Rural NorCal hospitals at risk as Medicaid Cuts hit Doug LaMalfa’s district

In California’s rural 1st Congressional District, which lies in the so-called State of Jefferson, hospital staff and patients are bracing for the fallout from the One Big Beautiful Bill Act, a sweeping budget law signed by President Trump on July 4. The bill’s deep Medicaid cuts could lead to the closure of several small hospitals that serve this mountainous, largely impoverished region.  

Six rural hospitals in Rep. Doug LaMalfa’s district (CA-01) appear on a nationwide list that includes 28 facilities in California at risk of closing compiled by four Democratic U.S. Senators as Medicaid funding is slashed. They include facilities such as Oroville Hospital in Butte County and St. Elizabeth Community Hospital in Tehama County – the only hospitals for miles in their respective communities. 

“Without [local] healthcare, people will leave, so these rural communities are going to die off,” warned Robi Camacho, a former rural hospital worker who joined dozens of residents protesting outside LaMalfa’s Redding office recently. “Any cuts to [Medicaid] will devastate [rural hospitals], and it will cause closures."

For towns scattered across LaMalfa’s sprawling district, a hospital closure doesn’t just mean a longer drive for emergencies; it threatens the economic viability of the community as many hospitals are major employers.

Low-Income Communities Feel the Squeeze

The pain of Medicaid cuts in CA-01 is sharpened by the region’s economic fragility. The median household income in LaMalfa’s district is about $69,000, well below the income in California’s larger communities. By contrast, many urban California districts that voted for Democrat Kamala Harris in 2024 enjoy far greater affluence, for example, one Bay Area district has a median income over $105,000d 

Yet despite its poverty, CA-01 has been a Republican stronghold. Nearly 200,000 voters in the district, about 61 percent, backed Trump in the last presidential election, reflecting a deep reservoir of conservative loyalty. 

“The majority of my patients are at or below the poverty level,” Jo Campbell, CEO of a rural clinic in Round Mountain, Calif., said. “They’re working people who just don’t earn enough.”   

Locals worry that the federal budget cuts amount to broken promises. Many in these Trump-leaning counties depend on Medicaid (Medi-Cal in California) as their safety net, and now face losing it even as they continue to support leaders pushing the cuts.

Thousands May Lose Healthcare Access

Under the One Big Beautiful Bill Act, Medicaid eligibility rules are being tightened, including the introduction of new work requirements for adults. Health experts say these changes will strip coverage from millions. The nonpartisan Congressional Budget Office projects that the law will cut over $1 trillion from Medicaid, causing 11.8 million Americans, approximately 17 percent of current enrollees, to become uninsured by 2034.  

That toll will hit hardest in rural areas where Medicaid covers a large share of residents. In fact, the American Hospital Association warns 1.8 million rural residents could lose Medicaid, including roughly 134,900 in California alone. In LaMalfa’s district, thousands stand to lose doctor’s visits, prescriptions, and preventive care. Shasta County health officials estimate that about 7,000 people in that county alone would be cut off from Medicaid under the new rules.

“It’s not the rich who are going to get impacted. It’s those who cannot afford health care,” Sam Itani, CEO of Shasta Regional Medical Center, said, emphasizing that many rural families will be left with no alternative coverage.

Elderly and disabled residents are especially fearful. 

“Many of my friends are in the same boat,” shared 83-year-old Frank Treadway, who relies on Medi-Cal in Redding. “If anything is cut, then we all suffer together. A lot of us are one Social Security check away from being on the street.”

The human stakes are painfully clear – losing Medicaid isn’t just a policy change here, it could be a matter of life and death for vulnerable neighbors.

LaMalfa Defends Bill as Constituents Worry

Congressman Doug LaMalfa, a Republican who has represented this district since 2013, voted for the One Big Beautiful Bill Act. He argues that the reforms will ultimately benefit the economy and rural healthcare. 

LaMalfa notes the package includes tax relief and job measures, as well as a special provision to help country hospitals. 

“The major reforms include returning to [1990s] work requirements… There is a $50 billion fund to ensure any impacts from [Medicaid tax changes] do not hit rural hospitals like those in our district,” LaMalfa’s office said in a recent statement.  

The congressman insists the Medicaid changes target “people who aren’t supposed to be on the program” and will eliminate “waste, fraud, and abuse,” not legitimate patients. In LaMalfa’s view, able-bodied adults should work in exchange for benefits, and California’s state government can manage any shortfalls in hospital funding. 

Despite the healthcare concerns, Doug LaMalfa remains a beloved figure among many of his constituents. The congressman’s past election performance suggests he is in little danger even if hospital budgets bleed red ink. 

In November 2024, even as voters knew Medicaid cuts were on the table, LaMalfa cruised to 65 percent of the vote in his district, a landslide margin. California's First Congressional District is simply deep red territory: the district’s partisan lean is R+12 by the Cook Political Index, and it gave Trump a 25-point victory over Harris. 

Many residents say they trust LaMalfa to stick up for their values, even if they disagree on certain policies. Indeed, LaMalfa’s personal connection to the community, as a fourth-generation rice farmer from rural Butte County, has earned loyalty that transcends individual issues. Political analysts predict he will handily win re-election in 2026. 

For rural voters here, frustrations over health care cuts coexist with an enduring conservative identity. “He’s one of us,” is a common refrain about LaMalfa at local coffee shops. 

That hometown credit outweighs the very real pain the One Big Beautiful Bill Act may inflict. In the end, the district's constituents might suffer from this federal health policy, but they are likely to send Doug LaMalfa back to Washington, nonetheless, hoping he can find a way to protect them even as he champions his party's agenda.