By Dianne Anderson

If people aren’t sticker-shocked already, there’s a big surprise in the coming weeks.

Up to two to three times as much money is now needed to cover healthcare, a hard hit especially for older adults age 50 to 64, who tend to have more health issues while struggling to pay the rent and food.

It has top healthcare leaders worried about how their systems can meet increased need, survive steep cuts and keep the doors open.

Dr. Jason Lohr, CEO of SAC Health, said he has seen a serious drop in patients with Covered California since January 1, losing hundreds due to rising costs they can’t afford.

Many missed deadlines or are not aware of the premium increases, and risk losing coverage.

“And they don’t know how it impacts them until they actually go online or get a bill and get a phone call and are told what their new cost is,” he said. “They hear on the news, but are not sure how it will impact them until they see that cost in a bill or coming in the mail.”

He expects emergency rooms to be overwhelmed because chronic conditions will not disappear as access to service and coverage becomes unavailable.

Patients unable to afford medicine or a hospital visit will look for doctors with no upfront costs, but someone must pay. He said the new policies only shifts costs from the government to the patients, and hospitals and clinics.

For now, he encourages the community to check out the Community Health Association’s network of local clinics at CHAISR.org for affordable care as more of these access points emerge across the region

“If they use these safety net clinics, the doctors, we can tell them whether they need a higher level of care, instead of having to worry about it. Come to us first,” Lohr said.

The problem is how the funding shortfall is shifting much of the financial burden from the government to clinics, hospitals, and patients.

“We’re going to feel that burden, but we will still do the right thing. We’ll still see the patients. Just like the emergency room, we do not turn patients away for inability to pay. [The challenge is] how are we going to survive financially as we have these challenges?”

Patients with serious conditions, like cancer, also face lost coverage.

Ongoing care, including oncology treatments and expensive medications, can cost tens or even hundreds of thousands of dollars, which he said is far beyond what safety-net clinics or emergency rooms can provide.

“What does a person do when they lose coverage when they have something like cancer? A safety clinic will not be able to provide therapy. Emergency room cannot provide therapy,” he said.

Shifting costs to patients and healthcare systems also threatens long-term access in other ways.

He said financial strain is pushing rural hospitals to the brink, with several in the region already scaling back services or facing closure.

“We’re seeing that in Blythe near the Arizona border, the local hospital is literally very close to shutting down. They’re in their final days. They had to close multiple services in the hospital because of costs, and it’s only a matter of time,” he said.

Last week, the House voted 230–196 to extend enhanced subsidies under President Obama’s Affordable Care Act to help keep services in place for three more years so health insurance costs wouldn’t double.

Even so, that bill is not likely to pass the Republican-controlled Senate.

Right now, new work rules under H.R. 1 Trump’s “One Big Beautiful Bill” are rolling out, requiring six-month eligibility checks and cuts to retroactive coverage, meaning people only receive benefits for the past 30 days instead of three months.

In California, about 3.4 million people are at risk, and 400,000 could lose Medi-Cal because they can’t keep up with the paperwork, like proof of income, pay stubs or tax forms.

Seniors and others could see their costs soar.

Dr. Jarrod McNaughton, CEO of IEHP said disenrollment is already affecting Medi-Cal, the dual-eligible program for those on both Medicare and Medi-Cal, and Covered California.

“For us, this month alone at IEHP we’ve lost 50,000 members and it’s not even halfway through the month,” he said. “Today I was in contact with a lot of my peers across the state. All are local health plans like us. All of them are seeing a decrease in membership.”

Other than emergency rooms, it means they won’t have access to coverage or doctors. He said it is scary for the entire community.

“There’s one door to the emergency room, and all of us have to use it,” he said. “If you start to see a lot of primary care visits or preventative care going to the emergency room, it can create a strain on the system [for people] that have real emergencies like stroke or heart attack.”

After the pandemic, the Affordable Care Act provided a safety net with programs that are no longer available, and no fallback.

“It’s really concerning that so much of that is now gone. I’m very worried for our community for sure,” he said.

It is a hard hit and takes a lot of resources, but he said his team at IEHP has stepped up their wellness centers in Riverside, Victorville, and San Bernardino to sustain weekly mobile clinics, where members can access things like mammograms and well-child visits for free.

He also wants the community to check out the Community Health Association, an association made up of all the federally qualified health centers (FQHCs) in the IE, which provides free quality care.

More access points are popping up, but services have limits, but hospital closures remain a big risk

“It is worrisome after seeing the number of disenrollments happening in this program,” he said. “We certainly try to do everything we can to support them,” he said, adding that they are sending out text messages, mailers, digital ads, updated web pages, to guide people and prevent lapses in coverage.

Most of all, he said don’t ignore the mailman when he comes.

“The key is that when they get that envelope in the mail, they act on it right away. We also have a couple of upcoming webinars on YouTube, IEHP Healthcare, that will walk folks through some of that.”

For San Bernardino County, Francis Delapaz said they are expanding partnerships with health plans and community agencies to get care for high-risk populations, using alternative care delivery models in the community.

“The county operates several healthcare facilities, including Arrowhead Regional Medical Center, its Primary Care Clinic, Family Health Centers, Mobile Clinics, and specialty care clinics,” said Delapaz, spokesperson for the Department of Public Health.

He said they are exploring opportunities to engage and partner with communities around patient needs, like enrollment assistance.

For the year ahead, he sees the county’s urgent priorities for the year include managing chronic disease and addressing clinical workforce shortages

“While the county is not yet seeing a significant change in the Medicare population, Delapaz emphasized that all residents can seek care at the Department of Public Health’s Federally Qualified Health Centers and community clinics. “Programs like Medi-Cal eligibility assistance and Enhanced Care Management (ECM) agreements with health plans like IEHP ensure continuity of care for our most vulnerable populations,” he said.