Opinion: Congress Must Act to Protect Medi-Cal for Low-Income San Diegans

by Eric Rafla-Yuan
March 17, 2025, 11:05 p.m.

A hospital emergency entrance in San Diego. (File photo by Chris Stone/Times of San Diego)

For decades, Medicaid has been a lifeline for more than one third of California residents, and millions of Americans, providing essential mental health care coverage to individuals and families across all demographics, including low-income workers, children, seniors, and people with disabilities.

California's version of Medicaid is known as Medi-Cal, and in San Diego County alone, nearly 900,000 individuals rely on Medi-Cal for essential health care, including 300,000 children. From California’s rural communities to urban centers, Medi-Cal ensures access to critical medical services, preventive care, and life-saving treatments for our fellow Californians who might otherwise go without.

By bridging gaps in the healthcare system, Medi-Cal also plays a crucial role in promoting public health and economic stability across every corner of our state.

Congress's proposed cuts to this vital program are not just numbers on a budget sheet — they represent a direct threat to the health and well-being of thousands of families across California. At a time when healthcare costs continue to rise, these cuts could push many to the brink, forcing impossible choices between life-saving medical treatment and basic necessities. Such a move is not just fiscally reckless — it is morally indefensible.

We have a significant mental health and substance use disorder crisis in this country, and California is no different. Cutting Medicaid funding or benefits, as well as imposing burdensome work requirements, would disproportionately harm people with mental health and substance use disorders, who make up approximately 40 percent of non-elderly adults on Medicaid.

These cuts threaten to reverse the positive downward trend in overdose mortality rates, potentially leading to a resurgence of the opioid epidemic that has had a devastating impact on communities in San Diego and across the nation for more than a decade.

Medi-Cal is lifesaving for my patients. Children with cancer, adults with diabetes, those recovering from heart attacks or stroke, and people seeking mental health care — all of these and more are covered by Medi-Cal. I think often of a patient of mine who suffered from severe postpartum anxiety and depression. Because of Medi-Cal, she was able to get the care she needed, which supported not just her, but the health of her new baby.

Now is not the time to scale back services and coverage for those in need of accessing essential health services. Cutting these services does not erase the need for them, it simply causes patients who cannot access the treatment they need to worsen until they reach a crisis point, necessitating more costly and intensive care, and putting further strain on the health care system.

All people, regardless of their economic circumstances, deserve access to health care, and this absolutely includes evidence-based mental health and substance use care. We all pay a high cost when that care is unattainable.

I urge Congress, especially those members representing Californians, to reject cuts to the Medicaid program.

Eric Rafla-Yuan, M.D., is a psychiatrist and state legislative representative for the San Diego Psychiatric Society. He lives in Hillcrest.