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County officials warn federal budget standoff could raise premiums and shrink coverage; state action preserves vaccine access
Summary
Presenters told the Health and Hospital Committee the pending federal budget fight, including cuts in HR 1 and a likely shutdown, could sharply raise health insurance premiums and reduce coverage. County and state actions aim to blunt vaccine access disruptions after confusing federal vaccine guidance.
Santa Clara County health staff told the Health and Hospital Committee that a likely federal budget showdown and provisions in HR 1 could sharply raise premiums for people who buy insurance on the health exchanges and increase the number of uninsured. “The biggest issue before the congress and really the only issue before the congress right now is the prospect of a government shutdown next week,” policy consultant Bert Margolin said during the committee’s presentation.
Why it matters: committee members were warned that two federal actions in particular — proposed Medicaid reductions in HR 1 and expiration of enhanced premium tax credits — would have immediate and widespread effects on county health systems and patients. “More than 20,000,000 Americans will face these higher premiums next year,” Margolin said, citing analyses of the premium-tax-credit changes, and he quoted the Kaiser Family Foundation’s estimate that premiums could rise about 75 percent on average if the credits expire.
Margolin outlined the two baskets of Democratic demands in Congress: reversal of Medicaid cuts in HR 1 and extension of the enhanced premium tax credits that currently lower exchange premiums. He said Democrats are pushing the issue to highlight harm from the cuts, and that the tax-credit question has cross‑party interest because the credits boosted enrollment even in many red states. “These credits are given credit for double the enrollment in the exchanges, since 2020,” Margolin said.
County staff also flagged other federal risks: potential disruption to telehealth reimbursement and the role of Office of Management and Budget guidance during a shutdown. “There is an argument that if there’s a government shutdown, those telehealth visits would not be reimbursable,” Margolin said, adding that county leaders are watching that issue closely.
Health‑system and vaccine access: committee members also heard a separate briefing from county public health officials about federal vaccine-advisory actions and how state and county steps are preserving access locally. The county’s public health official said California enacted trailer‑bill language ensuring that, in the state, “anyone 6 months and older is able to get the updated vaccine this season,” and that state policy requires insurers regulated by California to cover COVID vaccine for eligible people.
“There is no link between autism and vaccines,” the county health official said in response to recent federal statements that generated public confusion. The official added that the county will continue to offer COVID‑19 and influenza vaccines and is working with health systems and pharmacies to expand access as supply arrives.
What the committee did: the Health and Hospital Committee received the federal/state policy briefing; supervisors asked county staff to continue tracking federal negotiations, telehealth reimbursement, DSH (disproportionate share hospital) deferrals, and to brief the board as needed.
County context and next steps: presenters said a shutdown is possible and that the timing and duration are uncertain. Margolin and county staff urged monitoring for immediate operational impacts (telehealth payments, federal staff designations) and the longer-term fiscal risk from reduced federal support. The county is also coordinating with hospital partners to model local impacts and to protect vaccine access through state mechanisms.
