The country is waiting to see the final version of Donald Trump’s “big, beautiful bill,” which was being worked on by the U.S. Senate in the reconciliation process as of this writing.
All variations of the package include major federal funding cuts that could eliminate health insurance for millions of Americans, including more than 650,000 current Medi-Cal recipients in Riverside and San Bernardino counties. It could remove critical funding for health-care providers, as well as dollars for critical medical research.
As a result, people are scared. Doctors, health-care administrators and, particularly, lower-income patients are concerned and anxious. Many in the health-care sector, in fact, are so unnerved that they have gone incommunicado, declining to speak to the media about the federal funding cuts and their possible ramifications.
One local provider who did speak to the Independent got cold feet, and called just before this story’s deadline, pleading for us to remove his input—because of a fear of federal retaliation. (We removed the comments, because we did not want to lose the provider as a source.)
One exception came from the California Hospital Association’s president and CEO, Carmela Coyle. Her public statement, issued on May 12, and provided to the Independent by the CHA, stated unequivocally: “The legislation proposed by the House Energy and Commerce Committee to enact massive Medicaid cuts is a devastating blow that will be felt by all who need hospital care. … Cuts of this magnitude cannot be absorbed. Hospitals will have no other choice but to reduce patient-care services or, in the worst cases, close entirely. That means care is lost for everyone—children, seniors, privately insured people—no matter what type of health insurance coverage you have. These cuts will further damage an already fragile economy. … Hospitals are often among the largest employers in a community.
“Reducing services and closing hospitals will mean the loss of thousands of well-paying jobs across our state,” Coyle continued. “… Congress must revisit budget priorities. Limiting access to health care is not an acceptable outcome. Hospitals are committed to our patients, our employees and our communities and will continue engaging with federal lawmakers—making sure that every elected official understands how Medicaid cuts will hurt everyone.”
Five of the seven health-care provider organizations and industry associations we contacted—Kaiser Permanente, the Desert Care Network, Eisenhower Health, Coachella Valley Volunteers in Medicine, and Innercare—either did not respond to interview requests, or told us they were unwilling to speak on the record with the Independent about the damage that could be done.
Only two were willing to speak to us.
One of those two was CJ Tobe, the chief transformation officer at DAP Health; the organization is a provider of “comprehensive health care and support services where all people are seen, heard, and affirmed,” according to its website.
“We’re (still) in the process of trying to get more clarity on exactly what those cuts will look like … and what that impact will be,” Tobe said. “For DAP Health, we could be looking at losing close to a million dollars in HIV prevention funding. … I think one (threat) that’s unrecognized is the cuts to Housing Opportunities for People with AIDS (HOPWA) funding, which is for housing folks who are living with HIV. We know that if you don’t have a roof over your head and food on the table, nothing else in life is really going to matter. We’re looking at that very seriously, because we have hundreds of patients who are living with HIV who currently receive HOPWA support, whether it’s for rent assistance to live somewhere, or even if it’s to live on one of our DAP campuses, where we have housing structures for patients.”
Tobe explained some additional threats within the contents of the “big, beautiful bill” reconciliation package.
“There’s a federal pharmaceutical program called 340B,” Tobe said, “and it provides revenue that comes through organizations (to defray pharmaceutical costs for patients). When patients have a doctor prescribe a medication, and they pick it up from the pharmacy, there is revenue that comes back to the prescribing organization. What these cuts will do is eliminate some of these grants that have connected some of these smaller organizations to obtain that 340B revenue. … We (at DAP Health) will be fine, however, and not affected by this issue at this time.”
Numerous services that DAP Health provides to its larger patient community are also threatened by the proposed cuts.
“If it’s mandated that we cannot provide gender-affirming care, we need to have contingency plans in place so that our 1,000 trans and non-binary patients … still have access to the care that they deserve, and that they need.”
CJ Tobe, chief transformation officer at DAP Health
“We’re talking about anybody who may be coming in for HIV tests, and people who are trying to get on PrEP (the medication taken to prevent HIV),” Tobe said. “… Outside of the HIV-prevention funding side, there have been different executive orders that have not been made into law, such as recognizing male and female (gender identities) only, invading gender-affirming care services and also the elimination of DEI for anything that we do. We have patients who probably, if we were to guess, are not U.S. citizens, who are receiving care as well.”
DAP Health is not sitting idly by. Instead, their administrative team has been working on contingency plans and identifying ways in which they can fund services to keep their patient community thriving.
“We have a lot of contingency plans in place across the spectrum of all the executive orders that have been issued, while we continue to wait to see what becomes law, and what is enforced,” Tobe said. “At DAP Health, it’s been in our DNA for over 40 years to be ahead of the curve in responding and adapting to whatever the needs may be. We have a dozen contingency plans to make sure that our patients, regardless of who’s in office or what comes through from the government, are going to have access to be cared for. So if and when the time comes for certain things to happen—it would be like our COVID response and our MPOX response—we’ll flip a switch, and we’ll immediately get into “respond” mode, and implement one of our contingency plans.”
Tobe explained how the organization could respond to a federal mandate to cease all gender-affirming care.
“Since DAP Health is a federally qualified health center, if it’s mandated that we cannot provide gender-affirming care, we need to have contingency plans in place so that our 1,000 trans and non-binary patients … still have access to the care that they deserve, and that they need. We’re looking at different options with different partners, essentially, that will not have to abide by the federal law, because they don’t get money from the federal government.”
At the Martha P. Johnson Youth Drop-in Center at the Transgender Health and Wellness Center (THWC) in Palm Springs, the pain of funding cuts is already being felt.
“We were supposed to receive funding from Housing and Urban Development as part of the YHDP (Youth Homelessness Demonstration Program),” said Renae Punzalan, director of youth services and the administrator in charge of the drop-in center’s operations and activities. “Our Youth Drop-in Center and our main THWC office were supposed to be access points to connect youth from 18 to 24 years old with housing support. … It was really great that we were working with the county, and that things were going to happen. This was last year. Then, of course, the new administration came in and started creating executive orders, some of which were to defund any kind of HIV and AIDS research, anything dealing with gender ideology, or anything LGBTQ+-related. So all those funds got reallocated, or just disappeared—and we don’t know where the hell it went. That kind of put us in a bind.”
Punzalan said trans staff members have left the organization—and the country, because they no longer feel safe here.
“They want to be out of the United States, and they’re going to Canada or to Mexico,” she said. We’re worried that (the federal government) might do what they’re doing with undocumented folks and make it illegal to be trans. In Texas now, you cannot be trans. It’s illegal to change your documents if you’re a trans person, or identify as trans. It’s giving Gestapo vibes. It’s scary—but this is the time we live in. We wake up every day not knowing what’s going to happen, so I just focus on what I’m doing here at the MPJ.”
As at DAP Health, Punzalan and the rest of the staff are working to find solutions and make contingency plans.
“It’s scary—but this is the time we live in. We wake up every day not knowing what’s going to happen.”
Renae Punzalan, Martha P. Johnson Youth Drop-in Center at the Transgender Health and Wellness Center
“Thomi (Clinton, THWC’s founder and CEO) and I started working on some new initiatives,” Punzalan said. “She has this network of friends and supporters who have supported her for years with the Transgender Health and Wellness Center. We created a new program called the Guardian Angel Program, which is a community of LGBTQ+ people who want to support youth. That could be in a multitude of ways. They could sign up as a volunteer to mentor. They could help us at events, or they can donate funding to help a kid or our drop-in center. … The Palm Springs Gay Men’s Chorus is one of our Guardian Angels. They’re like, ‘Just tell us what you need.’ That touches my heart. So we’ve taken her network of community, and we’ve expanded it. … to promote financial support for the drop-in center, because there’s really no other way. We did a fundraiser recently called the Pink Ball, and that funding was allocated to our housing support services.”
Creative thinking and outside-of-the-box solutions are the orders of the day for many nonprofit health-care providers.
“We’re working our grants manager to death,” Punzalan said. “… We can’t get federal grants, (but) there are a lot of different private grants and other foundations out there. We’ve gotten some money from the RAP Foundation, which is amazing. We’ve gotten some funding from the city of Palm Springs (and) some sponsorship for events from Cathedral City and different nonprofits out here. The LGBTQ Center of the Desert has been so wonderful to us. Mike Thompson (the president and CEO) is just an amazing ally, and has been helping us a lot. So our community has really grown, and we’re starting to come together.
“I’m really doing what nonprofits have done (historically), like partnering, throwing events and doing community building. That’s how we feel like we’re going to survive and stay open.”
At DAP Health, CJ Tobe emphasized that people can’t give up hope.
“I would just try to encourage people to continue to speak up in whatever way, shape or form that may work for them,” Tobe said. “Whether it’s writing their elected officials, going to Sacramento to do lobbying work, or donating to DAP Health, try to take action in whatever way you can at this time.
“It’s tough, but we’re going to get through this. It’s sad to see decades and decades of so much work that has been done, even before I was born, to get us to this point where you can live and thrive with HIV—like me, for example. … I hate to think that we’re going to lose 30 years of so much work that’s been done, but people should not give up. Keep up the fight. We have to continue to take action. It’s time to not operate in silos, but work together and come up with solutions on how to better care for the community.”
