MERCED, Calif. — Hospital executives in the San Joaquin Valley are assessing how to take in looming Medicaid changes from the Big Beautiful Bill Act passed by Congress and signed by President Trump earlier this month.
Health advocates say the bill in several ways will limit health care access in addition to cutting social safety net resources for residents, like food assistance. On the other hand, the bill extended tax cuts passed under President Trump’s first term and increased spending on immigration enforcement and the military.
Among the changes for Medicaid – or Medi-Cal as the government subsidized program is known in California – are stricter reporting and working requirements for users that could make staying on the program harder to manage.
Fewer people on Medicaid could impact hospitals, which are at risk of receiving fewer payments as a result, and it could combine with already difficult financial situations. Much of the changes to Medicaid won’t take effect until after the 2026 midterm elections.
Kiyoshi Tomono, a marketing executive with Adventist Health, which operates hospitals across the San Joaquin Valley, said residents should be assured the hospitals will try to remain open.
“We're not going anywhere,” Tomono said. “Those hospitals are anchors in those communities and we know if you don't have a hospital in some of these rural communities and they're literally designated in areas [as critical access], you're driving 30 to 40 minutes away to see emergency care.”
But two of Adventist Health’s hospitals in Reedley and Tehachapi were included in a recent letter by U.S. Senators to the Trump administration warning that the hospitals could close under the Medicaid changes included in the Big Beautiful Bill. The letter listed hundreds of hospitals nationwide.
The letter by U.S. Senators was issued in June, weeks before the bill was adopted. It included a study from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina that labeled hospitals across the country as “financially vulnerable.”
It determined that status based on “whether the hospital has been unprofitable for the last three years, whether the hospital is at risk of financial distress relative to peer hospitals, and whether the hospital serves a disproportionately high share of Medicaid patients.”
In California, 28 hospitals are at risk, according to the study, and a quarter of them are located in or near the San Joaquin Valley. KVPR reached out to six of the seven area hospitals shown on the list.
Tomono, from Adventist Health, acknowledged to KVPR the bill’s passage will likely mean fewer people may have access to health insurance. That could have effects, including fewer people seeking preventative care, and more uninsured people visiting emergency rooms for acute injuries, for example.
“If somebody comes in with no insurance, at the end of the day, we see that person because it's the right thing to do,” Tomono said. “But how do hospital systems continue to take care of those folks and pay for all those operations and services? That's the challenge I think that people are pondering…. I think there's a lot of uncertainty still around that.”
Those are the same questions being asked at Memorial Hospital in the city of Los Banos.
“We are continuing to evaluate the financial implications of the final legislation on our hospitals,” a spokesperson from Sutter Health, which operates the hospital, said. “Following the passage of the legislation, we remain committed to addressing long-standing gaps in access to care in communities like Merced County and plan to move forward with key investments.”
Hospital officials say they are also turning more directly to elected officials for answers and support.
“We're going to have to figure this out,” Tomono said. “We know that health care is critical.”
Valley Republican Congressmen tout hospital support
The Valley hospitals included in the University of North Carolina study were located across five different congressional districts, including those representing parts of Fresno, Merced, and Kern counties.
Republican Congressman David Valadao has especially faced criticism for his support of Trump’s spending bill, including by California Gov. Gavin Newsom, who said Valadao should be voted out of office for supporting the bill.
House District 22, which Valadao represents, has the highest enrollment of Medicaid in the country, according to a New York Times analysis. The Times found 68% of residents in Valadao’s district are enrolled in the healthcare program.
Valadao, for his part, said he would continue to work with colleagues to ensure Valley hospitals were protected. In a statement after the vote, he stressed the inclusion of a program in the spending bill meant to support rural hospitals known as the Rural Health Transformation Fund – which he said he pushed for. The final bill included $50 billion in funding for the program.
“I’ve been assured by the administration that it will be structured in a way that benefits our providers and keeps our hospitals and communities running,” Valadao said.
Republican Vince Fong, who represents House District 20, also touted the program in a statement to KVPR following the vote.
“This funding will support rural hospitals, primary care facilities, and telehealth services that our communities rely on,” he said.
The National Rural Health Association, a national nonprofit that advocates for rural hospitals, had spoken out about earlier versions of the Big Beautiful Bill that did not meet the funding needs for rural hospitals and which the organization said would result in less coverage and support for hospitals. The final bill appeared to mostly fill a funding gap that the nonprofit was concerned about.
Democratic Valley Congressman worry over ‘fragile health care system’
Democratic congressmen Jim Costa and Adam Gray voted against the bill – joining all Democrats and two House Republicans in the final vote.
“Healthcare is essential as the majority of the people that I represent rely on Medicaid, Medicare and the Supplemental Nutrition Assistance Program (SNAP),” Costa said, naming cuts to other programs. “These vital safety nets ensure families can access food, healthcare, and stable housing. But this bill guts those services and puts rural hospitals at risk of closure, while adding $4 trillion to the deficit. That’s not fiscal responsibility—it’s a direct attack on the communities I represent.”
Costa highlighted an analysis from the Joint Economic Committee (JEC) in the Senate that showed 247,384 people in the San Joaquin Valley could be left without Medicaid coverage as a result of the bill’s passage.
More than half of those people reside in congressional districts with at least one rural hospital that the University of North Carolina study stated was at risk of closure.
Gray said the bill poses a threat to the “Valley’s already fragile health care system.” Two hospitals in his district are listed as financially vulnerable.
“While we face one of the worst physician shortages in the state, we cannot afford to lose two rural hospitals that families in Los Banos and Coalinga rely on for care,” Gray said. “The cuts to health care in this bill were completely unacceptable for the Valley.”
Since entering Congress, Gray has introduced four bills looking at expanding grant funding for rural medical schools, rural telehealth programs and access to prescription medications. Two of the bills were bipartisan.
“Despite the chaos and reckless partisanship in Washington, I am focused every day on delivering for the Valley,” Gray said.
