The Brief

Perhaps no state has more to lose than California in the federal budget proposal House Republicans passed this week.

That spending plan sets up significant cuts to Medicaid, the health insurance program for low-income people. California has taken just about every route and opportunity to expand the Medicaid program. Today, 14.9 million Californians are enrolled in it, and federal funding cuts would almost certainly roll back services and coverage for some of them.

Looking for a way to offset the cost of extending President Donald Trump’s 2017 tax cuts, the House advanced a bill Tuesday that directs the Energy and Commerce Committee to find $880 billion in spending cuts over the next 10 years. Those cuts, budget and health policy experts say, would largely have to come from Medicaid, also known as Medi-Cal in California.

The Senate voted for its own, narrower budget bill last week. Next, both chambers have to work out their differences and agree on one budget.

At this point, it’s not clear which Medicaid services would be cut or how many people exactly would lose coverage because lawmakers can hit the spending reductions in a number of ways.

Still, enrollees, health advocates and providers in California and across the country are now grappling with what the cuts would mean for them and the people they care for. In press conferences and online meetings, they’ve called the proposed cuts a “five-alarm fire” and Republicans’ vote “the ultimate betrayal” of their constituents.

Their outcries echo the first Trump administration, when in 2017 House Republicans voted to repeal the Affordable Care Act. The law ultimately survived, but that health care vote helped stir up the “blue wave” that flipped Republican House seats in the 2018 election.

“These cuts would rip care away from children, seniors, disabled Californians, and more while raising costs for everyone, all to give tax breaks to the ultra-wealthy,” Amanda McAllister-Wallner, interim executive director of Health Access California, a health consumer advocacy group, said in a statement following the House vote. “This is just the beginning — we will be pushing our California congress members at every turn to put the health of their constituents first.”

Medicaid is the backbone of California’s social safety net. It covers half of all children and 40% of all births. It also covers long-term care services for seniors and disabled people.

Since 2014, the state has expanded the program big time — first to more adults allowed in the Medicaid expansion under the Affordable Care Act, and gradually to low-income immigrants, regardless of their legal status. Cuts to the scale that Republicans in Congress are proposing, advocates and providers say, would be harmful across the board.

Hospitals, doctors and county officials are also speaking out against the proposed cuts because Medicaid is a key payer, especially for those located in rural areas or communities with high poverty rates. If these facilities can’t keep their doors open, entire communities, not just people enrolled in Medicaid, could lose access.

House Speaker Mike Johnson, a Louisiana Republican, has said savings could be accomplished through eliminating Medicaid fraud and waste — although that would only get Republicans so far. Johnson has cited about $50 billion in alleged fraud, a small slice of the GOP’s goal total, the Washington Post reports.

Cuts would leave big budget hole for state

Medicaid accounts for a significant portion of states’ budgets. The program is jointly funded by the federal government and states, meaning federal cuts would leave major budget gaps that would force reductions in services and enrollment, and also could trigger cuts to other state programs. California’s budget includes $161 billion for Medi-Cal, of which more than half is paid for with federal funds.

Based on proposals that Republicans in Congress are considering, California could lose $10 billion to $20 billion a year, the California Budget Policy Center estimates.

Speaker of the House Mike Johnson speaks at the Conservative Political Action Conference (CPAC) at the Gaylord National Resort and Convention Center in National Harbor, Maryland on Feb. 20, 2025.

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Jack Gruber

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USA TODAY via Reuters

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A big question mark is how exactly Congress will meet its savings goal — Republican lawmakers have floated a number of proposals, but it’s unclear yet what could stick.

They’ve proposed imposing work requirements, for example. The idea behind that is enrollment would drop as people who don’t meet the requirements get kicked off the program. But the spending reductions from such a policy would not get Republicans all the way to their target, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.

A second proposal would require restructuring the program so that instead of the federal government paying states a fixed percentage of Medicaid costs, it could set a spending cap per enrollee.

Under the Affordable Care Act, California opened up its Medi-Cal roll to low-income adults who had previously not been covered. The federal government pays California 90% of the cost for this expansion group — that’s up from the state’s 50% regular match rate. Republicans may also choose to eliminate the increased match rate for adults covered under this expansion.

“One reason that these types of cuts are popular among federal policy makers is because…it really allows the blame to be placed on governors and state legislatures,” Park said. “The federal government is cutting federal funding, making it harder for states to finance their share of the cost of Medicaid, but it’s not actually saying ‘You have to cut eligibility in this way or cut provider rates in this way.’”

“It’s really, ‘States, you figure it out, you have to balance your budget,’’” Park added. “And you know, there’s only three choices: higher taxes, cutting the rest of the budget, which is primarily education in California, and then, most likely, really dramatically cutting Medi-Cal in the state.”

Coverage for seniors and people with disabilities

President Trump and Republicans have promised to not touch seniors’ Medicare, but millions of seniors also rely on Medicaid. In California, about 2.2 million seniors and people with disabilities are enrolled in Medi-Cal, according to data from the state’s Department of Health Care Services.

Traditional Medicare does not cover services including dental, vision and hearing benefits. Seniors typically have to buy into a Medicare Advantage plan to get that covered. Low-income seniors in California can access those services with no or at a low-cost through Medi-Cal.

Nursing home stays and in-home care are also largely covered by Medicaid. Nationally, about 6 in 10 nursing home residents are covered by Medicaid, according to an analysis by KFF, a health polling and research organization.

“Medicare has huge gaps in coverage and Medicare is really expensive,” said Amber Christ, managing director of health advocacy at Justice in Aging, which advocates on behalf of older adults. “It is Medicaid, not Medicare, that is the primary payer of long-term care in this country.”

Because of their high needs, seniors and people with disabilities are the most costly population. In California, they make up about 15% of the people enrolled in Medi-Cal, but account for roughly half of all the program’s spending.

“So if the state wants to go where the money is, that’s seniors and people with disabilities. That’s long-term care, nursing home care, community-based services,” said Park. To protect the coverage of this population, he said, the state would have to consider potentially making larger cuts for other groups of people.

A safety net for California kids

More than 5 million kids in California are insured through Medi-Cal and the accompanying Children’s Health Insurance Program. It pays for their preventive care, such as immunizations and screenings, but it also covers support services, such as counseling and therapy. For about 160,000 children in the foster care system, it also pays for an array of social services.

Getting kids insured has long been a priority for California. When the state began expanding Medi-Cal to undocumented people in 2016, children were first in line.

Perhaps less known is that Medi-Cal is also a big player in services provided at schools. It helps fund services and equipment for students with disabilities, such as hearing aids and specialty transportation. It reimburses school districts for certain providers, including psychologists and social workers, for example. Across the state, some districts also provide physical and mental health care to children and their family through school-based health centers that also draw down on Medi-Cal funding.

“The rates of depression and anxiety among youth are rising at alarming rates, and for many, Medi-Cal services are their only option for care,” said Michele Cantwell-Copher, the Fresno County Superintendent of Schools, on a media call with advocates and parents on Thursday. “Ensuring that children have access to the mental health support they need is critical to their well-being and their success in schools.”

Medi-Cal is a keystone program for many kids but also for their birthing parent — it pays for about 40% of the state’s births. California offers coverage for pregnant people at slightly higher income levels than the regular cut-off, allowing more to qualify. It provides coverage during their pregnancy and 12 months postpartum, paying for standard obstetric visits, prescriptions, laboratory services, doula services and hospital care.

“If we want kids to have a healthy start, that means making sure that their birthing parent has access to health care,” said Mike Odeh, health policy director at Children Now. “Those early years really are important for both babies and parents. There are a lot of services in that time period that really are critical, and any reduction in those services could have very bad effects.”

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.

I think we all breathed a sigh of relief when we saw the recent headline that fire season in L.A. is all but over. Forget Dodgers season tickets — I can’t think of a better holiday gift for this city.

Music-wise, ease into December with Lady Blackbird at the Blue Note on Monday. Our friends at Licorice Pizza also recommend RuPaul’s Drag Race all-star Alaska 5000’s A Very Alaska Christmas Show at the Regent on Tuesday and superstar rapper Blxst’s first of four nights at the Roxy (he’ll also be there Wednesday, Thursday and Saturday). On Wednesday, Twin Shadow is at the Regent, and on Thursday, our personal faves, Public Service Broadcasting, are also at the Regent.

Explore more on LAist, where you can find the best local food and drink gifts to give this holiday season, read up on FilmWeek’s latest film picks, and we talk to Wicked: For Good costume designer Paul Tazewell. And don’t forget to support LAist on Giving Tuesday!

Events

Frank Meyer in concert

Wednesday, December 3, 11 p.m. 
Old Towne Pub 
66 N. Fair Oaks, Pasadena
COST: $10; MORE INFO 

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Mario Luis

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Frank Meyer has been playing the L.A. punk scene for decades. Founder of West Coast punk legends Streetwalkin' Cheetahs, Meyer (he might look familiar also because his brother is actor Breckin Meyer), has collaborated with folks like James Williamson (Iggy & the Stooges), Wayne Kramer (MC5), FEAR and Eddie Spaghetti (Supersuckers). He’ll play from his debut solo album at Old Towne Pub in Pasadena — get all that post-Thanksgiving rage out with some punk jams!

Writers Bloc presents NY AG Letitia James with Brian Tyler Cohen

Thursday, December 4, 7:30 p.m.
The Ebell Lounge
743 S. Lucerne Ave., Mid-Wilshire 
COST: $35; MORE INFO

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Writers Bloc Presents

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Few people have been in the news the past few weeks more than New York Attorney General Letitia James. Fresh off the dismissal of the cases against her and former FBI director James Comey, James is coming to Writers Bloc for a conversation with No Lie podcast host Brian Tyler Cohen. No doubt this will be a topical and exciting evening at the Ebell.

World AIDS Day: Artists and Activism, co-presented by Artillery

Wednesday, December 3, 7:30 p.m. to 9 p.m. 
Oculus Hall at The Broad
221 S Grand Ave., Downtown L.A.
COST: FREE; MORE INFO 

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Courtesy The Broad

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Dec. 1 is World AIDS Day, and a group of incredible artists — including Rubén Esparza, Ken Gonzales-Day, Joey Terrill and photographer-documentarian Judy Ornelas Sisneros — will join journalist Carolina A. Miranda for a conversation about artists, social justice and the history of arts amid the AIDS crisis at the Broad. Across their long careers, the speakers featured have worked to shape how we view the AIDS crisis, LGBTQ+ equality and other issues.

Grand Illuminations

Wednesday, December 3, 12 p.m. 
The Yard at Cal Plaza
350 S. Grand Ave., Downtown L.A. 
COST: FREE; MORE INFO 

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Courtesy DTLA Alliance

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Downtown lights up for the annual Grand Illuminations opening celebration. It’s free, and there are events from 12 p.m. all through the evening, with a holiday marketplace curated by The Goddess Mercado, live entertainment from 4 p.m. to 7 p.m. and the community tree lighting at 5 p.m.

Last DTLA Art Night of the Year

Thursday, December 4, 6 p.m. to 10 p.m.
Various locations (see map), Downtown L.A. 
COST: FREE; MORE INFO 

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Courtesy DTLA Artnight

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It’s the last Downtown L.A. art night until 2026, so grab a jacket and stroll through the various galleries around downtown, many of which have new exhibits open for the holiday season. We recommend checking out the opening of Airbrush to AI: Fifty Years of Reinvention: A Retrospective by Patti Heid at the Los Angeles Center for Digital Art.

Fiber Night

Thursday, December 4, 4 p.m. to 9 p.m.
StichStop L.A.
13270 Moorpark Street, Sherman Oaks
COST: FREE; MORE INFO

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Sharon Waldron

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Unsplash

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Whether you’re an avid knitter, embroiderer, weaver or just a dabbler, head to StitchStop LA for their free Fiber Night event in Sherman Oaks. Adults and kids can swing by to learn more about fiber arts and participate in hands-on demonstrations of all kinds of crafts, including crochet, pompom-making, needle-felting and even a special tufting gun demo from Tuft House LA (whose awesome rug classes we’ve featured here before!). Just in time for homemade holiday gifting.

Holiday Undie Run

Thursday, December 4, 6:30 p.m.
The Penmar 
1233 Rose Ave., Venice 
COST: FREE; MORE INFO

MeUndies (who else?) is sponsoring a holiday-themed Undie Run at Rose Ave. hotspot The Penmar. Snag free holiday undies (and sport them on the fun run around the public golf course), as well as other gifts, tacos and a “Naughty Santa” photo op.

Brazil: Director's Cut

Monday, December 1, 9:30 p.m.
Alamo Drafthouse 
700 W. 7th Street, Ste. U240, Downtown L.A.
COST: $22.68; MORE INFO 

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Twentieth Century Fox

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OK, so it’s probably the least “holiday” movie I could find, but you don’t want to miss a chance to see Terry Gilliam’s most chilling work, Brazil, on the big screen at Alamo Drafthouse downtown. Take a trip into a pretty dark timeline of future social and political upheaval in this Orwellian masterpiece about bureaucracy gone wrong.

Castanea x Washington Square Pizza

Wednesday, December 3, 6 p.m.
31 Washington Blvd., Venice 
COST: $20; MORE INFO 

Grab a “Memento Box” of pastries, snacks and surprise goodies from Castanea Sicilian Cafe and Washington Square Pizza at Washington Square Pizza for one night only. The event is free, but the box is $20 of yum.

National Cookie Day

Thursday, December 4, 10 a.m. to 4 p.m.
McCormick x Milk Bar 
7150 Melrose Ave., Melrose
COST: FREE; MORE INFO

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Courtesy McCormick

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Join McCormick, Milk Bar and Christina Tosi are celebrating National Cookie Day with free giveaways of the limited-edition McCormick x Milk Bar Eggnog English Toffee Cookie. The first 50 customers at the Los Angeles flagship location will receive a free limited-edition cookie. If you’re late, don’t fret: The cookies will be on sale for $4 through Dec. 31.

The Food and Drug Administration intends to get tougher on vaccine approvals, as top officials raised concerns about the risk of COVID vaccines for children.

Speaking on Fox News Saturday morning, FDA Commissioner Marty Makary said the agency would no longer "rubber-stamp new products that don't work," claiming it made a "mockery of science."

Makary's comments came the day after FDA's top vaccine regulator, Dr. Vinay Prasad, told his team the agency would change its annual flu vaccine framework, update vaccine labels to be "honest," and make other changes to how it reviews vaccines, according to contents of an internal email reviewed by NPR and reported on first by a PBS News Hour correspondent and later by The Washington Post.

Prasad wrote that the FDA would also no longer authorize vaccines for pregnant women without stricter requirements. And for pneumonia vaccines, manufacturers will have to prove they reduce disease rather than show they generate antibodies. He also raised questions about giving multiple vaccines at the same time, which is standard practice.

The changes could make it much more difficult and expensive for vaccines to get approved, further limiting the availability of vaccines, which are considered among the safest and most effective tools for protecting people against infectious diseases.

While all vaccines carry some risks, most public health experts argue the current process for vetting vaccines before marketing has long assured that the benefits of vaccines outweigh their risks. Studies required after vaccines are approved and surveillance systems, including the Vaccine Adverse Event Reporting System (VAERS), also flag potential safety issues once vaccines are in use.

FDA says an analysis links COVID shots to some deaths

Makary said on Fox News that 10 children had died from the COVID shot during the Biden administration, but did not offer specifics about how the FDA came to that conclusion. Millions of children have received the vaccine. 

Officials with the Department of Health and Human Services and Food and Drug Administration didn't immediately respond to requests for comment on the COVID analysis and changes to vaccine review standards.

According to the FDA email from Prasad, he told the agency's biostatistics and pharmacovigilance team to analyze 96 reported deaths from 2021 to 2024, and they determined 10 children died "after and because of" the COVID vaccine. But Prasad said the true number was likely higher.

Dr. Paul Offit, who directs the Vaccine Education Center at the Children's Hospital of Philadelphia, said in a text message that Prasad has not shared the evidence that these vaccines killed 10 children.

"Because he doesn't provide any evidence, he is asking us to trust him on an important issue," Office said. "All this will do is scare people unnecessarily. At the very least, he should provide all the evidence he has so that experts in the field can review it and decide whether he has enough data to prove his point."

Dr. Jesse Goodman, a professor at Georgetown University who held Prasad's job at FDA from 2003 until 2009, said in an email that the FDA's Center for Biologics Evaluation and Research, which oversees vaccine approval, has been "recognized globally as a gold standard regulator." Goodman defended "immunologic endpoints like antibody levels" for the accelerated approval of pneumonia and influenza vaccines. He said science supports their use and they are confirmed with studies after approval: "These approaches have helped provide children and adults with timely access to safe and effective vaccines, saving many lives."

Michael Osterholm, an epidemiologist at the University of Minnesota, reviewed the email from Prasad and challenged his statement that "COVID-19 was never highly lethal for children." Osterholm also questioned the FDA's latest analysis of adverse event reports attributing the 10 deaths to COVID vaccines.

"Prasad's email is filled with factual mistakes and misrepresents both the severity of COVID in children (1597 deaths in 2020-2022) and how the US responded to the first signals of possible vaccine-associated pediatric deaths in May 2021," Osterholm wrote in an email to NPR.

"While Prasad's email notes 10 such deaths, these cases have never been presented for review by the medical and public health communities or published in the medical literature," Osterholm continued. "Given the record of this Administration to misrepresent scientific data regarding vaccines, until these cases have been reviewed by an expert third party, like the National Academy of Science[s], we can not accept the fact they are vaccine-associated deaths."

Surveillance system collects vaccines reports

The FDA makes public data from the VAERS surveillance system co-sponsored by the Centers for Disease Control and Prevention. But the FDA cautions, "it is important to note that for any reported event, no cause and effect relationship has been established." In his email, Prasad wrote that "with case reports, causality is typically assessed on a subjective scale. In this scale ranging from certain to unlikely — certain, possible/likely, and probable are broadly considered as related to the product."

Makary said on Fox News that when the COVID shot was first rolled out, it was "amazing" for people at high risk of coming down with severe disease, but things have changed.

"Back in 2020, we saw a reduction in the severity of illness and lives saved, but now recommending that a 6-year-old girl get another 70 million COVID shots — one each year for the rest of her life — is not based on science. And so we're not going to just rubber stamp approvals without seeing some scientific evidence."

The claim is the latest move by Trump administration health officials questioning the safety and effectiveness of vaccines and how the government has regulated them. Health Secretary Robert F. Kennedy Jr. has long questioned vaccines.

The FDA restricted eligibility for the updated COVID vaccines in August after announcing the agency planned to require more evidence about the shots' safety and effectiveness going forward.

CDC committee will meet to review vaccine policies

The FDA email on vaccine policy comes just before the CDC convenes a crucial two-day meeting of that agency's influential Advisory Committee on Immunization Practices on Dec. 4-5. The committee is in the process of conducting a major review of how children are inoculated against dangerous infectious diseases such as measles, mumps, rubella, polio and hepatitis B.

Many public health experts are concerned the committee will upend the childhood vaccination schedule. It could move to delay the timing of some inoculations, space out vaccinations and call for the reformulation of some vaccines. Taken together, the moves could result in fewer children getting protected and the resurgence of once-vanquished diseases.

Asked about Makary and Prasad's claims that the COVID vaccine caused deaths among 10 children, Moderna, whose COVID vaccine is approved for children as young as 6 months old, pointed to a statement it made in September. The company says that multiple published, peer-reviewed studies from a variety of sources show its shot is safe and that it is "not aware of any deaths in the last year or pertinent new information from prior years."

Moderna says it monitors its vaccine's safety along with regulators in more than 90 countries. "With more than one billion doses distributed globally, these systems — including in national health systems across Europe, the United Kingdom, Canada, Australia and the U.S. — have not reported any new or undisclosed safety concerns in children or in pregnant women."

Pfizer did not immediately respond to requests for comment.
Copyright 2025 NPR

California is home to the nation’s largest concentration of Afghan immigrants, many of them now grappling with the Trump administration’s abrupt visa and asylum freeze.

Friday’s announcement by the White House followed the fatal shooting of a National Guard member in Washington, D.C. a couple days earlier by a suspect who had immigrated from Afghanistan.

In Orange County, where many Afghans have settled as their immigration applications pend, local officials are gearing up to help them navigate the change, even as guidance is scant from U.S. Citizenship and Immigration Services.

Jose Serrano, director of Orange County's Office of Refugee and Immigrant Services, said the goal is to provide the “most up-to-date information so they can continue on towards their pathway towards citizenship here in the United States.”

“The Afghan population in Southern California, specifically in Orange County, is one that is really important to the DNA of who we are,” Serrano said. “Let's continue to stay together and strong and reimagine a place for belonging for everyone.”

As they await more information, Serrano advised visa and asylum seekers to:

• stay on top of updates from USCIS and the Department of Homeland Security
• contact their local office of immigrant and refugee affairs
• connect with organizations that work closely with immigrant and refugee populations, such as resettlement agencies and legal aid groups

The pull of OC

Nearly 200,000 Afghans are in the U.S., with 39% of them residing in California, according to the Migration Policy Institute.

Hundreds of Afghan households have settled in Orange County, Serrano said, making it one of the state’s hubs for Afghan immigrants alongside San Diego and Sacramento.

Serrano said a big draw for immigrants to Orange County is Little Arabia in Anaheim, a regional destination for Middle Eastern food, culture and community life.

Serrano, who spent more than a decade working with immigrants at World Relief Southern California and the state's refugee programs bureau, said entering Afghan homes means being offered large meals. One family had prepared a whole feast for a Time Warner cable worker, he recalled.

“They didn't understand why that person couldn’t stay to dine with them,” he said. “That’s the type of people that are here in Orange County, folks who are so committed to being a part of civic engagement, to connecting alongside other communities.”

Visa applications in limbo

Serrano said many of the Afghans who resettled in the county are Special Immigrant Visa holders, a program created for Afghan nationals who helped the U.S. government during the war in their home country.

That program has now been frozen by the State Department.

Serrano said immigrants who entered the U.S. as refugees and have since become green card holders could see their cases reopened.

Joseph Edlow, who leads USCIS, said the new immigration measures will last until “we can ensure that every alien is vetted and screened to the maximum degree possible.”

For Serrano, the current screening process is rigorous and involves multiple organizations aside from USCIS, such as the U.S. Department of Justice, the F.B.I. and counterterrorist organizations.

Applicants undergo health screenings and multiple fingerprinting appointments, he said.

“They're constantly doing an assessment to verify that you are a good-standing citizen,” Serrano said. “One of the things that I think we should be very proud of within the United States is that there is an in-depth screening process for anyone who is seeking a protection.”