Can Santa Barbara’s Deep State of Medical Care Save Medi-Cal Recipients from Trump’s Red Tape Cliff?

IT’S WORSE THAN IT LOOKS:  I was up way too early that morning. And I would not be getting back to sleep. I just knew. I have a similarly afflicted friend who claims he regularly holds court in front of the bagel shop up on the Mesa beginning at 5 a.m. A long time ago, he got me a penis gourd worn by men in Papua New Guinea, a place he knows well and has written extensively about. I am told these gourds — also called phallic sheaths — can also be used for holding cigarettes, money, and small tools. They are to be worn, I have been informed, at jaunty angles. I figured this would be a good time to go badger my friend at the bagel shop. I was riding my bike. I would not be wearing any gourd. Dawn hadn’t broken when I rolled up; light was pouring out of the Vons next door. My friend was nowhere in sight.

“What the hell,” I muttered.

Turns out, I happened to have a $90 check with me from Donald J. Trump, just burning a hole in my wallet. Might as well visit the ATM and make a deposit: $90 is $90. I pushed all the right buttons and inserted the check. It whirred and clicked. Nothing in the accompanying envelope explained why I got it. I would read later it was to make me captain of my own Medicare health care destiny by putting my own money into my own hands. About 20 million of us — Medicare Part B enrollees — got a check for the same amount. That these checks arrived just a couple of weeks before November’s midterm elections, I’m sure, was just a coincidence.

Plan B enrollees pay $203 for our monthly premiums. And those premiums are going up by $80 next year. Looked at in this context, that’s not much health care destiny for me to captain. Maybe it wasn’t such a coincidence after all. Isn’t Trump also offering to write $5,000 checks for every voting age U.S. citizen if the Republicans hold onto the House. Isn’t that bribery? Isn’t bribery against the law? Isn’t Trump the guy making all the noise about election fraud?

I know. I know. Isn’t consistency the hobgoblin of little minds? 

Such thoughts need not have roiled my mind as the rosy fingers of dawn tickled the morning sky. (Yes, I stole that.) The ATM machine spat Trump’s check right back out at me. It lay there, long, flaccid, and flopping, the bloated tongue of a long-dead cow. The ATM notified me it could not discern the digits inscribed on the front of Trump’s check. 

No deposit. No return. 

All these $90 checks, I have since learned, are costing the federal government $2 billion. In a perverse way, I’m impressed. Trump is attempting to bribe us by offering us money that already belongs to us. Nice trick. The $5,000 checks — should any ever get written — are estimated to cost the American taxpayers $1 trillion. Trump says the money will come from the higher tariffs he’s charging. But the law that would allow the tariff money to be used for such purposes has yet to be written, let alone voted for.

A grifter to the bitter end. Yet we never somehow tire of it. 

Let’s do lunch.

Way back in 1965, when Lyndon Baines Johnson passed the monumental landmark bill creating Medicare and Medicaid, he did so over the hair-on-fire opposition from anyone wearing a stethoscope around their neck. Providing medical care for poor people and old people was seen as creeping communism. Four years before the bill was signed, Ronald Reagan — still an actor and not yet a resident of Santa Barbara or a budding blip on anybody’s political screen — cut an album lambasting Medicare as “socialized” medicine. “One day, we will spend our sunset years telling our children and our children’s children what it was once like in the United States where men were free.”

That must have been when America was still great.

Part of Trump’s plan to restore that greatness is to push as many poor people as humanly possible off Medicaid. The trillion bucks saved by doing so will underwrite the trillion-dollar tax break for the top one percent.

Trump has transformed a bulwark of public care into a weapon of one-way class struggle. It’s no longer, “Let them eat cake.” It’s more like, “Let them choke to death on their own saliva.” 

The operational theory of Trump’s approach is that by forcing more poor people to work in to qualify for Medicaid, they’d get off their asses and go get jobs and then they wouldn’t be poor anymore. As with all such theories, reality has a habit of intruding. This approach — tightening up on eligibility requirements and making recipients apply twice a year instead of once — was first tried out in earnest in Arkansas circa 2017. About 18,000 work-age Medicaid recipients lost their medical insurance. Researchers from Harvard discovered that 97 percent of medically disenfranchised ex-recipients already were working. Huh? Longitudinal studies showed that the number of people with jobs actually went down by 3 percentage points, not up the way proponents of this policy anticipated. 

What pushed these 18,000 people over the edge, the Harvard researchers discovered, was all the red tape involved with filling out the applications so many times. They just gave up. 

So much for the American entrepreneurial spirit. In his second term, Trump doubled down in this strategy in his signature “Big Beautiful Bill.” To qualify for coverage, applicants must now apply twice a year. They must now document they are working more hours or that they are volunteering more hours at some nonprofit or attending more hours in some classrooms to elevate their earning potential. Or too bad for them.

Trump’s bean counters estimate all this extra red tape will save the federal government $1 trillion worth of health care as dispensed through Medicaid. Did I mention $1 trillion is also the same amount the Big Bad Beautiful Bill bestows upon the top one percent in tax cuts? What an interesting coincidence. 

Ninety dollars? 

The check’s in the mail. All politics, as they say, is local. In Santa Barbara County, 29,000 current Medi-Cal recipients are estimated to be at risk of being pushed off the red tape cliff. Maybe you’re one. Or your son or daughter is. In San Luis Obispo, the number is 15,000. Where do we suppose all these sons and daughters will go when their insurance benefits are discontinued? To all the same emergency rooms upon which we all rely. You think the waits are bad now. Under federal law, hospitals cannot legally deny care to anyone just because they can’t pay. I don’t have any stats handy as to the number of households that declared bankruptcy because of medical debt or the number of patients being dunned by collection agencies over unpaid medical bills. I will wager it’s a whole lot.

Make America Broke Again.

Yes, Santa Barbara is the American Riviera with more private jets per capita even than nonprofits and all that joyful noise. The flip side of that equation is this: Fully one-third of our population is covered by Medicaid. In case you haven’t surmised, that’s poor people insurance.

The good news here is that the Deep State of Medical Care — Cottage, Marian, CenCal, the Neighborhood Clinics, County Public Health, American Indian, and many more — has come together to form a consortium with the less than catchy name of Central Coast Coverage. The whole point of this new group is to keep people who are currently enrolled in Medicaid from falling off the red-tape cliff. 

CenCal — which administers Medicaid to 220,000 recipients in Santa Barbara and San Luis Obispo counties — has ponied up $2 million to keep Central Coast Coverage humming. They will be working overtime holding all the hands that need to be held, helping applicants make sense of forms that make no sense. If you need to document extra hours of volunteer service for some nonprofit to stay covered, Central Coast will reach out to the Santa Barbara Foundation to see if they know of any nonprofits in search of volunteers. It’s all hands on deck. It’s like one of those outer space movies where the space craft gets rocked by an incoming asteroid yet somehow survives. We hope.

Since 2025, 18,000 county residents have already lost their MediCal coverage with renewal challenges being the number cause. What did Woody Guthrie say? “Some will rob you with a six-gun, and some with a fountain pen.”

Hey, if you get one of those $90 checks, think about donating it to the Central Coast Coverage. (And if you are one of the thousands facing the red-tape cliff, check out their Get Help page.) In the meantime, Donald J. Trump, you can take my penis gourd from Papua New Guinea and shove it where no stethoscope shines. 

As for my early-rising no-show friend, Craig Harris, he will be giving a public talk about Papua New Guinea at City College on Thursday, October 29, at 5:30 p.m. in the BC Forum on West Campus. And, oh yes, refreshments will be provided. But no penis gourds.