After meeting with Cottage Health’s head honchos on Wednesday about the Trump administration’s cuts to health insurance, Santa Barbara Representative Salud Carbajal brought up Elon Musk’s big move into trillionaire status.
“If we have reached a point where trillionaires exist, but a working mom on the Central Coast is losing her health insurance, something is very wrong with our country,” he told the Independent. He was joined by Cottage Health CEO Scott Wester for a media availability after their rendezvous at Cottage Hospital.
It’s been a year since Donald Trump’s HR 1, a k a “One Big Beautiful Bill” — or as Carbajal likes to call it, the “Big Bad Ugly Bill” — made its docket debut. Amid its laundry list of safety-net reductions, the bill will effectively gut Medicaid (Medi-Cal in California), which provides government-funded insurance for working families and people on fixed incomes. Additionally, the administration is allowing Affordable Care Act tax credits to expire, which have reduced health insurance premiums for low-income Americans since the Obama era.
Carbajal marked the milestone by meeting with Cottage Health’s leadership to brace for impact: close to 40,000 Central Coast residents left without health coverage, another 37,000 who will see higher premiums, and, talking dollars, a roughly $40 million initial impact on Cottage.
Carbajal described the far-more-demanding, “onerous” work requirements that the bill will demand for people to qualify for federal assistance, such as Medicaid and SNAP food benefits (known as CalFresh in California). Beneficiaries will now also need to requalify and reapply every six months. When these requirements go into effect on January 1, the number of uninsured patients at Cottage will skyrocket.
“I think only time is going to tell how bad that impact will be to our communities in terms of displacement of those with healthcare, who will not be eligible for healthcare anymore,” Carbajal said.
Right now, 25 percent of Cottage’s patients are insured by Medicaid. Roughly one-third (about 256,000) of Central Coast residents are, too.
Preventative care goes “poof” when people cannot pay, leading to worsening medical conditions that lead to emergency room visits. And the law says Cottage cannot turn these patients away, instead absorbing the costs of that care (thus, the $40 million).
Carbajal said he was there on Wednesday to “learn from Cottage” as part of his tour of hospitals on the Central Coast, “to understand not only the impacts in dollars and cents, but all of those stories of people that are losing their health care.”
“A lot of residents on the Central Coast are hurting and will hurt because of this law, and all for what? To add $4 trillion to our national debt and to give tax breaks to the ultra-wealthy individuals like Mr. Musk,” he said.
He called the situation an “evolving crisis” and promised to continue monitoring it. Come November, his hope is that the pendulum in Washington will swing to a congressional makeup that may lend itself to changing course and “mitigating” the administration’s decisions.
Wester said Cottage is beginning to see the “trickle” effects of the bill, as more patients are coming in uninsured or having lost subsidized premiums. But it’s just a sliver of what he anticipates the hospital will see once the changes are in full effect.
“It’s not just about the cost to Cottage,” he said. “These are real people, these are our neighbors. They aren’t just numbers on a piece of paper. These are real individuals in our community that are going to be suffering, and we’re going to do whatever it takes to make sure we provide the level of care they need.”
To prepare, he said, Cottage is working with its partners, such as the Santa Barbara Neighborhood Clinics, the Santa Barbara Family Service Agency, and CenCal — which manages the network of medical professionals who treat Medi-Cal beneficiaries — to help people now on Medi-Cal maintain coverage, navigate the slew of new requirements, and be able to access to affordable treatment.
Cottage is hiring “community health workers,” Wester said, who will be like individual health insurance brokers to help educate people on new requirements, make sure their paperwork is clean, and maintain a consistent level of communication with those patients.
“So we’re all hands on deck with this,” he said.
The changes will come amid a shortage of healthcare workers nationwide, and a budding effort among Cottage’s nurses to unionize.
In terms of staffing, Wester said Cottage is doing everything it can “to make sure we have the right level of staffing.” But the industry is very unpredictable, he noted.
“We’re also preparing in terms of how we really operate efficiently in the emergency room,” he said. “Right now, we’re much better than many other places around the United States, but healthcare is pretty much at a breaking point as it relates to capacity, and that capacity strain is real.”
The wait time at Cottage’s ER is variable, Wester explained. “Some days we might be holding a couple people in the emergency room just because we don’t have capacity,” he said.
“Our teams work extremely well together,” he continued. “We meet multiple times during the day on capacity and capacity management, and it’s vitally important.”
If someone comes to Cottage and cannot pay their bill, Wester said they can apply for Cottage’s “charity care” policy, which reduces or eliminates the cost of care based on their income status. A family of four making up to $165,000 qualifies. No matter what happens in Washington, no one will be turned away or denied treatment, Wester affirmed.
