A nurse with the Kern County Public Health Department gives a shot of the COVID-19 vaccine to nine-year-old patient Bajron Perez during a vaccination drive at the old courthouse in Wasco on Feb. 26, 2023.
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Larry Valenzuela
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CalMatters/CatchLight Local
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Topline:
Whether federal cuts are legal is still undecided. But local health departments have closed clinics, stopped programs, cut immunization appointments and laid off workers anyway.
Why now: Across the state, county health and human services departments have made significant reductions to bread-and-butter programs as a result of the Trump administration’s funding cuts and freezes. Kern, San Luis Obispo, Orange and Los Angeles counties, as well as the city of Long Beach, are among those reducing health services. The state’s budgetary crisis and subsequent public health cuts have also strained local resources.
Why it matters: California cities and counties have closed public health clinics, eliminated family planning programs, stopped dental services, reduced appointment availability for immunizations, instituted hiring freezes and laid off dozens of local health workers. At the end of the month, because of cuts in Trump’s so-called One Big Beautiful Bill, most county health departments will shut down nutrition programs focused on teaching low-income families how to stretch their food stamp dollars and cook healthier food.
Read on... how DOGE cut billions in public health dollars and more on how counties across California are eliminating programs.
Earlier this year, Selena Peña spent her days helping Kern County residents learn how to lead healthier lives through nutrition and fitness classes. She was part of a public health team focused on reducing high rates of obesity and heart disease.
But in July the county eliminated the program, citing the loss of $12.5 million in federal public health funding. It was early in a series of cascading cuts to Kern’s health programs this year. Other counties are making similar decisions.
Across the state, county health and human services departments have made significant reductions to bread-and-butter programs as a result of the Trump administration’s funding cuts and freezes. Kern, San Luis Obispo, Orange and Los Angeles counties, as well as the city of Long Beach, are among those reducing health services. The state’s budgetary crisis and subsequent public health cuts have also strained local resources.
California cities and counties have closed public health clinics, eliminated family planning programs, stopped dental services, reduced appointment availability for immunizations, instituted hiring freezes and laid off dozens of local health workers. At the end of the month, because of cuts in Trump’s so-called One Big Beautiful Bill, most county health departments will shut down nutrition programs focused on teaching low-income families how to stretch their food stamp dollars and cook healthier food.
Kern has the highest rate of diabetes-related deaths in the state, and 78% of adults are overweight or obese, according to state data. Peña, who was born and raised there, has seen firsthand how poverty, lack of education and language barriers contribute to poor health. That’s why she was thrilled to do work that helped people like her mom begin to take control of their health.
The irony is not lost on local health leaders that while U.S. Health and Human Services Secretary Robert F. Kennedy Jr. vocally pushes an agenda targeting leading causes of chronic disease like obesity and heart disease, local programs to address these issues and more have been gutted. His recent “Make Our Children Healthy Again” strategy report called out poor diet and lack of physical activity as primary drivers of chronic disease among kids.
“It’s not good enough to say this is important,” said Bernadette Boden-Albala, dean of the school of population and public health at UC Irvine. “They talk about nutrition, but where’s the money on nutrition?
Health departments are well-positioned to improve community health outcomes, Boden-Albala said, because their services are often aimed at improving systemic barriers that make it harder for people to be healthy. They focus on food insecurity, health education and access, disease prevention and surveillance, mental health and regulations to promote safety.
The work is preventative in nature, and without it communities will have more illness, higher costs and fewer health care options, said Long Beach Health and Human Services Director Alison King.
“When public health funding is reduced, prevention work is often the first to be impacted,” King said.
Long Beach has lost nearly $4 million in federal grants with the largest cut affecting its HIV and sexually transmitted infection prevention program.
These policies “will reverberate for the rest of this administration if not well beyond that,” said Arthur Reingold, professor of epidemiology at UC Berkeley School of Public Health and global infectious disease expert.
Those cuts targeted money that health departments had used to bolster their response to the COVID-19 pandemic by shoring up laboratory capacity, community outreach and immunization programs. In turn, many counties hired dozens of public health workers and were able to expand other services.
The grants were, in some cases, scheduled to last until 2027. Their abrupt termination left counties scrambling.
“We couldn’t even prepare for the end of this funding. That was what was so catastrophic for us,” said Brynn Carrigan, Kern County public health director. “We received notification the day after the stop-funding order was effective.”
California sued to prevent the Trump administration’s cuts, and a federal judge ruled in May that the money must be restored while the lawsuit plays out. But in many ways, the tug of war between federal cuts and state litigation still left local governments with no choice but to eliminate services. If the courts were to ultimately side with the Trump administration, counties would have to repay the money to the federal government.
On Tuesday and Wednesday, pop-up food distributions in Los Angeles served 1,600 tourism industry workers facing reduced wages or job loss.
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Photo courtesy of Los Angeles Regional Food Bank
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“At the end of the day all of the liability and all of the risk is on the county, and we're talking millions of dollars,” Carrigan said.
That’s why programs like Peña’s healthy habits team and others have been terminated.
Her team — called “Know Your Numbers” — checked residents’ blood pressure, glucose, cholesterol and body mass index before providing seven weeks of free dietary and exercise classes to show them how their numbers improved.
“Our health should be a priority. We should want to combat the things that make us unhealthy: Diseases, tobacco, unhealthy foods,” said Peña, a member of Service Employees International Union Local 721. “It’s discouraging when the government doesn’t want to care for the health of the public.”
California counties eliminate dental, other programs
In Kern County, the department has also been forced to close a clinic serving rural farm communities, stop most mobile clinic services, reduce appointment availability at its primary Bakersfield clinic by 67%, and eliminate 35 jobs.
More than 170 miles south, Orange County Health Director Veronica Kelley has grappled with the same difficult decisions. Public health has “not been whole for decades,” Kelly said, but the early federal grant terminations have been especially harsh. They cost Orange County $13.7 million over the next two years.
In May, the county closed its emergency dental clinic. A month later, the children’s clinic and family planning clinic also closed. A federal program to help new moms with diapers, breastfeeding support and food has also been reduced. In October, the county will lose an additional $4 million to combat obesity and food insecurity.
“If we do care about the health of Americans and people who live here and the health of Orange County residents, then we need to put more focus on funding these services,” Kelley said.
The department tried to make reductions in areas where other community providers could absorb the patient load and have the least impact on access to services, Kelley said. But the county isn’t blind to the probability that more cuts will happen in the coming years, as federal support for Medicaid decreases substantially.
Most counties rely on Medicaid to provide mental health services and inpatient substance abuse treatment. It also helps pay for public health clinics where people can get immunizations and testing and treatment for sexually transmitted infections. Counties that run public hospitals are facing even greater uncertainty.
Los Angeles public hospitals brace for Medicaid cuts
In Los Angeles County, the health services department projects it will have a $1.85 billion annual deficit by 2028-29 largely due to Medicaid cuts. The department operates four public hospitals, and 80% of its patients rely on Medicaid for health insurance.
At a recent county supervisors meeting, county Chief Executive Fesia Davenport said federal cuts will likely result in thousands of layoffs and could precipitate the closure of a county hospital.
There are no current plans to close any hospitals, said Jorge Orozco, chief executive of L.A. General Medical Center, but the department has instituted a hiring freeze. County officials are also considering consolidating services that might be provided at multiple hospitals like radiation oncology and delaying maintenance and capital improvement projects.
Still, a deficit of that magnitude will be impossible for the county to fully absorb.
“Belt tightening efforts and cost efficiencies really are not sufficient to make up $1.85 billion,” Orozco said. “That’s really catastrophic.”
The L.A. County Department of Public Health earlier this year also lost $45 million in federal grants and has instituted a hiring freeze.
Orozco said cuts to the health care safety net will ultimately impact everyone in L.A. County. One-third of all trauma cases are taken to a county hospital, he added.
“Our safety net system really serves a huge segment of our population here at L.A. General,” Orozco said. “So the impact of service reductions, the impact of budget reductions, will be felt not only to the most vulnerable, but really all of our community.”
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.
