratic supermajority in the California Capitol, however, has spent the past several years passing laws to stymie future conservative administrations on health care, said Mia Bonta, chairperson of the Assembly health committee and a Democrat from Oakland. 

Legislators have protected insurance coverage of abortion and transgender care. They have expanded health insurance programs to low-income undocumented immigrants and paid for it with state funds. They have taken pieces of the Affordable Care Act and written it into state law, expanding the enrollment period and banning lifetime limits on coverage. And they’ve invested millions of dollars into public health after the system languished for a decade.

“We were able to be very deliberate in the past several years to Trump-proof our health system moving forward,” Bonta said.

Not all state lawmakers have been happy with California’s health care expansions. Senate Republican Minority Leader Brian Jones, for instance, said public insurance for undocumented immigrants, which as of this year is available to all income-eligible immigrants, is too expensive and should be “delayed or repealed entirely.”

But Democratic lawmakers and health care advocates say they are better prepared than the first time Trump took office — though they expect the new administration to put California’s new laws to the test.

“We have their playbook from 2017, and almost everything they tried to do, California helped stop through our advocacy … or through court cases,” said Rachel Linn Gish, communications director for Health Access California. “In that way we are in a much stronger position than before.”

Affordable health care at risk

During his first term, Trump tried and failed to repeal the Affordable Care Act. He has said for his second term that he has “concepts of a plan” for the program that insures more than 21 million Americans. 

Republican lawmakers in general have shifted away from talking about eliminating the program entirely, but some leaders, including Vice President-elect J.D. Vance have suggested changes that would make insurance more expensive. Vance during the campaign said he wanted to increase choices for consumers and “make the health insurance marketplace function a little bit better.”

Eliminating the health insurance marketplace, which is also known as Obamacare, has grown deeply politically unpopular even among Republican constituents. Since Trump’s first term, the number of people enrolled has grown by more than 9 million nationally. That political leverage is something that California advocates believe will help protect the program. 

“More people are enrolled in (Affordable Care Act) marketplaces than ever before,” Linn Gish said.

But in many ways the state’s Achilles heel is federal funding. Federal spending on California health care programs is more than three times greater than the state’s share. That’s more than $117 billion from the federal government to support Medi-Cal and the Affordable Care Act compared to $35 billion from California’s general fund for all state health spending, which includes public health, state hospitals and social services.

And much of California’s policies can only be fully realized with sufficient money in the bank.

With the state grappling with a third consecutive deficit next year, the most immediate and likely federal health care cut will be difficult to prevent: financial assistance for middle-class families. 

Outgoing President Joe Biden approved two rounds of Affordable Care Act subsidies during his presidency, making assistance available to middle-class families for the first time. Those  subsidies will expire at the end of 2025, and Trump and congressional Republicans have signaled that they don’t want to renew them.

Without them, premiums will increase by an average of $1,000 annually for residents with insurance through Covered California, the state’s Affordable Care Act program. Premiums are already set to increase by about 8% next year, and without federal assistance other out-of-pocket costs such as deductibles and copays will most likely spike as well. 

Prior to Biden’s push to lower health care premiums, many Californians paid upwards of 18% of their income on health insurance, according to Covered California data. Federal assistance capped that expense at 8.5%.

“You’re talking about a world where we’re doubling how much people pay,” Linn Gish said.

In 2023, California lawmakers established a backstop of state funding to help more people afford health insurance, but those reserves can’t make up the gap if federal funding stops.

Health care for immigrants

Medi-Cal, the state Medicaid program, offers expansive benefits to all low-income individuals regardless of immigration status.  The program could face uncomfortable cuts with a less-than-friendly federal administration. 

Federal dollars cover about 70% of Medi-Cal’s program costs, while the state invests approximately $30 billion in general fund spending. 

“The largest concern many of us have who have worked with our state budget is the resources we will be receiving from the federal government this upcoming year,” said Assemblymember Joaquin Arambula, a Democrat from Fresno who has focused on expansions for undocumented workers. “There are many who are struggling who need their government to help.”

About 7 million more Californians qualified for Medi-Cal after Affordable Care Act rules allowed the state to bump up income limits in 2014, and about 1.8 million undocumented immigrants have gotten Medi-Cal coverage after the state began expanding eligibility for them  in 2015.

Some California Republicans have strayed from the party platform when it comes to health care for undocumented immigrants. The Central Valley relies heavily on immigrant labor, and a handful of state Republicans from those communities supported expanded access to health insurance for undocumented residents. 

The state GOP, however, still officially opposes coverage for undocumented immigrants and several Republican lawmakers want the state to undo that health care expansion.

Gov. Gavin “Newsom and Democrat lawmakers insist on expanding free health care for illegal immigrants to the tune of $5 billion per year. In the midst of a multi-billion dollar budget deficit, hospitals and maternity wards shutting down, and a massive influx of migrants illegally crossing our open border, we should not be expanding this costly government program,” Jones, a Republican from San Diego said.

Immigrants who came to the United States in their youth and who are protected by the Obama-era program known as Deferred Action for Childhood Arrivals (DACA) for the first time can enroll in Covered California thanks to expanded eligibility under the Biden administration.

Liberal lawmakers and policy advocates hailed the expansions as a long-sought-after victory, but they remain controversial among California Republicans. Many lawmakers and advocates expect these expansions to be challenged over the next four years. 

“Anything that has Biden’s fingerprints on it is going to be the first touched. The DACA expansion is going to be high on the list,” Linn Gish said.

This year a bill expanding Covered California to all undocumented immigrants, not just those who came to the U.S. as children, stalled in committee. That measure would have allowed immigrants who make too much money to qualify for Medi-Cal to purchase insurance.

Arambula, who authored the bill, said those populations are “unjustly excluded” from buying insurance at full price even if they want to. He plans on reintroducing the measure, which could be implemented without federal approval. 

Family planning and abortion cuts

On the campaign trail Trump took credit for appointing the Supreme Court justices who ended the national right to abortion by overturning Roe vs. Wade, but he said he would not support a national law banning abortion.  

Still, California Democrats aren’t taking any chances on abortion rights. They passed more than two dozen laws to protect access to abortion, contraceptives and gender-affirming services in the last three years.

In 2022, voters also protected abortion as a right in the state constitution. 

Democratic lawmakers say they have more work to do. 

Bonta said she plans on introducing bills to further protect reproductive rights on the first day of the legislative session. Those bills would require hospitals to provide emergency abortions, protect birth control for Medi-Cal recipients and ease the regulation of birth centers. Bonta said lawmakers are working quickly and she expects many of the bills introduced in December to have urgency clauses that allow immediate implementation.

“It’s going to be a huge change within the health care space,” she said.

The first time Trump was president, he also dismantled Title X regulations that fund the federal family planning network by instituting a “gag rule” prohibiting clinics from performing or referring for abortions. The clinics funded have historically provided contraceptives, abortion care, sexually transmitted infection testing and treatment, gynecology services and postpartum care. After the rule change, the number of people served by Title X clinics dropped 60% nationally as a result of clinics exiting the program, according to the Kaiser Family Foundation, an independent health policy research center..

In California the number of people served dropped from 1 million to fewer than 200,000, said Amy Moy, co-CEO of Essential Access Health, which administers the state’s Title X money. 

California dedicated $10 million to bridge the gap, but Moy said if there is another federal cut, clinics say to expect longer wait times and fewer providers.

“We will be having to test the bounds of our guardrails and see what we can do here, but we are committed to working with partners and state leaders to do everything possible,” Moy said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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For the first time since the passage of the Affordable Care Act, undocumented immigrants who were brought to the U.S. as children can purchase subsidized health plans through Covered California, the state’s insurance marketplace. 

This move is expected to provide relief to thousands of so-called Dreamers, especially those who are freelancers, self-employed or have no other means of health coverage.

But the expansion is coming at an uncertain time both because of Donald Trump’s election as president and because of an ongoing lawsuit that contests the move to allow certain undocumented immigrants to buy health insurance through Affordable Care Act exchanges.

Trump in his first administration unsuccessfully tried to undo both the Affordable Care Act and the Obama-era policy known as Deferred Action for Childhood Arrivals (DACA) that protects certain undocumented immigrants. 

Covered California officials and immigration attorneys say that while it is difficult to predict what will happen in the coming months, those eligible should take the opportunity and get health insurance as soon as possible.

“Coverage is here right now. So if you need to go to the doctor, if you’ve been putting off care that you need, if you’ve never had the opportunity to get your preventive care, you can do that right now,” said Jessica Altman, the executive director of Covered California. “Let’s not let fears about the future prevent what can happen in the here and now and what you can have access to.”

Altman and her team have been touring the state to spread awareness of the open enrollment period and this new access for DACA recipients.

Created in 2012, DACA does not grant recipients legal status, but it does protect them from deportation and allows them work authorization. Up until now, they’ve only been allowed to sign up for health coverage through an employer. In California low-income DACA grantees can also sign up for Medi-Cal.

The Biden administration announced a rule change in May that updated the definition of “lawfully present” for Affordable Care Act eligibility so that DACA recipients could buy insurance in the federal or state insurance marketplaces.

“The rule is correcting a long-standing mistake of exclusion,” said Nicholas Espíritu, a deputy legal director at the National Immigration Law Center. 

For Trump’s Health and Human Services department to undo the rule, it would have to go through a similar administrative process, which includes a notice and public comment period, Espíritu explained. This route could take quite some time.

By some estimates more than half a million people are protected by DACA, but it’s unclear exactly how many of them are without health insurance. One survey from UC San Diego and the National Immigration Law Center estimates about 20% are uninsured. That’s because with permission to work, most have been able to obtain coverage through an employer. 

Expanding coverage to DACA recipients is estimated to cost the federal government between $240 million to $300 million a year. However, because DACA recipients are young, with an average age of 30, they could potentially have a positive impact on the health insurance risk pool — younger and healthier individuals can help bring down the cost of premiums for everyone enrolled in marketplace plans.

Covered California estimates that about 40,000 DACA recipients residing in this state are eligible for marketplace coverage this enrollment season.

Open enrollment started Nov. 1 and runs through Jan. 31. People must sign up by Dec. 31 if they want their coverage to kick in Jan.1. DACA recipients can also get coverage for December 2024 if they sign up before the end of this month. 

GOP states challenge Affordable Care Act expansion

The most immediate threat to Dreamers’ access to the Affordable Care Act is being fought in a North Dakota courtroom. 

In August, a group of 19 Republican attorneys general — from Kansas, Alabama, Florida, Texas, Idaho and other states — filed a lawsuit in federal court challenging the insurance marketplace expansion to DACA recipients. 

They argue that allowing DACA grantees into the marketplace creates “additional administrative and resource burden” in states that run their own exchanges. They also argue that access to subsidized health care is likely to encourage undocumented immigrants to remain in the U.S., and may eventually lead to more illegal immigration.

California and 18 other states last month filed a brief in defense of the Biden benefit expansion. 

“Dreamers pay billions of dollars in taxes each year to help fund programs like the Affordable Care Act. Yet until now, they’ve been unable to access these programs themselves,” California’s Attorney General Rob Bonta said in a statement. “As home to more Dreamers than any other state in the country, California is proud to stand up for their right to access affordable healthcare.”

DACA grantees in California pay an estimated $2.1 billion a year in federal taxes and another $1 billion in state and local taxes, according to figures from Center for American Progress.

Biden health subsidies could end under Trump

Arguably no other state has done more to expand health insurance coverage for its residents, including its immigrants, than California. The federal government’s move to open the insurance marketplaces to Dreamers complements California’s efforts.

The state already offers Medi-Cal coverage to low-income earners regardless of their immigration status. But thousands of workers who earn above the Medi-Cal income limit don’t have many options for affordable coverage. Undocumented people technically can purchase a health insurance plan directly from a broker in the private market, but that’s without any type of financial assistance, making it unaffordable for most. 

Health policy experts say one way that Trump and the incoming Republican-led Congress could undermine the Affordable Care Act, not just for DACA recipients but for everyone, is by not renewing the “enhanced premium subsidies” afforded by the Inflation Reduction Act, which are set to expire at the end of 2025. The enhanced subsidies increased the amount of financial assistance available to those already receiving it and made aid available to others for the first time by capping what they pay for the premium of a standard plan to 8.5% of their income. 

Increasing the cost of coverage likely would result in some people going without health insurance. The Congressional Budget Office estimates 4 million people nationwide would drop their coverage in 2026 if Congress does not act to extend the subsidies.

It’s unclear if Trump will once again go after the Affordable Care Act in its entirety. Republican efforts to repeal the health law in the past have failed, but during his first term, Trump was successful in eliminating or changing pieces of it. 

California health leaders say that they are having conversations about how to prepare for potential federal decisions that could impact the gains in coverage that California has made.

“We’ve made such progress, and it’s been incredible and hard-fought,” said Altman at Covered California. “Even through the pandemic and the Medi-Cal redeterminations we’re at the lowest uninsured rate on record. We’ve lowered our uninsured rate more than any other state in the nation.

“And so really it’s just thinking about…how do we keep moving forward on our mission, whether we have headwinds or tailwinds,” she said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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During the four years that Donald Trump was president the first time, California sued him about every 12 days on average.

Now that he’s returning to office, Democratic state leaders are preparing potential new lawsuits.

Gov. Gavin Newsom today called a special legislative session to accelerate the Democratic administration’s preparations. Beginning Dec. 2, he’s planning to ask lawmakers to set aside additional money for the lawsuits he anticipates.

“California will seek to work with the incoming president — but let there be no mistake, we intend to stand with states across our nation to defend our Constitution and uphold the rule of law,” Newsom said in a written statement Wednesday. “Federalism is the cornerstone of our democracy. It’s the United STATES of America.”

State Attorney General Rob Bonta has been developing plans to defend California policies since the summer, when polls showed a good chance that Trump would win the election. Bonta has said his team has preemptively written briefs on a variety of issues in preparation of what’s to come.

“We bring cases when we believe will win, when we’ve done the due diligence, the preparation, the research, the planning, the fact factual development and the legal analysis to win. And we will do that again here,” Bonta said today at a press conference in San Francisco.

California sued the Trump administration 123 times and scored major victories. Among them: California defended the state’s clean air rules, preserved the Deferred Action for Childhood Arrivals program (DACA) that benefits undocumented people who came to the United States as children, and protected the Affordable Care Act. 

Those issues — the environment, immigration and health care — could once again be the main battle lines in the lawsuits that are expected to be waged between California’s Democratic administration and Trump’s White House.

This time, some experts anticipate that Trump will bring forward a more methodical approach to policy.

They point to Project 2025, a 900-page document by the conservative think tank the Heritage Foundation that lays out a conservative agenda. While Trump tried to distance himself from the blueprint during his campaign, former members of his administration contributed to the report. There is also some overlap between what he’s proposed and what’s outlined in the document, such as mass deportations and overhauling the Justice Department. 

Choosing battles in a second Trump term

In his victory speech, Trump signaled policy objectives that would likely conflict with California’s goals, such as expanding oil production and turning the nation’s public health agencies over to vaccine skeptic Robert F. Kennedy Jr. — although in what capacity is still unclear.

“He’s going to help make America healthy again,” Trump said about Kennedy during his speech. “I just said: ‘But, Bobby, leave the oil to me. 

“‘Bobby, stay away from the liquid gold. Other than that, go have a good time.’”

While Democratic leaders vow to uphold their values, they may be more careful in choosing their battles this time around, said Matt Lesenyie, a political science professor at Cal State Long Beach.

“Some of the legal challenges are substantive, like we want to regulate greenhouse gases. Other ones may be more symbolic, and that’s not to trivialize cultural or gender identity, but one thing that has been clear, at least to me in this Trump win, is that those cultural issues are motivating his voters,” he said.

Because it is a large state, California also has power to negotiate with the federal government. 

“Faced with near-total Republican control of the federal government, Sacramento may think the state does better by negotiating,” said David A. Carrillo, executive director of Berkeley Law’s California Constitution Center. “That affects whether California’s strategy is to fight on all fronts, or to focus on leveraging its size and market power in making its own domestic and international agreements — call it soft secession.”

Likely disputes over abortion, health care

By most accounts, health care policies are expected to be contested again. 

In his first term, Trump’s efforts to repeal the Affordable Care Act failed, but he did slash some provisions of the landmark health law. 

He also influenced the reversal of Roe v. Wade, the 1973 ruling that protected abortion rights, by appointing three conservative Supreme Court justices.

In 2019 the Trump administration also blocked clinics and providers that offer or refer patients to abortion services from receiving federal family planning dollars. California sued. The Biden administration later reversed Trump’s rule. Any similar restrictions on abortion would certainly prompt California to respond with litigation again. 

Carrillo anticipates that the Trump administration might move to restrict mifepristone, one of the medications used to induce abortion, by using a 19th Century law known as the Comstock Act.

“One fight California probably can’t avoid is abortion, specifically access to mifepristone,” Carrillo said. “For example, the federal Comstock Act in general bans sending something for ‘abortion-causing purposes’ in the mail. 

“Expect a major legal battle if federal prosecutors start enforcing that to prevent interstate shipping of medical abortion drugs or contraceptives,” he said.

Others say they also expect a fight from states if Trump attempts to make drastic cuts to the Medicaid program. About 14.7 million low-income Californians rely on Medicaid for health coverage. The program is also known as Medi-Cal in California.

Project 2025, for example, proposes to cap what the federal government pays for the Medicaid program, which is funded by both the feds and the states. This means that states would receive a fixed amount regardless of their costs. In the health policy world this is referred to as “block grants” or “per capita caps.”

“So that’s a big cut, a big cost shift to states, and states would have no choice but to either raise taxes substantially or far more likely, shrink their Medicaid programs to a great degree, which means more uninsured, more people go without needed care,” said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.  

Park says one key difference between a second Trump administration and the first is that Trump and his team could have a clearer vision of what they want to do with health care programs this time around. That includes the potential for things like imposing work requirements to qualify for Medi-Cal or slashing aid in Obamacare marketplaces, making it less affordable to sign up.

CalMatters reporter Cayla Mihalovich contributed to this story.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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Doctors who serve California’s poorest residents will get paid more, in some cases, for the first time in two decades, thanks to a ballot measure approved by voters Tuesday. 

The Associated Press called Proposition 35 victorious after results showed it jumped to a sizable lead. The ballot measure asked voters to earmark between $2 billion and $5 billion of special tax revenue annually to Medi-Cal, the state’s health insurance program for low-income residents and people with disabilities. The revenue comes from an existing tax on health insurers that lawmakers are currently able to spend in other ways. 

Supporters of the measure, which includes nearly the entire health care industry, have long argued that the tax revenue comes from health care and should be reinvested in the state’s health care system.

“Prop 35’s victory on the ballot is a victory for patients across California,” said Jodi Hicks, president of Planned Parenthood Affiliates of California and Prop. 35 co-chairperson, in a statement. 

Dustin Corcoran, the other co-chairperson and chief executive of the California Medical Association, said voters have made a “generational investment” that will stabilize the Medi-Cal program

Nearly 15 million Californians, a third of the state’s population, rely on Medi-Cal. Over the past decade the state has taken steps to expand access and benefits to its poorest and most vulnerable populations. 

That expansion, however, has not come with incentives for doctors to see more patients, and the Medi-Cal system is plagued with long wait times and poor outcomes. 

Opponents of the measure, who were mostly small community providers and disability advocates, warned that Prop. 35 would restrict Medi-Cal spending too much. They conceded the results and said the vote showed Californians want to secure funding for Medi-Cal.

“Today’s vote makes clear that Californians support the Medi-Cal program and want to improve access to health care for the most vulnerable. While we opposed Prop. 35 because of the details, state leaders now have a mandate to improve Medi-Cal and must fulfill that obligation,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Coalition, which led the opposition campaign.

What does Prop. 35 promise? 

Payments to doctors and others who serve Medi-Cal patients have not kept up with the state’s benefit and eligibility expansions. According to the Kaiser Family Foundation, California’s reimbursement rate falls in the bottom third state Medicaid systems.

Prop. 35 earmarks a majority of the state’s Managed Care Organization Tax — or MCO Tax — to raise rates for certain providers in an effort to improve access to health care.

The tax on health plans comes from a long-standing agreement with the federal government: Health insurers agree to put tax money into the Medi-Cal system in order to get a dollar-for-dollar match from the feds. California has levied the tax on health insurers on-and-off for the past two decades but has never specified how the money should be spent.

Some of the winners who will see better pay if Prop. 35 passes include doctors and certain specialists, behavioral health facilities, outpatient clinics, hospitals, ambulances and doctors-in-training.

What happens to the state budget? 

Medi-Cal gets about $35 billion from California’s general fund, and the state currently uses about $7 billion from the MCO tax toward that program. Gov. Gavin Newsom and lawmakers agreed in this year’s budget to use a portion of the tax to pay for some rate increases and program expansions, but they weren’t necessarily the rate increases supporters of the measure wanted. 

Since voters approved Prop. 35, the state will face a $2.6 billion deficit in the current budget because the ballot measure will redirect money that was dedicated to other things. That deficit would increase to $11.9 billion over the next three budget cycles, according to an analysis from the Department of Finance.

Lawmakers won’t have to address the shortfall until next year’s budget deadline in June. But the majority of the MCO tax would no longer be available for general government spending.

Some of the rate increases that would be canceled if the proposition passes include ones for air ambulances, pediatric and adult day services, congregate living health facilities, private duty nursing and continuous Medi-Cal coverage for children under age 5.

Who supported it?

A broad health care coalition that includes doctors, hospitals, dentists, community clinics, emergency responders and Planned Parenthood supported Prop. 35. 

Supporters raised more than $55 million with the largest donations coming from the California Hospital Association, the California Medical Association and Global Medical Response, an ambulance company.

They argued that without a serious investment, Medi-Cal patients would continue to get health care in a second-tier system that didn’t have enough doctors to meet their needs. Proponents also said they were tired of politicians promising to fully fund Medi-Cal and not delivering. Last year, Gov. Gavin Newsom made a deal with Prop. 35 supporters to inject more MCO tax revenue into Medi-Cal, but redirected most of the money this year to fill the state’s budget gap.

Who opposed it and why? 

Prop. 35 was opposed by a small group of community health advocates and Medi-Cal providers, including the California Pan-Ethnic Health Network, The Children’s Partnership, Western Center on Law and Poverty and Disability Rights California.

They acknowledged that providers needed to be paid more for their services but argued that the proposition could backfire and cause Medi-Cal to lose billions in federal funding. That’s because California has been reprimanded by the federal government for exploiting a loophole in the tax law. If the proposition passes, it would make it extremely difficult for the state to change how it funds Medi-Cal, opponents said. 

After the measure passed, opponents said the state must be transparent in how it spends the special tax revenue and consult with communities that rely on Medi-Cal.

“In the longer-term, state leaders will face the challenge created by capping federal revenues under Prop. 35. Fully funding Medi-Cal will require raising revenues and ensuring that the wealthiest Californians and corporations pay their fair share to support the health and wellbeing of all Californians,” Savage-Sangwan with the California Pan-Ethnic Health Coalition said in a statement.

Newsom did not formally oppose the measure but voiced concerns about its potential to restrict how lawmakers spend money while facing down a multibillion-dollar state deficit.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

Beverly Hills officials delayed permit approvals and pressured the landlord to prevent an abortion clinic from opening in the city last year, violating state constitutional protections for reproductive rights, according to an investigation by the California Department of Justice.

The city must now conduct comprehensive training for its employees about state and federal protections for abortion clinics and develop a procedure for reporting potential future violations to the state under a stipulated judgment announced today by Attorney General Rob Bonta. It is the first complaint the state has brought under Proposition 1, a measure approved by voters in 2022 that added “reproductive freedom” to the California constitution.

Bonta, who is weighing a run for governor in 2026, touted the settlement as a warning to other local governments that may consider similar actions “illegally interfering” with abortion access. He would not confirm whether his office has opened additional investigations.

“Unfortunately, it’s a reminder that anti-reproductive freedom actions don’t just happen in Texas or red states that are cracking down on reproductive health care, but it can happen right here in California, even though we have some of the strongest reproductive health laws in the nation,” Bonta said in an interview with CalMatters.

“These are important rights that need to be protected,” he added. “We will get involved, we’ll investigate, we will sue and we will prevail if any other cities or jurisdictions seek to follow Beverly Hills’ poor example here.”

But Beverly Hills, which faces ongoing litigation from the clinic operator, continues to deny any wrongdoing. The city released a statement ahead of Bonta’s announcement disputing the allegations and noting that the settlement included no fines or penalties and could not be used in court.

“The City reaffirms and pledges that it did not and will not discriminate against any reproductive healthcare provider and strongly supports a woman’s right to choose,” Mayor Lester Friedman said.

One member of the city council, John Mirisch, said he voted against the stipulated judgment and accused Bonta of singling out Beverly Hills, a Jewish-majority city, while ignoring a rise in anti-Semitic incidents on college campuses over the past year.

“I cannot support political theater from the Attorney General’s office, aimed at scoring cheap political points by grandstanding using the Beverly Hills name, while at the same time other important issues are left by the wayside,” Mirisch said in a statement.

Bonta called the response “a lot of spin after the fact” and “gaslighting.” He said Beverly Hills would not have signed onto the settlement if it had done nothing wrong and the terms reflect what is possible under Proposition 1, which does not authorize monetary damages.

“They went out of their way to undermine the rights of DuPont and the patients it could have and would have served,” he said. “It was deliberate and intentional and reprehensible.”

The situation in Beverly Hills caught the attention of activists and state officials because it exposed the limits of California’s positioning as a haven for abortion rights, CalMatters reported earlier this year. Though the state has strengthened its protections since the U.S. Supreme Court overturned a constitutional right to abortion in 2022.

Conservative politicians have blocked at least two other proposed abortion clinics from opening in their communities over the past two years, while many California counties have no clinics at all. Because abortion is prohibited in the state once a fetus can live outside the womb — around 24 weeks of pregnancy — except when the life or health of the mother is threatened, most providers will not treat women who need abortions late in their pregnancy, forcing them to leave California for care.

DuPont Clinic, a Washington, D.C., provider that performs abortions into the third trimester, had sought to add an office in Beverly Hills to fill that gap. But before it even opened, the clinic became a target of anti-abortion protesters — who projected the words “MURDER MILL” onto the side of the building during a demonstration and spoke out at a city council meeting in April 2023 — raising fears among city officials about security and disruptions.

Email records show that Beverly Hills, which has publicly professed support for abortion rights, subsequently placed a hold on approved permits for the project while staff reviewed whether the abortion clinic was an allowed use for the property. At the same time, city officials, including from the police department, met with opponents and Douglas Emmett, Inc., the company that owned the building, to discuss safety concerns.

The Justice Department concluded that the city “unlawfully interfered with DuPont’s opening by improperly delaying the issuance of approved building permits and actively engaged in a pressure campaign against the property owner” until it terminated the lease in June 2023.

This included suggesting without any evidence that the clinic “would cause security threats against the building’s other tenants, going so far as to say that the building would be subject to violent protests, bomb threats, and ‘lone-wolf’ active shooters,” according to a summary of the findings, and then claiming that the city would be “so overwhelmed by this fictitious threat that they’d be unable to provide resources to the landlord and building — threatening to abandon their sworn responsibility to uphold public safety.”

When Douglas Emmett rescinded its lease, DuPont Clinic sued both the landlord and Beverly Hills, alleging that they “colluded and conspired with the protestors to try to drive DuPont out of the City.” Though they denied the characterization, local abortion rights activists launched a campaign to hold Beverly Hills accountable for what they believe was a betrayal of the city’s public commitment to reproductive freedom in order to avoid more disturbances from anti-abortion groups.

It’s unclear what impact the Justice Department agreement might have on DuPont’s lawsuit, which Beverly Hills is currently seeking to dismiss, or its effort to open a clinic in California. Dr. Jennefer Russo, executive director of DuPont LA, said in a statement that “DuPont will continue to fight for abortion access for Californians and those who need to travel here for care they cannot access in their own states.”

Jessica Corpuz, an attorney for the company, called the state’s intervention a “huge step.” She said the investigation had uncovered useful new information, including an interview where the city manager discussed additional security measures that Beverly Hills takes for special events such as the Golden Globe awards.

“The city had the opportunity to keep people safe and they chose not to do that,” she said. “The information that was in the complaint will be part of our case.”

Earlier this year, the Legislature approved and Gov. Gavin Newsom signed a new law to create a streamlined approval process for reproductive health clinics that meet certain development criteria. The measure — which could make it easier for clinics to open even in communities that largely oppose abortion — was part of a wave of legislation to tamp down on a surging rebellion in more conservative parts of California against the state’s liberal governance.

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In the heart of California’s dairy country, workers kitted in respirators, face shields and gloves are grappling with one of the largest bird flu outbreaks in history. California has reported 16 human cases of bird flu this month, and worker advocates say the state isn’t doing enough to protect dairy workers. 

Only 39 people have been tested for H5N1, the strain of bird flu ravaging herds of cattle, according to the California Department of Public Health. California’s confirmed cases of sick workers account for almost all of the country’s cattle-to-human transmissions, according to the Centers for Disease Control and Prevention.

Human cases in California have been mild with no hospitalizations, officials say. Sick workers have reported flu-like symptoms in addition to pink eye. There have been no documented cases of human-to-human transmission, state health officials say, and the general public’s risk is low. 

The current bird flu surveillance strategy places the majority of the responsibility on farmers to self-report disease among animals and employees, which is problematic, said Elizabeth Strater, a spokesperson for United Farm Workers.

“Workers are actively avoiding testing, I can assure you,” Strater said. “We have heard directly from farmworker communities and veterinarians that they can see that there are workers out there who are sick.”

Workers, who are often low-income, can’t afford the 10-day isolation period with no pay if they are positive, Strater said.

Millions of poultry have been slaughtered since the virus first took hold in California farms two years ago, and this year the highly transmissible virus jumped to cattle, posing a new threat to those who work with the animals. 

Authorities have confirmed bird flu infections at 178 California dairies since it first emerged in August, according to the state Department of Food and Agriculture, and there is no sign of infections among cows slowing. The transmission from cows to humans is thought to occur through close and prolonged contact with sick animals. 

“The most concerning data we have is how little data we have,” Strater said. “Hundreds of herds have tested positive, and the number of people tested is in the dozens — that’s a problem.”

Dr. Erica Pan, chief epidemiologist with the state health department, said about 20 to 30 people are screened weekly for various influenza variants, including bird flu, in the course of routine flu monitoring. 

The difference between testing for bird flu and COVID-19, which required widespread surveillance, Pan said, is that the eye needs to be swabbed, which must be done by a clinician.

“This is about looking for symptoms and then testing for them instead of testing people without symptoms,” Pan said. 

California distributes PPE for bird flu

The state and local health departments are focusing on distributing protective gear and educating workers on how to use it, Pan said. More than 3.3 million pieces of PPE have been distributed to local health departments and farms, according to the state health department. 

The state also deployed 5,000 doses of seasonal flu vaccine for farmworkers. Although that vaccine won’t protect against bird flu, it reduces the chances of a severe coinfection.

Last week KFF Health News reported farmers in other states have refused to cooperate with local health departments and disease investigators.

Tricia Stever Blattler, executive director of the Tulare County Farm Bureau, said she has not heard of any instances of local employers refusing to cooperate with authorities.

Tulare County, the nation’s largest milk producer, has been the epicenter of the outbreak among cattle and dairy workers, reporting the state’s first human cases in early October. Cases have since been reported in surrounding counties. 

Early in October when temperatures soared above 100 degrees, it was difficult to get workers to don additional protective equipment, said Stever Blattler, but that concern has abated with cooling temperatures.

Dairies surprised by bird flu

The severity of the disease for cattle and its rapid spread among herds caught the industry off-guard, Stever Blattler said, and has had “a huge economic ripple.”

“Our dairies are really trying to fast-track their learning on the situation,” Stever Blattler said. “They’re trying to create an appropriate and safe workplace, and they’re also trying to increase the care and monitoring of the cattle itself.”

Carrie Monteiro, a spokesperson for Tulare public health, said farmers in the county have cooperated with efforts to mitigate the spread of the virus. 

“They really are reporting and making sure we’re getting the care to their workers and the medication to help their employees recover from this illness,” Monteiro said.

The county has increased its testing capacity to include 15 community doctors, although they are still relying on people with symptoms coming forward. If someone tests positive, they and their household are monitored for 10 days and given antiviral flu medication, Monteiro said.

Still, Strater said she’d like to see the state do more to assure farmworkers, who often work grueling jobs for low pay, that they will be compensated if they get sick on the job. Doing so would encourage workers to come forward if they are sick. The federal government has committed financial assistance to farmers to help pay for lost milk, PPE and measures to prevent infection, but no such offerings have been made to workers.

According to the state Department of Industrial Relations, workers who get sick with bird flu qualify for workers compensation regardless of immigration status. Employers are required to give employees a workers’ compensation claim form, and they are also required to report cases to the local health department.

“I would like to see public health agencies working together with (industrial relations) and doing a push to reassure people to get tested,” Strater said. “If you test positive, all of your lost wages should be compensated by workers comp.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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Providence St. Joseph Hospital and the California Attorney General’s office have reached a temporary agreement in a case alleging the Catholic-owned hospital in Humboldt County violated multiple state laws by denying emergency abortion care to pregnant patients.

Last month, Attorney General Rob Bonta sued Providence St. Joseph Hospital in Eureka, alleging it illegally refused to provide emergency abortion care to a woman who was 15 weeks pregnant and hemorrhaging.

According to the stipulated agreement released tonight, St. Joseph agrees to fully comply with the state’s Emergency Services Law, which prohibits hospitals from denying patients emergency care. 

The hospital will allow physicians to terminate a patient’s pregnancy if not doing so would seriously risk the patient’s health. The hospital also agreed not to transfer a patient to another facility without first providing emergency stabilizing care, including abortion if that is what a patient needs.

St. Joseph and its parent organization Providence admit no liability under the stipulation. The stipulation is subject to court approval and will remain in place while the litigation continues.

“While Providence St. Joseph should have been complying with state law up to now, thereby avoiding the harm and trauma to Californians they caused, I am pleased that the hospital has agreed to fully comply with the law going forward, ensuring access to life-saving health services including emergency abortion care,” Bonta said in a statement.

Representatives for Providence St. Joseph did not immediately respond to a request for comment.

In the lawsuit against the hospital, local chiropractor Anna Nusslock alleges that she arrived at the hospital in February bleeding and in severe pain after her water broke prematurely. Nusslock was pregnant with twins. Court documents state that a doctor at Providence St. Joseph Hospital told her internal policy prevented them from treating her because one of her twins had a “detectable heartbeat.”

Nusslock was given a bucket and towels “in case something happens in the car,” court documents filed by the state allege, and told to drive to the next closest hospital 12 miles away. 

That hospital, Mad River Community Hospital, will close its labor and delivery unit on Oct. 31, leaving Providence St. Joseph Hospital the only operating maternity ward in Humboldt County.

The lawsuit claims that Nusslock’s condition put her at risk of permanent harm or death from infection and hemorrhage. 

Though California has enacted some of the nation’s strongest abortion protections since the U.S. Supreme Court in 2022 overturned Roe vs. Wade, the state has struggled to navigate religious and personal belief exemptions governing hospitals and anti-abortion pregnancy centers.

This is the first lawsuit filed against a hospital under the Emergency Services Law, according to the attorney general’s office.