More people without health insurance are showing up at Bay Area hospitals and emergency rooms, and hospital leaders say it is an early sign of what is coming when federal and state Medi-Cal cuts take effect next year.
Santa Clara County: admissions doubled
Santa Clara Valley Healthcare, the county-run safety-net system, treated hundreds more uninsured patients a month this summer, CEO Paul Lorenz told the Mercury News. At its four emergency rooms, visits by uninsured patients rose from about 2,300 in January to 2,600 in July, a 13% increase, a spokesperson said. Uninsured hospital admissions averaged about 125 a month in the fiscal year that ended in June. They have since doubled to about 250 a month.
The system plans to spend at least $25 million more this year on subsidized care for people who cannot afford a doctor and is redesigning programs to take on more patients. "We're just seeing the beginning of what we see as a major problem for access to healthcare," Lorenz said. Medi-Cal enrollment in the county has dropped from about 425,000 in 2024 to about 355,000, according to the county social services agency. Valley Healthcare is running on a $4.7 billion budget this year. Supervisors directed all of the roughly $340 million a year from the sales tax county voters approved last year to the system, and it has not made major cuts to services or jobs so far.
North Bay and East Bay
NorthBay Health, which runs hospitals in Fairfield and Vacaville, projects about 4,000 uninsured patient encounters this year, up from 3,345 in 2025, an increase of nearly 20%, the Napa Valley Register reported. NorthBay said patients with limited coverage can have a harder time getting home health care, medical equipment and skilled nursing after they leave the hospital, which makes safe discharges harder to arrange.
At Queen of the Valley Medical Center in Napa, uninsured emergency visits rose 6.7%, from 510 to 544, and uninsured inpatient stays rose from 22 to 31, compared with last year. Chief administrative officer Dr. Amy Herold called the increase substantial but said the financial impact so far is limited. In Hayward, staff at St. Rose Hospital, part of Alameda Health System, who staged a "die-in" last week, said the number of uninsured patients they see each day has also spiked.
Why it is happening, and what comes next
Extra federal tax credits for Affordable Care Act plans expired at the start of this year, raising premiums. Covered California reported that new enrollment for 2026 fell 32%, and 24.3% of middle-income customers who lost the extra help canceled their coverage at renewal, up from 11.9% in 2025, the Register reported.
Bigger changes start in 2027. A federal rule from the 2025 One Big Beautiful Bill Act will require some Medi-Cal adults without young children to work, volunteer or attend school part time, and some members will have their eligibility checked every six months instead of once a year. California will also freeze new Medi-Cal enrollment for undocumented immigrants in January and start charging them at least $30 a month next summer. A state agency expects 1.3 million Californians to lose Medi-Cal by 2030. "I think that's only going to grow as we head into '27," said Katie Rodriguez of the California Association of Public Hospitals.
If you have lost coverage
Adventist Health urged patients not to put off care over cost. Ask the hospital about financial assistance first, and check Covered California or Medi-Cal, since many people qualify for programs they do not know about.