California hospitals and clinics are on high alert as immigration raids continue and their patients — both legal residents and undocumented immigrants — are afraid to step out and increasingly canceling medical appointments.

This story was originally published by CalMatters. Sign up for their newsletters.

A Los Angeles-area clinic system, St. John’s Community Health, told CalMatters about a close encounter with officials who appeared to be immigration agents. Staff said armed officers wearing tactical gear tried to enter a parking lot in Downey, about 10 miles southeast of Los Angeles, where doctors and nurses in a mobile health clinic were seeing patients, many of them walk-ins from the community.

Alfredo Contreras, the driver of the mobile clinic, said five unmarked SUVs and vans on Wednesday morning pulled up to a gate in the parking lot where they had set up, located at a drug and alcohol recovery center. Contreras and a security guard stood in front of their vehicles, blocking the entrance.

Contreras said he and the guard “held our ground, we did not move” and the officers didn’t get out of their vehicles.

“I told (the security guard) ‘Don’t worry, they can’t come in without a warrant,’ so I’m sure they (agents) could hear us because their windows were down,” Contreras said.

Both of them started walking back as the center’s gate slowly closed in front of them. The agents eventually left after a few minutes, Contreras said.

Peggy Hernandez, the mobile clinic coordinator who also was at the scene, said while Contreras and the security guard dealt with the agents, her staff calmly alerted patients who were waiting in line. None identified themselves as being at risk because of their legal status, but still, she said both patients and staff were shaken up.

“That's the first time they (immigration officials) have ever come that close to the clinic or to us providing health care services,” said Jim Mangia, CEO of St. John’s Community Health. Staff at the clinics, he said, have been training for this type of situation.

Growing fear and cancelled health appointments

One of President Donald Trump’s first orders upon taking office in January was to rescind a Biden-era rule that protected “sensitive locations” — places of worship, hospitals, clinics and schools — from immigration operations.

In an email response to CalMatters, Tricia McLaughlin, assistant secretary for public affairs at the Department of Homeland Security, did not address whether U.S. Immigration and Customs Enforcement agents visited any LA-area medical clinics this week.

But asked why ICE would target such locations, McLaughlin said the administration is protecting “Americans who attend” these sensitive locations “by preventing criminal aliens and gang members from exploiting these locations and taking safe haven there because these criminals knew law enforcement couldn’t go inside under the previous administration.”

"ICE will be using the ‘common sense’ standard for any enforcement actions at these locations, relying on the discretion of the law enforcement officer."
TRICIA MCLAUGHLIN, DEPT. OF HOMELAND SECURITY

“Officers would need secondary supervisor approval before any action can be taken in locations such as a church or a school. We expect these to be extremely rare,” McLaughlin said in the email.

Trump’s directive “gives our law enforcement the ability to do their jobs…ICE will be using the ‘common sense’ standard for any enforcement actions at these locations, relying on the discretion of the law enforcement officer,” she said.

Government data and news reports show that ICE is increasingly detaining people without criminal convictions. The same day that immigration agents tried to enter the Downey parking lot where St. John’s mobile health van was stationed, some also showed up outside two nearby churches where they apprehended people, including one elderly man, according to local news reports.

Health advocates and providers say that rather than protecting people, ICE is scaring people from seeking basic medical care.

That fear is expected to grow, especially after, as the Associated Press first reported Friday, the Centers for Medicare and Medicaid Services shared Medi-Cal data, including people’s immigration status, with the Department of Homeland Security. California officials, including the state’s Department of Health Care Services which oversees Medi-Cal, have long reassured undocumented immigrants that their personal information would not be shared with federal agencies for immigration enforcement.

At St. John’s, which has 28 sites across Los Angeles County and the Inland Empire, Mangia estimates that roughly a third of medical appointments and half of dental appointments were cancelled this week.

People have been skipping care out of fear for months now, but recent raids have increased the no-shows and cancellations. When possible, his clinics are turning people to telehealth and a recently-launched home visitation program, he said.

The Hospital Association of Southern California said on Thursday that it was not aware of any immigration enforcement activity inside or directly outside any Southern California hospital campus, but that the chilling effect was noticeable in some emergency waiting rooms.

“Some hospitals have reported a decline in emergency department volume, which raises our concern that individuals may be delaying necessary care out of fear,” Adam Blackstone, a spokesperson for the association, said in a written response.

“Fear of going outside or being picked up by ICE...can create worse outcomes, such as ending up on my operating room table with an amputation or a ruptured appendix."
SANDY REDING, CALIFORNIA NURSES ASSOCIATION

Sandy Reding, an operating room nurse at Bakersfield Memorial Hospital and president of the California Nurses Association, said anecdotes of similar patterns were reported in Bakersfield following January raids there.

The consequences of putting off care are never good, especially for people with chronic conditions, such as diabetes and hypertension, she said.

“Not having the optimal care because of fear of going outside or being picked up by ICE creates delays in care, which can create worse outcomes, such as ending up on my operating room table with an amputation or a ruptured appendix,” Reding said.

“My concern right now is that we take care of everybody in a timely manner, and that they feel that the hospital is a safe place to go to get care,” she said.

Many patients seeking virtual care

For non-emergency care, patients have more options. The Los Angeles County Department of Health Services has published resources for remote care. Included are phone numbers and portals where county clinic patients can call a nurse advice line and request medication drop-offs. The department encourages people who would rather stay home to call their clinic and change their appointments to virtual or phone visits.

Officials with the county health department said immigration agents have not entered any of their county health facilities. “However, the mere threat of immigration enforcement near any medical facility undermines public trust and jeopardizes community health,” they wrote in an unsigned email.

People without a preferred clinic may also seek services from organizations such as Zócalo Health, which provides virtual-first care, including mental health visits. The group was created to boost culturally competent care in Latino communities, said CEO Erik Cardenas. Services are available for people throughout California, including those covered by certain Medi-Cal plans. People can call the group’s main line to check insurance eligibility and book appointments online.

“Having a virtual network of physicians and therapists that look like you, talk like you, think like you, is a really good tool to have right now because it augments access,” Cardenas said.

Since the pandemic, most clinics and doctors’ offices across the state now offer virtual care.

'A devastating contradiction’

The immigration raids are coinciding with major proposed rollbacks in Medi-Cal for undocumented people.

As the state tries to offset a projected $12 billion deficit, Gov. Gavin Newsom last month put out a budget proposal that freezes enrollment and reduces services for this population. State health officials have said the state is spending more on medical coverage and prescription drugs for undocumented enrollees than they anticipated.

The Legislature, in its own version of the budget, on Friday accepted most of Newsom’s freezes and cuts for immigrants with some modifications. For example, lawmakers want to charge undocumented immigrants $30 a month for their Medi-Cal insurance instead of the $100 that Newsom proposed. Legislators also want a six-month grace period for people to re-enroll if they fall off coverage for missing payments.

Lawmakers and Newsom face a June 27 deadline for agreeing on a final budget.

Republican lawmakers say the governor and Democratic lawmakers are responsible for a Medi-Cal expansion that has become unsustainable. “We committed spending to something we can’t afford,” Sen. Roger Niello, a Republican from Roseville and vice chair of the Senate budget committee, has told CalMatters.

Meanwhile, health and immigration advocates are pushing the state to keep immigrants covered, especially in this time of fear.

Mar Velez, director of policy at the Latino Coalition for a Healthy California, said it doesn’t make sense for Democrats to defend immigrants in the face of the federal immigration raids and at the same time go after their health coverage.

“They've been very clear that we need to protect immigrant communities, and so why isn't the state budget reflecting that?” she said.

Mangia at St. John’s said his clinics’ staff have been getting questions from patients almost daily about the future of their Medi-Cal coverage.

“Our patients are very worried about it,” he said. “And I think it's a devastating contradiction, on the one hand to have the governor and elected officials say we support immigrants, but when it comes to making sure that they have health care, they're willing to kind of cut those services away.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

To really understand the whole mess in San Mateo County, you have to start with the overtime logs. Or maybe it was the urinating puppy. Or perhaps it was the $1,200 boots.

This story was originally published by CalMatters. Sign up for their newsletters.

San Mateo County Sheriff Christina Corpus is facing removal by the Board of Supervisors after a cascade of allegations — some scandalous, some concerning, some just plain odd — portrayed a chaotic picture of her two years and three months in office.

After a county investigator found Corpus violated policies on nepotism and conflicting relationships, voters empowered the supervisors to remove her, a three-month process slated to begin at the end of April. If successful, it would be the first removal of a county sheriff in California history.

Six cities in San Mateo County have called for her resignation. The county executive is suing Corpus. Corpus is suing the county. Taxpayers are probably picking up the tab for all of it. At stake is the administration of law enforcement in one of the wealthiest enclaves in the country.

Corpus’ road to professional peril began when the sheriff’s captain decided to run for her boss’s job in 2022.

Her opponent, then-Sheriff Carlos Bolanos, had his years in office bookended by scandal. In 2007, when he was the undersheriff of San Mateo County, he and former Sheriff Greg Munks were briefly detained by police in a raid at a Las Vegas brothel. The raids were dubbed “Operation Dollhouse.” Five people were arrested, but Munks and Bolanos were not among them.

Munks said at the time that he believed the brothel was a legitimate massage business. Bolanos could not be reached by CalMatters for comment.

Fifteen years later, in one of his final acts in 2022, Bolanos sent four sheriff’s office employees to Indiana to raid a production facility that makes $210,000 Batmobiles, complete with flamethrowers to simulate the superhero vehicle’s jet turbine exhaust. The reason: A constituent complained that his car delivery had been delayed over a missed payment. Attorney General Rob Bonta declined to investigate Bolanos.

Corpus ran as a reformer and promised changes.

Bonta endorsed Bolanos and the incumbent held a significant early polling advantage, but Corpus won the 2022 nonpartisan open primary anyway with 57% of the vote. Candidates who receive more than 50% of an open, top-two primary vote are declared the winners without the need for a general election.

“We stood up to an establishment,” Corpus said on the night of her primary victory, “and it’s been amazing.”

A contemporaneous account of her election night watch party in the local Redwood City Pulse said Corpus’ supporters presented her with a large custom bottle of champagne emblazoned with her name, the year and the sheriff’s office logo.

Beneath that were the words: “A sheriff we can trust.”

Before everything that followed – the arrest of the deputies’ union president; a damning, 400-page outside investigation; the sheriff’s divorce and whispers about her personal conduct – this was one of the first and last highlights of Corpus’ early tenure.

When the sheriff-elect was thanking her volunteers, she called out four by name. One of them was local activist Nancy Goodban.

“A lot of us activists were her best volunteers, because we wanted a reform sheriff,” Goodban said.

So what transformed Goodban from one of Corpus’ top supporters to someone who attends board meetings just to call for her removal?

“Oh,” Goodban said. “When that report came out.”

First: The county seal hangs on the wall of the San Mateo County Board of Supervisors Chamber in Redwood City on April 8, 2025. Last: A man rides on a bicycle during sunset near Pillar Point Harbor in San Mateo County on Feb. 26, 2025. Photos by Jungho Kim for CalMatters and Tayfun Coskun, Anadolu via Getty Images

Hiring an ally kicked off firestorm

The trouble started, according to a November report commissioned by the county, when Corpus named one of her campaign consultants to a position in the Sheriff's Department, executive director of administration.

Retired Santa Clara Superior Court Judge LaDoris Cordell’s report described the campaign consultant, Victor Aenlle, as “someone who has far more experience as a Coldwell Banker associate real estate broker than he has in law enforcement.” (Aenlle served for 17 years as a reserve deputy in the sheriff’s office, according to records held by the Commission on Peace Officers Standards and Training.)

Rumors were already swirling in the county building about the relationship between Corpus and Aenlle, according to the 408-page report, specifically a trip to Hawaii the pair took with Corpus’ children in October 2022, four months after she won election.

Corpus’ then-husband, who was also a sworn member of the sheriff’s office, allegedly told a former sheriff’s office employee that “Corpus was having an affair with Aenlle and that he did not go on the Hawaii trip because Corpus told him that the flight was full and that there wasn’t a plane ticket available for him,” according to the report.

Corpus’ ex-husband could not be reached for comment.

In an interview with CalMatters, Aenlle said he and Corpus are just close friends, and any other insinuations are meritless.

“It’s made up,” Aellne said. “It’s fabricated. I’ve always spoken very highly and cared deeply about the sheriff. I came into the scene when she decided to run because I really saw the injustices in the department. I saw the abuse, the corruption.”

Cordell found that Corpus violated the county’s policy on nepotism and conflicting relationships. She alleged in the report that, by 2024, Corpus had “relinquished control” of the department to Aenlle.

Cordell afforded all of the 40 people she interviewed anonymity in the report. Most of the allegations relating to the personal relationship between Aenlle and Corpus are attributed to one person, identified only as Employee No. 3, a civilian working in the sheriff’s office.

That person alleged that Corpus and Aenlle were physically intimate, sharing massages and on one occasion kissing in front of the employee.

Then there were the boots.

Purchased at a Nordstrom’s, according to Employee No. 3, and hidden away in a black shoebox in the back of her van, the $1,200 boots – and an $11,000 pair of diamond earrings – were the physical embodiment of an inappropriate relationship between Corpus and Aenlle.

Employee No. 3 told Cordell, according to the report, Corpus showed her the boots and said “I’m keeping them back here for now so (her then-spouse) won’t see them.”

Over the next two years, Corpus would make at least four requests to raise Aenlle’s salary. One was granted, raising his pay to $246,979. The other three were denied by the county’s human resources department.

Cordell concluded that their relationship went beyond friendship. She considered the earrings and the boots, allegations that Aenlle gave Corpus late-night rides home from the office

“These, and so many more observations reported by interviewees demonstrate that Aenlle and Sheriff Corpus are not engaged in a ‘mere friendship,’” Cordell wrote.

In the meantime, Corpus’ husband filed for divorce.

Corpus has not responded to multiple calls from CalMatters seeking comment. When asked at a November press conference about her relationship with Aenlle, Corpus dismissed the allegations as “rhetoric.”

“I have a personal relationship with Mr. Aenlle and with other members of my staff,” Corpus said during a heated reply at the press conference. “I’ve been dealing with this kind of rhetoric my entire career. I am a woman of color that has gone up the ranks in a male-dominated field. This is nothing new to me.”

Meanwhile, morale in the office was cratering.

“Of course it’s demoralizing,” said Eliot Storch, secretary of the San Mateo County sheriff’s deputies union. “Fear, retaliation, we are seeing it.”

The deputies’ union and the command staff of the sheriff’s office filed a complaint with the California Public Employment Relations Board, alleging that the sheriff and Aenlle had created a toxic work environment and were retaliating against union members.

On Nov, 12, the county published Cordell’s report.

Then, the mess at the San Mateo County Sheriff’s Office turned into full-blown chaos.

Deputies' union president arrested

Hours before Cordell’s report was published, the president of the deputies’ union was arrested and charged with time card fraud.

The sheriff’s office alleged that the president, Carlos Tapia, was doing union business on company time and falsified the record of his working hours. But an investigation by the San Mateo County District Attorney’s Office found no reason to charge Tapia, determining that the errors on his time cards were clerical and concluding that Tapia “should not have been arrested.”

A captain in the sheriff’s office resigned rather than arrest Tapia, and Tapia alleged in a lawsuit filed against the county that Corpus demanded his arrest as retaliation against him for complaining about her leadership.

First: A slide outlining procedures for removing the sheriff is displayed on a screen during a San Mateo County Board of Supervisors meeting. Last: Members of the San Mateo County Board of Supervisors and county staff watch the presentation during the board meeting in Redwood City on April 8, 2025. Photos by Jungho Kim for CalMatters

A series of formal no-confidence votes against Corpus followed: from the cities of San Carlos, Millbrae and San Mateo and from the Organization of Sheriff's Sergeants, the union representing command staff. In its unanimous no-confidence vote, the Millbrae City Council cited “the decline in leadership, poor decision making, low morale, and a fear of retaliation by Sheriff Corpus and her executive management team” among the reasons for the resolution.

A day after Tapia’s arrest, the county Board of Supervisors demanded Corpus’ resignation. She refused. But Aenlle was relieved of duty the day after the judge’s report’s release, according to county records released to CalMatters.

Regardless, Corpus brought Aenlle back into the office in January, along with a puppy that, as is common with young dogs in new places, urinated a lot. Quite a lot, according to an email sent by a sheriff’s department captain to the rest of the staff and obtained by the Palo Alto Daily Post.

Aenlle’s appearance was distressing to department employees who had spoken to Cordell as part of the county investigation, the email from Capt. Mark Myers said, and employees worried that Aenlle might have been carrying a concealed weapon.

Aenlle denies all of the allegations against him. He, like Corpus, believes he’s a victim of a long-entrenched good-old-boys network that was loath to release its grip on the county.

“The minute I received that title (of executive director of administration), the jealousy ensued, and they had to do everything they could to break us down,” Aenlle said.

Aenlle said he and Corpus arrived as reformers and immediately ran into resistance, followed by the allegations of an intimate personal relationship.

He disputes several elements of the Cordell report, beginning with its design; Aenlle said it’s unfair to grant anonymity to people who were free to make unsubstantiated claims about him and Corpus.

For instance, he said, the report makes mention of his lack of law enforcement experience. Aenlle points to his time as a reserve deputy, but Cordell alleged he was out of compliance with the necessary hours to maintain his reserve status and could face misdemeanor charges in connection with wearing a gold sheriff’s office badge.

“This report hinges on the voices of just 40 individuals — current and former employees — who stand in opposition to progress,” Aenlle wrote in a four-page rebuttal to Cordell’s report. “These individuals represent a faction resistant to the transformative changes aimed at improving our communities, clinging instead to the remnants of a previous administration that lost the community’s trust and mandate to lead.”

Aenlle asserts that the transcripts released with the report of his interview by Cordell were missing crucial pages, including his own defenses of himself and Corpus, and his allegations of a set-up by San Mateo County Executive Mike Callagy. He also said he knows who Employee No. 3 is, and believes that person is seeking revenge because Corpus denied the employee a promotion.

A San Mateo County Board of Supervisors meeting in Redwood City on April 8, 2025. Photo by Jungho Kim for CalMatters

But the biggest change Corpus made, he said, was the reason for the campaign to remove her from her elected office: Threatening the overtime pay deputies had come to expect. That, he said, led to the Cordell report and all of the ensuing fallout.

Some sheriff’s deputies in San Mateo County earn annual overtime that far exceeds their salaries. One deputy received $168,000 in regular pay in 2024 and $489,183.94 in overtime. Another deputy, also in 2024, earned $140,000 in regular pay and more than $318,000 in overtime.

And beginning in 2024, in order to cover vacancies and encourage deputies to work overtime, the sheriff’s office offered double pay for overtime instead of the usual time-and-a-half pay.

That, Aenlle said, led to ballooning overtime costs in the first half of 2024.

Aenlle said he has personally reviewed documents showing the sheriff’s office spent $17 million on overtime in the first six months of 2024, which would exceed the amount spent in any previous year.

Corpus made the same assertions while defending her actions in a September press conference, alleging that Callaghy, the county executive, negotiated the massive overtime bill behind her back and without her knowledge, calling such actions “serious political dirty dealings.”

CalMatters requested a month-by-month breakdown of the county’s overtime spending on sheriffs’ deputies working in patrol and the jails. Records provided by the county show that in 2024, the sheriff’s office spent slightly less in the second half of the year, about $2.2 million per month, than it did in the first half of the year when it spent about $2.6 million per month on average.

The records do not reflect a significant reduction in overtime spending after June 2024.

Finally, on March 4, the question of how to handle Corpus went to the voters. Titled Measure A, the San Mateo County ballot measure asked voters to choose whether to amend the county charter to give the Board of Supervisors the power to remove the sheriff by a four-fifths vote.

San Mateo is a charter county, giving its supervisors the cheaper and quicker option of removal, rather than a recall campaign. At least one California county sheriff has been recalled before, back in the 1970s, and a few have resigned with a recall on the ballot, but Corpus would be the first sheriff removed from office.

The measure passed with 84% of the vote. Corpus again refused to resign, setting off a removal process at the county that’s expected to last about three months. At a board hearing in April, members of the public urged county supervisors to move quickly.

The final removal hearing is scheduled to take place behind closed doors, though CalMatters has requested that the meeting be held in an open session.

No matter what happens, Corpus may still face further investigations, this time by San Mateo County District Attorney Steven Wagstaffe, who said his office was looking into Corpus’ conduct but decided to wait until the removal process plays out.

“We are waiting, but we have not closed (the investigation into Corpus),” Wagstaffe said. “There is evidence we have uncovered that provokes us to continue with our inquiry.”

CalMatters journalism engineer Tomas Apodaca contributed reporting to this story.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

This story first appeared at Cal Matters.

During the four years that Donald Trump was president the first time, California sued him about every 12 days on average.

Now that he’s returning to office, Democratic state leaders are preparing potential new lawsuits.

State Attorney General Rob Bonta has been developing plans to defend California policies since the summer, when polls showed a good chance that Trump would win the election. Bonta has said his team has preemptively written briefs on a variety of issues in preparation of what’s to come.

“During the previous Trump administration, California (Department of Justice) fought hard against Trump’s rollbacks and unlawful policies that infringed on Californians’ rights…and would do so again if need be,” the attorney general’s office said in an unsigned email response before the election.

California sued the Trump administration 123 times and scored major victories. Among them: California defended the state’s clean air rules, preserved the Deferred Action for Childhood Arrivals program (DACA) that benefits undocumented people who came to the United States as children, and protected the Affordable Care Act.

Those issues — the environment, immigration and health care — could once again be the main battle lines in the lawsuits that are expected to be waged between California’s Democratic administration and Trump’s White House.

Gov. Gavin Newsom foreshadowed potential disputes in a statement Wednesday.

“California will seek to work with the incoming president — but let there be no mistake, we intend to stand with states across our nation to defend our Constitution and uphold the rule of law,” he said. “Federalism is the cornerstone of our democracy. It’s the United STATES of America.”

This time, some experts anticipate that Trump will bring forward a more methodical approach to policy.

They point to Project 2025, a 900-page document by the conservative think tank the Heritage Foundation that lays out a conservative agenda. While Trump tried to distance himself from the blueprint during his campaign, former members of his administration contributed to the report. There is also some overlap between what he’s proposed and what’s outlined in the document, such as mass deportations and overhauling the Justice Department.

Choosing battles in a second Trump term

In his victory speech, Trump signaled policy objectives that would likely conflict with California’s goals, such as expanding oil production and turning the nation’s public health agencies over to vaccine skeptic Robert F. Kennedy Jr. — although in what capacity is still unclear.

“He’s going to help make America healthy again,” Trump said about Kennedy during his speech. “I just said: ‘But, Bobby, leave the oil to me.

“‘Bobby, stay away from the liquid gold. Other than that, go have a good time.’”

While Democratic leaders vow to uphold their values, they may be more careful in choosing their battles this time around, said Matt Lesenyie, a political science professor at Cal State Long Beach.

“Some of the legal challenges are substantive, like we want to regulate greenhouse gases. Other ones may be more symbolic, and that’s not to trivialize cultural or gender identity, but one thing that has been clear, at least to me in this Trump win, is that those cultural issues are motivating his voters,” he said.

Because it is a large state, California also has power to negotiate with the federal government.

“Faced with near-total Republican control of the federal government, Sacramento may think the state does better by negotiating,” said David A. Carrillo, executive director of Berkeley Law’s California Constitution Center. “That affects whether California’s strategy is to fight on all fronts, or to focus on leveraging its size and market power in making its own domestic and international agreements — call it soft secession.”

Likely disputes over abortion, health care

By most accounts, health care policies are expected to be contested again.

In his first term, Trump’s efforts to repeal the Affordable Care Act failed, but he did slash some provisions of the landmark health law.

He also influenced the reversal of Roe v. Wade, the 1973 ruling that protected abortion rights, by appointing three conservative Supreme Court justices.

In 2019 the Trump administration also blocked clinics and providers that offer or refer patients to abortion services from receiving federal family planning dollars. California sued. The Biden administration later reversed Trump’s rule. Any similar restrictions on abortion would certainly prompt California to respond with litigation again.

Carrillo anticipates that the Trump administration might move to restrict mifepristone, one of the medications used to induce abortion, by using a 19th Century law known as the Comstock Act.

“One fight California probably can’t avoid is abortion, specifically access to mifepristone,” Carrillo said. “For example, the federal Comstock Act in general bans sending something for ‘abortion-causing purposes’ in the mail.

“Expect a major legal battle if federal prosecutors start enforcing that to prevent interstate shipping of medical abortion drugs or contraceptives,” he said.

Others say they also expect a fight from states if Trump attempts to make drastic cuts to the Medicaid program. About 14.7 million low-income Californians rely on Medicaid for health coverage. The program is also known as Medi-Cal in California.

Project 2025, for example, proposes to cap what the federal government pays for the Medicaid program, which is funded by both the feds and the states. This means that states would receive a fixed amount regardless of their costs. In the health policy world this is referred to as “block grants” or “per capita caps.”

“So that’s a big cut, a big cost shift to states, and states would have no choice but to either raise taxes substantially or far more likely, shrink their Medicaid programs to a great degree, which means more uninsured, more people go without needed care,” said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.

Park says one key difference between a second Trump administration and the first is that Trump and his team could have a clearer vision of what they want to do with health care programs this time around. That includes the potential for things like imposing work requirements to qualify for Medi-Cal or slashing aid in Obamacare marketplaces, making it less affordable to sign up.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.