Kaiser Health News

Amid Lack of Accountability for Bias in Maternity Care, a California Family Seeks Justice

Published

2 years ago

August 8, 2023

by Sarah Kwon
Tue, 08 Aug 2023 09:00:00 +0000

Aniya was ready to leave. She was dressed in a fuzzy white onesie her mother had packed for her first trip home. Yet Aniya’s family had more questions than answers as they cradled the newborn out of the hospital, her mother’s body left behind.

April Valentine, a 31-year-old Black mother, died while giving birth in Inglewood, California, on January 10. Her family has raised questions of improper care: Why didn’t nurses investigate numbness and swelling in her leg, symptoms she reported at least 10 times over the course of 15 hours? Why did it take nearly 20 hours for her doctor to see her after she arrived at the hospital already in labor?

Valentine’s family wants the state to investigate how she died and whether systemic or interpersonal racism could have played a role. Los Angeles politicians and media have amplified their demands. “I think she would have been treated differently if she was white,” said Valentine’s cousin Mykesha Mack, who filed a complaint.

The official cause of death was a blood clot that formed in her leg and traveled to her lung — a preventable condition. The state has issued a $75,000 fine to Centinela Hospital for risking the health and safety of Valentine, and an inspection report suggests it failed to properly assess her risk for blood clots, take precautions, and alert her physician. Centinela announced last month that it would close its maternity services on Oct. 25.

Even so, the odds of finding discrimination and getting justice remain stacked against her family.

The statuses of the state’s investigations aren’t clear, and a federal investigation is pending. The hospital and Valentine’s OB-GYN deny allegations of improper care and reject assertions by some family members that Valentine’s care team, which was largely Black, could have harbored bias toward her. But a KFF Health News analysis shows state authorities are ill-equipped to investigate discrimination complaints and often avoid fining hospitals that violate regulations. That highlights a big gap in the state’s ability to hold doctors and hospitals accountable when it comes to reducing bias in maternal care.

Aiming to reduce stark health disparities, in 2019, California became the first state to require implicit bias training for maternity care providers. But the state hasn’t penalized physicians and hospitals that treat patients inequitably, as it hasn’t found discrimination in the incidents brought to their attention. Neither of the agencies overseeing health care facilities and physicians — the California Department of Public Health and Medical Board of California — has found discrimination, despite hundreds of complaints going back a decade, the KFF Health News analysis found.

In the unlikely event that regulators find discrimination, they usually prefer corrective actions for violations, such as improvement plans, as opposed to penalties. Karen Smith, a physician who led the Department of Public Health from 2015 to 2019, said the agency wants hospitals to provide high-quality care, not to shut them down. So when one violates a regulation, the agency typically tries to help it remedy the problem, depending on the severity. The medical board has come under fire for avoiding meaningful penalties, even for grossly negligent doctors.

California’s rate of maternal deaths is among the lowest in the country, but is up to 3.6 times as high for Black women as for women of other races. Multiple factors, including systemic racism and provider bias, implicit or not, are thought to contribute to this disparity. Valentine’s is not the only high-profile death of a Black mother whose family said her care providers dismissed her.

Some advocates believe these cases keep happening because the state’s oversight of hospitals and doctors is too lax. “There’s no accountability,” said Linda Jones, a co-founder of Black Women Birthing Justice, a nonprofit organization seeking birth equity. “Why should they do anything different?”

A Mother’s Pleas Are Dismissed

Valentine, who worked with at-risk youth and styled hair on the side, was acutely aware of the risks Black mothers face, so she diligently attended prenatal visits and sought a birth doula and Black doctor, her family said.

Valentine’s sister Kesiah Cordova said she accompanied the first-time mother to a late-afternoon visit on January 9 with her OB-GYN, Gwen Allen, who told them Valentine was dilated and that she would meet them at the hospital. Valentine went to Centinela Hospital Medical Center, owned by Prime Healthcare, one of the country’s largest for-profit health systems.

Cordova and Valentine’s partner, Nigha Robertson, were both with her throughout her stay. They said she got to the hospital around 8:30 p.m. While being admitted, Valentine was asked several questions by staff that made her feel uncomfortable, including if she knew who her baby’s father was and what type of housing her baby would live in, they said. Robertson said he doubts white mothers are asked these questions as often. Centinela responded in a statement that every patient is asked these questions to identify any nonmedical factors that could affect their health, so it can provide any necessary resources. Nurses then forbade her doula from attending her delivery, despite the hospital’s approval a month earlier, Robertson and Cordova added. The hospital said it welcomes doulas.

After receiving an epidural five hours later, Valentine reported leg numbness and, later, swelling, they said. Cordova and Robertson estimated that they witnessed Valentine ask nurses to examine her leg and call her doctor at least 10 times. Each time, they said, the nurses declined, saying her symptoms were normal.

“Every time they came to check on her, she would say, ‘Hey, can you look at my leg?’” said Cordova. “The nurse didn’t even lift up the blanket to check.”

Cordova and Robertson said nurses repeatedly told them they couldn’t call Valentine’s OB-GYN because she would get upset. They said Allen did not visit her until 4 p.m. the next day and did not address her concerns.

Two hours later, Cordova and Robertson said, Valentine coughed and vomited. A nurse told them this was normal. Then Valentine stopped breathing. Robertson and Cordova said the nurse in the room froze, so Robertson stepped in and gave Valentine CPR for about five minutes until additional staff, then Allen, arrived. They said her providers did not try to revive her before she was wheeled away. Centinela refuted these allegations but said it could not comment further.

Aniya was delivered via emergency cesarean section from her mother’s body.

No Track Record of Finding Discrimination

The state’s public health department and medical board would not comment on the details of Valentine’s case.

The California Department of Public Health is “deeply saddened” by what happened to Valentine and her family and takes “every action within its legal authority to safeguard patients,” including thoroughly investigating complaints, said spokesperson Ali Bay in a statement.

Asked how it evaluates the possibility of discrimination, the public health department sidestepped and said its role is to determine if any federal or state regulations were violated, and later added that hospitals must follow regulations that allow patients to exercise their rights without regard to race. It provided KFF Health News a copy of a letter dated Feb. 23 from Mark Ghaly, secretary of the California Health and Human Services Agency, to the Los Angeles County Board of Supervisors. Ghaly declined to be interviewed.

In the letter, he said the state would review medical records, interview medical staff, and assess the hospital’s policies and procedures in its investigation.

But the public health department’s track record shows it hasn’t substantiated a discrimination complaint yet. Statewide, the department has not found any violations of regulations protecting patients against discrimination since 2007, Bay said. She said the department found over 650 complaints that mention racism, discrimination, or both in all available records since 2007. It receives an average of around 45,000 total complaints and reported incidents across all facility types every year.

The medical board also hasn’t substantiated discrimination complaints against physicians. Since 2014, it has not found that a physician discriminated against a patient in any of the over 240 complaints it has closed, said Aaron Bone, the board’s chief of legislation and public affairs. He cautioned against drawing conclusions from a small sample; the agency received approximately 10,000 complaints of all types in 2020 alone.

Both agencies’ figures have limitations. The medical board tracks only discrimination resulting in a doctor’s refusal to treat. And neither agency knows exactly how many discrimination complaints were race-based.

The exact reasons for their limited track records are unclear, but some experts point to the high burden of proof for substantiating these cases.

Abbi Coursolle, a senior attorney at the National Health Law Program, said anti-discrimination laws and regulations can be hard to enforce. They are intended to protect people from intentional discrimination and policies or actions that disproportionately harm them. But people can unconsciously harbor biases, or there could be alternative explanations for ignoring a patient, such as a provider being busy, which can make discrimination hard to substantiate.

Racism “is complicated and hard to isolate, but the law hasn’t quite caught up to that,” she said.

State agencies, she added, can interpret the law so narrowly that people can’t take advantage of these protections.

The California agencies said they do their best within their legal authority. The medical board blamed current law, which, it said, requires “clear and convincing evidence” to discipline a physician, and it can be challenging to substantiate cases if the allegations aren’t documented or aren’t corroborated by witnesses. There may not always be sufficient evidence to find a violation, said Bay, of the public health department.

Smith, the former public health department director, said discrimination by a facility is typically hard to find unless investigators identify a pattern, but that type of research can be labor-intensive and hampered by underreporting of complaints.

So far, the public health department has imposed a $75,000 fine for risking Valentine’s health and safety. In his letter, Ghaly said the state could revoke or suspend the hospital’s license if it finds Centinela violated state or federal regulations. It could also refer the case to other agencies. The federal Department of Health and Human Services’ Office for Civil Rights acknowledged it is investigating Valentine’s case but declined to comment.

Centinela’s fine is the exception, not the rule. Last year, roughly 100 fines were levied against hospitals statewide out of nearly 12,000 complaints and incidents closed, according to a state database. The department cautioned that the data contains many redundant complaints and noted that not all violations require issuing fines. It declined to provide aggregated data on corrective actions, such as improvement plans, and nonfinancial penalties, such as license suspensions.

Evidence is mixed on whether financial penalties improve hospital care, illustrating how regulators’ hands may be tied.

‘Thoughts and Prayers’

The state public health department conducted an inspection of Centinela in February. It found the hospital failed to properly assess an unnamed labor and delivery patient’s risk for clotting and failed to notify her physician when she reported “leg heaviness” and when her vital signs were abnormal. Though the inspection, first reported by the Los Angeles Times, does not name Valentine, it describes the account her partner and family shared, including the date she was admitted to the hospital.

In its report, the department deemed the situation “immediate jeopardy,” meaning the hospital’s failure to meet requirements caused or could have caused death or serious injury. But regulators removed that label after the hospital submitted an improvement plan. Among other measures, it promised to reeducate nurses on how to prevent blood clots.

The report found Centinela made similar missteps with other patients, potentially increasing their risk for developing blood clots in deep veins, typically in the leg, which, when untreated, can travel to the lungs. Known as a pulmonary embolism, this condition is one of the most common causes of pregnancy-related deaths in the United States, and is preventable and treatable if discovered early, according to the Centers for Disease Control and Prevention. It was also the official cause of Valentine’s death, stated the Los Angeles County medical examiner’s website.

Centinela said it immediately addressed the inspection’s findings. Sue Lowe, a Centinela spokesperson, said it was the hospital, not the state, that decided to close its maternity and newborn units, “to create capacity for services of greatest benefit and need for patients.”

Robertson, Valentine’s partner, said he felt the report validated his account.

“They killed her,” said Robertson, who has retained an attorney. For him, justice would mean a punishment severe enough to ensure Valentine’s situation never happens again, but he wants Centinela to remain in business since it’s the only hospital in Inglewood.

Lowe said the hospital could not discuss specifics due to patient privacy laws but extended the hospital’s “thoughts and prayers” to Valentine’s family. She added, “We express our deepest condolences.”

Before the results of the state’s inspection report and the county’s autopsy report were publicized, Centinela implied the death was unpreventable. “Despite the highest standards of care,” said Lowe, “there are certain medically complex and emergent situations that cannot be overcome.” Centinela declined to comment on the autopsy results.

Lowe defended the hospital’s track record, noting it has won national awards for quality and patient safety. She said it had gone a decade without a maternal death in labor and delivery before Valentine’s. She also said the unit was appropriately staffed.

In 2020, the hospital registered 1.8 times the number of complaints and incidents as the state average. So far this year, it’s 9.5 times as many. Lowe responded that the state hasn’t substantiated many of these and that, in some recent years, the hospital had fewer total violations than the state average for hospitals of its size.

The hospital, Lowe said, maintains “robust policies prohibiting discrimination” and requires diversity and implicit bias training for staff. “Our staff reflects the community that we serve,” she added.

Allen, the OB-GYN, directed questions to her attorney, Ludlow B. Creary II, who said his client could not comment on the case, citing patient privacy protections. But he urged against drawing conclusions without both sides of the story and a medical expert’s assessment of whether Allen caused Valentine’s death. Allen, like the community she has served for 20 years, is Black, he added.

Doctors Oppose More Oversight

Mack, Valentine’s cousin, said Valentine’s providers being largely Black did not sway her view that they could have discriminated against her. She said she hopes the state evaluates whether interpersonal or systemic racism, or both, contributed to Valentine’s death. Did her clinicians dismiss her complaints due to bias, and did the hospital, located in a minority neighborhood, provide lower-quality care?

Both types of racism can be hard to see. The numbers, however, show they exist. Studies suggest Black mothers are more likely than white ones to report being ignored or mistreated by clinicians and to deliver at hospitals with lower-quality care.

The public health department considers how discrimination and systemic racism could have contributed to a maternal death in a quality improvement process known as the California Pregnancy-Associated Mortality Review. But this committee lacks authority to discipline hospitals or clinicians.

Attempts to reform laws often face resistance. Last year, the medical board asked the state to lower the burden of proof for disciplining physicians from “clear and convincing” to a standard equivalent to “more likely than not,” followed by most states. A bill including this request recently passed the California State Senate and is pending in the Assembly.

The California Medical Association, which represents physicians, opposes the bill, unless amended. “Clear and convincing” is the standard for disciplining professional license-holders in California, spokesperson Shannan Velayas said.

In Inglewood, a world away from bureaucrats and lobbyists, Robertson grieves and struggles as a single father. His job in crime scene and disaster cleanup can require long and unpredictable hours. He was recently called in to work at 2 in the morning, leaving him scrambling to get ahold of Aniya’s godmother to come watch her.

“It’s overwhelming, just all this juggling,” he said.

In periods of calm, father and daughter bond over picture books Valentine bought and go to the park with their dog. Robertson said Aniya, now over 6 months old and sitting up, is deeply loved.

Still, there’s a void that will only grow as Aniya gets older. He can’t style her hair the way Valentine would have and worries that he won’t be able to support her like a mother would when Aniya becomes a young woman.

“I don’t want nobody else to have to go through this hurt and pain,” Robertson said.

When told the state rarely finds discrimination, he paused, recognizing a gap in accountability. He said, “The government pick and choose which situations that they press the issue on.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

By: Sarah Kwon
Title: Amid Lack of Accountability for Bias in Maternity Care, a California Family Seeks Justice
Sourced From: kffhealthnews.org/news/article/maternity-care-bias-accountability-april-valentine/
Published Date: Tue, 08 Aug 2023 09:00:00 +0000

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Kaiser Health News

Push To Move OB-GYN Exam Out of Texas Is Piece of AGs’ Broader Reproductive Rights Campaign

Published

3 days ago

June 24, 2025

Staff Editor

kffhealthnews.org – Annie Sciacca – 2025-06-24 04:00:00

Annie Sciacca

June 24, 2025

Democratic state attorneys general led by those from California, New York, and Massachusetts are pressuring medical professional groups to defend reproductive rights, including medication abortion, emergency abortions, and travel between states for health care in response to recent increases in the number of abortion bans.

The American Medical Association adopted a formal position June 9 recommending that medical certification exams be moved out of states with restrictive abortion policies or made virtual, after 20 attorneys general petitioned to protect physicians who fear legal repercussions because of their work. The petition focused on the American Board of Obstetrics and Gynecology’s certification exams in Dallas, and the subsequent AMA recommendation was hailed as a win for Democrats trying to regain ground after the fall of Roe v. Wade.

“It seems incremental, but there are so many things that go into expanding and maintaining access to care,” said Arneta Rogers, executive director of the Center on Reproductive Rights and Justice at the University of California-Berkeley’s law school. “We see AGs banding together, governors banding together, as advocates work on the ground. That feels somewhat more hopeful — that people are thinking about a coordinated strategy.”

Since the Supreme Court eliminated the constitutional right to an abortion in 2022, 16 states, including Texas, have implemented laws banning abortion almost entirely, and many of them impose criminal penalties on providers as well as options to sue doctors. More than 25 states restrict access to gender-affirming care for trans people, and six of them make it a felony to provide such care to youth.

That’s raised concern among some physicians who fear being charged if they go to those states, even if their home state offers protection to provide reproductive and gender-affirming health care.

Pointing to the recent fining and indictment of a physician in New York who allegedly provided abortion pills to a woman in Texas and a teen in Louisiana, a coalition of physicians wrote in a letter to the American Board of Obstetrics and Gynecology that “the limits of shield laws are tenuous” and that “Texas laws can affect physicians practicing outside of the state as well.”

The campaign was launched by several Democratic attorneys general, including Rob Bonta of California, Andrea Joy Campbell of Massachusetts, and Letitia James of New York, who each have established a reproductive rights unit as a bulwark for their state following the Dobbs decision.

“Reproductive health care and gender-affirming care providers should not have to risk their safety or freedom just to advance in their medical careers,” James said in a statement. “Forcing providers to travel to states that have declared war on reproductive freedom and LGBTQ+ rights is as unnecessary as it is dangerous.”

In their petition, the attorneys general included a letter from Joseph Ottolenghi, medical director at Choices Women’s Medical Center in New York City, who was denied his request to take the test remotely or outside of Texas. To be certified by the American Board of Obstetrics and Gynecology, physicians need to take the in-person exam at its testing facility in Dallas. The board completed construction of its new testing facility last year.

“As a New York practitioner, I have made every effort not to violate any other state’s laws, but the outer contours of these draconian laws have not been tested or clarified by the courts,” Ottolenghi wrote.

Rachel Rebouché, the dean of Temple University’s law school and a reproductive law scholar, said “putting the heft” of the attorneys general behind this effort helps build awareness and a “public reckoning” on behalf of providers. Separately, some doctors have urged medical conferences to boycott states with abortion bans.

Anti-abortion groups, however, see the campaign as forcing providers to conform to abortion-rights views. Donna Harrison, an OB-GYN and the director of research at the American Association of Pro-Life Obstetricians and Gynecologists, described the petition as an “attack not only on pro-life states but also on life-affirming medical professionals.”

Harrison said the “OB-GYN community consists of physicians with values that are as diverse as our nation’s state abortion laws,” and that this diversity “fosters a medical environment of debate and rigorous thought leading to advancements that ultimately serve our patients.”

The AMA’s new policy urges specialty medical boards to host exams in states without restrictive abortion laws, offer the tests remotely, or provide exemptions for physicians. However, the decision to implement any changes to the administration of these exams is up to those boards. There is no deadline for a decision to be made.

The OB-GYN board did not respond to requests for comment, but after the public petition from the attorneys general criticizing it for refusing exam accommodations, the board said that in-person exams conducted at its national center in Dallas “provide the most equitable, fair, secure, and standardized assessment.”

The OB-GYN board emphasized that Texas’ laws apply to doctors licensed in Texas and to medical care within Texas, specifically. And it noted that its exam dates are kept under wraps, and that there have been “no incidents of harm to candidates or examiners across thousands of in-person examinations.”

Democratic state prosecutors, however, warned in their petition that the “web of confusing and punitive state-based restrictions creates a legal minefield for medical providers.” Texas is among the states that have banned doctors from providing gender-affirming care to transgender youth, and it has reportedly made efforts to get records from medical facilities and professionals in other states who may have provided that type of care to Texans.

The Texas attorney general’s office did not respond to requests for comment.

States such as California and New York have laws to block doctors from being extradited under other states’ laws and to prevent sharing evidence against them. But instances that require leveraging these laws could still mean lengthy legal proceedings.

“We live in a moment where we’ve seen actions by executive bodies that don’t necessarily square with what we thought the rules provided,” Rebouché said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

The post Push To Move OB-GYN Exam Out of Texas Is Piece of AGs’ Broader Reproductive Rights Campaign appeared first on kffhealthnews.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The article presents a viewpoint largely aligned with progressive and Democratic positions on reproductive rights and gender-affirming care. It highlights efforts led by Democratic attorneys general and the American Medical Association to protect abortion access and transgender healthcare amid restrictive state laws, portraying these actions positively. While it includes perspectives from anti-abortion advocates, their views are presented briefly and framed as opposition to the broader pro-choice initiatives. The overall tone and framing emphasize support for reproductive freedom and healthcare protections, reflecting a center-left leaning stance typical of mainstream health policy reporting sympathetic to Democratic policy goals.

Kaiser Health News

Federal Proposals Threaten Provider Taxes, Key Source of Medicaid Funding for States

Published

3 days ago

June 23, 2025

Staff Editor

kffhealthnews.org – Bernard J. Wolfson – 2025-06-23 04:00:00

Bernard J. Wolfson

June 23, 2025

Republican efforts to restrict taxes on hospitals, health plans, and other providers that states use to help fund their Medicaid programs could strip them of tens of billions of dollars. The move could shrink access to health care for some of the nation’s poorest and most vulnerable people, warn analysts, patient advocates, and Democratic political leaders.

No state has more to lose than California, whose Medicaid program, called Medi-Cal, covers nearly 15 million residents with low incomes and disabilities. That’s twice as many as New York and three times as many as Texas.

A proposed rule by the Centers for Medicare & Medicaid Services, echoed in the Republican House reconciliation bill as well as a more drastic Senate bill, would significantly curtail the federal dollars many states draw in matching funds from what are known as provider taxes. Although it’s unclear how much states could lose, the revenue up for grabs is big. For instance, California has netted an estimated $8.8 billion this fiscal year from its tax on managed care plans and took in about $5.9 billion last year from hospitals.

California Democrats are already facing a $12 billion deficit, and they have drawn political fire for scaling back some key health care policies, including full Medi-Cal coverage for immigrants without permanent legal status. And a loss of provider tax revenue could add billions to the current deficit, forcing state lawmakers to make even more unpopular cuts to Medi-Cal benefits.

“If Republicans move this extreme MAGA proposal forward, millions will lose coverage, hospitals will close, and safety nets could collapse under the weight,” Gov. Gavin Newsom, a Democrat, said in a statement, referring to President Donald Trump’s “Make America Great Again” movement.

The proposals are also a threat to Proposition 35, a ballot initiative California voters approved last November to make permanent the tax on managed care organizations, or MCOs, and dedicate some of its proceeds to raise the pay of doctors and other providers who treat Medi-Cal patients.

All states except Alaska have at least one provider tax on managed care plans, hospitals, nursing homes, emergency ground transportation, or other types of health care businesses. The federal government spends billions of dollars a year matching these taxes, which generally lead to more money for providers, helping them balance lower Medicaid reimbursement rates while allowing states to protect against economic downturns and budget constraints.

New York, Massachusetts, and Michigan would also be among the states hit hard by Republicans’ drive to scale back provider taxes, which allow states to boost their share of Medicaid spending to receive increased federal Medicaid funds.

In a May 12 statement announcing its proposed rule, CMS described a “loophole” as “money laundering,” and said California had financed coverage for over 1.6 million “illegal immigrants” with the proceeds from its MCO tax. CMS said its proposal would save more than $30 billion over five years.

“This proposed rule stops the shell game and ensures federal Medicaid dollars go where they’re needed most — to pay for health care for vulnerable Americans who rely on this program, not to plug state budget holes or bankroll benefits for noncitizens,” Mehmet Oz, the CMS administrator, said in the statement.

Medicaid allows coverage for noncitizens who are legally present and have been in the country for at least five years. And California uses state money to pay for almost all of the Medi-Cal coverage for immigrants who are not in the country legally.

California, New York, Michigan, and Massachusetts together account for more than 95% of the “federal taxpayer losses” from the loophole in provider taxes, CMS said. But nearly every state would feel some impact, especially under the provisions in the reconciliation bill, which are more restrictive than the CMS proposal.

None of it is a done deal. The CMS proposal, published May 15, has not been adopted yet, while the House and Senate bills must be negotiated into one and passed by both chambers of Congress. But the restrictions being contemplated would be far-reaching.

A report by Michigan’s Department of Health and Human Services, ordered by Democratic Gov. Gretchen Whitmer, found that a reduction of revenue from the state’s hospital tax could “destabilize hospital finances, particularly in rural and safety-net facilities, and increase the risk of service cuts or closures.” Losing revenue from the state’s MCO tax “would likely require substantial cuts, tax increases, or reductions in coverage and access to care,” it said.

CMS declined to respond to questions about its proposed rule.

The Republicans’ House-passed reconciliation bill, though not the CMS proposal, also prohibits any new provider taxes or increases to existing ones. The Senate version, released June 16, would gradually reduce the allowable amount of many provider taxes.

The American Hospital Association, which represents nearly 5,000 hospitals and health systems nationwide, said the proposed moratorium on new or increased provider taxes could force states “to make significant cuts to Medicaid to balance their budgets, including reducing eligibility, eliminating or limiting benefits, and reducing already low payment rates for providers.”

Because provider taxes draw matching federal dollars, Washington has a say in how they are implemented. And the Republicans who run the federal government are looking to spend far fewer of those dollars.

In California, the insurers that pay the MCO tax are reimbursed for the portion levied on their Medi-Cal enrollment. That helps explain why the tax rate on Medi-Cal enrollment is sharply higher than on commercial enrollment. Over 99% of the tax money the insurers pay comes from their Medi-Cal business, which means most of the state’s insurers get back almost all the tax they pay.

That imbalance, which CMS describes as a loophole, is one of the main things Republicans are trying to change. If either the CMS rule or the corresponding provisions in the House reconciliation bill were enacted, states would be required to levy provider taxes equally on Medicaid and commercial business to draw federal dollars.

California would likely be unable to raise the commercial rates to the level of the Medi-Cal ones, because state law constrains the legislature’s ability to do so. The only way to comply with the rule would be to lower the tax rate on Medi-Cal enrollment, which would sharply reduce revenue.

CMS has warned California and other states for years, including under the Biden administration, that it was considering significant changes to MCO and other provider taxes. Those warnings were never realized. But the risk may be greater this time, some observers say, because the effort to shrink provider taxes is embedded in both Republican reconciliation bills and intertwined with a broader Republican strategy — and set of proposals — to cut Medicaid spending by $800 billion or more.

“All of these proposals move in the same direction: fewer people enrolled, less generous Medicaid programs over time,” said Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy.

California’s MCO tax is expected to net California $13.9 billion over the next two fiscal years, according to January estimates. The state’s hospital tax is expected to bring in an estimated $9 billion this year, up sharply from last year, according to the Department of Health Care Services, which runs Medi-Cal.

Losing a significant slice of that revenue on top of other Medicaid cuts in the House reconciliation bill “all adds up to be potentially a super serious impact on Medi-Cal and the California state budget overall,” said Kayla Kitson, a senior policy fellow at the California Budget & Policy Center.

And it’s not only California that will feel the pain.

“All states are going to be hurt by this,” Park said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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This story can be republished for free (details).

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

The post Federal Proposals Threaten Provider Taxes, Key Source of Medicaid Funding for States appeared first on kffhealthnews.org

Political Bias Rating: Center-Left

This article critically examines Republican proposals to limit provider taxes that fund Medicaid, emphasizing the potential negative impacts on vulnerable populations and state budgets, particularly in Democratic-led states like California. It highlights Democratic leaders’ concerns and quotes Democratic officials, framing the Republican efforts as harmful cuts. While it presents some Republican perspectives and justifications, the overall tone and focus favor a viewpoint aligned with expanding and protecting Medicaid funding, reflecting a center-left bias.

Kaiser Health News

Trump Team’s Reworking Delays Billions in Broadband Build-Out

Published

7 days ago

June 20, 2025

Staff Editor

kffhealthnews.org – Sarah Jane Tribble, KFF Health News – 2025-06-20 04:00:00

Sarah Jane Tribble, KFF Health News

Updated June 20, 2025

Originally Published June 20, 2025

Millions of Americans who have waited decades for fast internet connections will keep waiting after the Trump administration threw a $42 billion high-speed internet program into disarray.

The Commerce Department, which runs the massive Broadband Equity, Access, and Deployment Program, announced new rules in early June requiring states — some of which were ready to begin construction later this year — to solicit new bids from internet service providers.

The delay leaves millions of rural Americans stranded in places where health care is hard to access and telehealth is out of reach.

“This does monumental harm to rural America,” said Christopher Ali, a professor of telecommunications at Penn State.

The Biden-era program, known as BEAD, was hailed when created in 2021 as a national plan to bring fast internet to all, including millions in remote rural areas.

A yearlong KFF Health News investigation, with partner Gray Media’s InvestigateTV, found nearly 3 million people live in mostly rural counties that lack broadband as well as primary care and behavioral health care providers. In those same places, the analysis found, people live sicker and die earlier on average.

The program adopts a technology-neutral approach to “guarantee that American taxpayers obtain the greatest return on their broadband investment,” according to the June policy notice. The program previously prioritized the use of fiber-optic cable lines, but broadband experts like Ali said the new focus will make it easier for satellite-internet providers such as Elon Musk’s Starlink and Amazon’s Kuiper to win federal funds.

“We are going to connect rural America with technologies that cannot possibly meet the needs of the next generation of digital users,” Ali said. “They’re going to be missing out.”

Republicans have criticized BEAD for taking too long, and Commerce Secretary Howard Lutnick vowed in March to get rid of its “woke mandates.” The revamped “Benefit of the Bargain BEAD Program,” which was released with a fact sheet titled “Ending Biden’s Broadband Burdens,” includes eliminating some labor and employment requirements and obligations to perform climate analyses on projects.

The requirement for states to do a new round of bidding with internet service providers makes it unclear whether states will be able to connect high-speed internet to all homes, said Drew Garner, director of policy engagement at the Benton Institute for Broadband & Society.

Garner said the changes have caused “pure chaos” in state broadband offices. More than half the states have been knocked off their original timeline to deliver broadband to homes, he said.

The change also makes the program more competitive for satellite companies and wireless providers such as Verizon and T-Mobile, Garner said.

Garner analyzed in March what the possible increase in low-Earth-orbit satellites would mean for rural America. He found that fiber networks are generally more expensive to build but that satellites are more costly to maintain and “much more expensive” to consumers.

Commerce Secretary Lutnick said in a June release that the new direction of the program would be efficient and deliver high-speed internet “at the right price.” The National Telecommunications and Information Administration, the Commerce Department agency overseeing BEAD, declined to release a specific amount it hopes to save with the restructuring.

The NTIA also declined to respond on the record to questions about program revisions and delays.

More than 40 states had already begun selecting companies to provide high-speed internet and fill in gaps in underserved areas, according to an agency dashboard created to track state progress.

In late May, the website was altered and columns showing the states that had completed their work with federal regulators disappeared. Three states — Delaware, Louisiana, and Nevada — had reached the finish line and were waiting for the federal government to distribute funding.

The tracker, which KFF Health News saved in March, details the steps each state made in their years-long efforts to create location-based maps and bring high-speed internet to those missing service. West Virginia had completed selection of internet service providers and a leaked draft of its proposed plan shows the state was set to provide fiber connections to all homes and businesses.

Sen. Shelley Moore Capito (R-W.Va.) praised removal of some of the hurdles that delayed implementation and said she thought her state would not have to make very many changes to existing plans during a call with West Virginia reporters.

West Virginia’s broadband council has worked aggressively to expand in a state where 25% of counties lack high-speed internet and health providers, according to KFF Health News’ analysis.

In Lincoln County, West Virginia, Gary Vance owns 21 acres atop a steep ridge that has no internet connection. Vance, who sat in his yard enjoying the sun on a recent day, said he doesn’t want to wait any longer.

Vance said he has various medical conditions: high blood sugar, deteriorating bones, lung problems — “all kinds of crap.” He’s worried about his family’s inability to make a phone call or connect to the internet.

“You can’t call nobody to get out if something happens,” said Vance, who also lacks running water.

KFF Health News, using data from federal and academic sources, found more than 200 counties — with large swaths in the South, Appalachia, and the remote West — lack high-speed internet, behavioral health providers, and primary care doctors who serve low-income patients on Medicaid. On average, residents in those counties experienced higher rates of diabetes, obesity, chronically high blood pressure, and cardiovascular disease.

The gaps in telephone and internet services didn’t cause the higher rates of illness, but Ali said it does not help either.

Ali, who traveled rural America for his book “Farm Fresh Broadband: The Politics of Rural Connectivity,” said telehealth, education, banking, and the use of artificial intelligence all require fast download and upload speeds that cannot always be guaranteed with satellite or wireless technology.

It’s “the politics of good enough,” Ali said. “And that is always how we’ve treated rural America.”

Fiber-optic cables, installed underground or on poles, consistently provide broadband speeds that meet the Federal Communications Commission’s requirements for broadband download speed of 100 megabits per second and 20 Mbps upload speed. By contrast, a national speed analysis, performed by Ookla, a private research and analytics company, found that only 17.4% of Starlink satellite internet users nationwide consistently get those minimum speeds. The report also noted Starlink’s speeds were rising nationwide in the first three months of 2025.

In March, West Virginia’s Republican governor, Patrick Morrisey, announced plans to collaborate with the Trump administration on the new requirements.

Republican state Del. Dan Linville, who has been working with Morrisey’s office, said his goal is to eventually get fiber everywhere but said other opportunities could be available to get internet faster.

In May, the West Virginia Broadband Enhancement Council signaled it preferred fiber-optic cables to satellite for its residents and signed a unanimous resolution that noted “fiber connections offer the benefits of faster internet speeds, enhanced data security, and the increased reliability that is necessary to promote economic development and support emerging technologies.”

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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Political Bias Rating: Center-Left

This article adopts a generally critical stance toward the Trump administration’s handling of the broadband program, emphasizing delays and negative consequences for rural communities. It highlights concerns from experts and advocates for fiber-optic technology, portraying the Biden-era BEAD program positively while critiquing the Trump-era restructuring as harmful to rural Americans. The tone and framing focus on social equity and government responsibility to underserved areas, which align with Center-Left perspectives prioritizing infrastructure investment and rural access. However, the article also presents viewpoints from Republican officials and notes bipartisan concerns, maintaining a level of balance overall.