By Kent Boes, California State Association of Counties
In Colusa County, where healthcare access is already limited and we rely on a single hospital to serve an entire region, H.R. 1 (also known as One Big Beautiful Bill) will directly determine whether families can continue to get care close to home unless the state takes action.
As a Colusa County Supervisor, I see firsthand how fragile that access already is. Almost 80% of Colusa County residents rely on some form of subsidized healthcare coverage. With H.R. 1, we estimate 30% of our Medi-Cal enrollees will lose their health care coverage.
Many of those individuals would not lose coverage because they are ineligible or unwilling to work. They would lose it because of new administrative hurdles and reporting requirements embedded in the legislation. In practice, these changes risk pushing eligible people out of the healthcare system simply because navigating the bureaucracy becomes too difficult.
The impacts would be devastating.
Our county’s only hospital, Colusa Medical Center, is already operating in a system where Medi-Cal reimbursements are essential to keeping its doors open. Like many rural hospitals across California, it depends heavily on that funding to sustain services and staffing. When thousands of residents lose coverage, the hospital loses critical revenue.
This is not just a Medi-Cal issue. Every resident in Colusa County could feel the consequences through longer wait times, reduced services, workforce shortages, and diminished access to care.
Left unchecked, these financial pressures threaten the long-term viability of the hospital itself, putting the community’s access to local healthcare at risk.
If our hospital were to close, residents would face a drive of up to 45 minutes to reach the nearest hospital in Marysville. For a routine appointment, that may be inconvenient. For a heart attack, stroke, or serious accident, it could be life-threatening.
This challenge extends far beyond Colusa County. Across rural California, healthcare deserts are expanding. Twelve California counties, including Colusa, no longer have labor and delivery services. Expectant mothers in some parts of the state must travel up to four hours to give birth safely. No family should have to worry about a multi-hour drive to reach maternity care while in labor.
Yet healthcare is only part of the story.
When residents lose access to healthcare coverage, counties inevitably become the safety net. Under California law, counties are required to provide indigent care – the care of last resort – to residents who have no other source of coverage. This is not optional; it is a state-mandated obligation that counties must fulfill.
Counties are already grappling with significant fiscal pressures as we work to deliver a wide range of critical services on behalf of the state. When healthcare costs rise and local resources are stretched thinner, the ability to maintain all core responsibilities becomes more difficult, and difficult choices follow.
Without state action, counties may be forced to divert funding away from core priorities such as fewer deputies on the street, reduced transportation maintenance and improvements, and strained election administration in order to meet legally required indigent care obligations. That is not a sustainable path forward.
This is not a partisan issue. It is a community issue. Rural and urban counties alike will feel the effects. The question before us is whether California will continue investing in the systems that keep residents healthy, safe, and connected to care.
Counties stand ready to work with Governor Newsom and the Legislature to protect California’s healthcare safety net. Our residents depend on it, and the future of many communities may depend on it as well.
Kent Boes is a Colusa County Supervisor and serves as Second Vice President of the California State Association of Counties.