Cuts to America’s complex health care system have been the tinder for increasingly inflammatory political fights in recent months — expiring Affordable Care Act tax credits were the central issue in the longest government shutdown in recent history.
And when it came to the passage of Trump’s sweeping policy bill earlier this year, major slashes to Medicaid, the health insurance program for low-income Americans, was often the first talking point on a laundry list of Democratic grievances.
Amidst the noise, it can be challenging to understand how these changes affect individual communities and people. But in San Mateo County, these are the statistics.
ACA premium tax credits
As of June 2025, roughly 24,200 San Mateo County residents use the Affordable Care Act marketplace, known in California as Covered California, to find a health care provider and potentially receive financial assistance paying their monthly health care premiums, according to a representative from Covered California.
Around 22,100 of those San Mateo County residents are benefiting from enhanced ACA premium tax credits. If these credits expire at the end of this year, these individuals will experience a projected 112% increase in monthly premiums, paying, on average, $201 more than before, per Covered California. Currently, those enrolled in Covered California pay, on average, a $246 monthly premium, and those enrolled in Covered California who benefit from the enhanced premium tax credits pay, on average, a $186 monthly premium.
The projected national increase sits at 114%, according to an analysis from KFF, a nonpartisan health policy organization. Nationally, 24 million Americans use the ACA marketplace to receive health insurance, and the vast majority of those individuals use the enhanced premium tax credits.
It’s important to keep in mind that ACA premium tax credits are meted out on a sliding scale, meaning higher-income individuals receive less of a subsidy, KFF Policy Analyst Matt McGough said.
“Younger people who maybe have a lower income, they only see it increase by $1 or $2,” he said. “However, people who are older and are more middle income could see how much they pay increase by over $10,000 next year.”
These credits, which were expanded during the Biden administration to help Americans through the pandemic, have been the subject of heated political discourse, with Senate Democrats forcing a shutdown after Republican colleagues refused to negotiate on the issue. That shutdown ended without any tangible plan for their extension, despite a promised mid-December vote on the issue.
Republican members of Congress are currently in discussions around a plan to extend the credits in some way, and Trump has broached the idea of sending money directly to individual Americans.
But with the end-of-year deadline quickly approaching, the future of these credits remain in flux and without a tangible plan for extension in play.
U.S. Rep. Kevin Mullin, D-South San Francisco, said in a statement that it’s integral for Republicans to enter into good-faith negotiations with Democratic colleagues to protect the tax credit program, especially given prior cuts to Medicaid.
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“The clock is ticking for Americans across the country whose health care premiums are skyrocketing due to Republicans’ cuts to Medicaid and refusal to extend the Affordable Care Act tax credits,” he said. “All year I’ve been hearing from families, seniors, people with disabilities, and those struggling to afford basic necessities, that they want Congress to prioritize addressing affordability challenges.”
Medicaid cuts
Medicaid, known in California as MediCal, offers health insurance to roughly 70.4 million low-income Americans, including children, according to a KFF analysis.
Major changes to the Medicaid program in Trump’s policy bill — including a strict work requirement for childless adults without disabilities, biannual renewals and increased paperwork requirements — could mean 7.6 million Americans lose health insurance in the next decade, per KFF. Changes to the ACA marketplace laid out in the bill could jeopardize health insurance for another 2.1 million Americans.
In San Mateo County, 157,000 people use MediCal, and 61,000 of those will be affected by the new restrictions, Navjeet Singh, San Mateo County Human Services director of Economic Self Sufficiency, said.
While the agency is looking at individuals between the ages of 19 and 64, who will be subject to new work requirements, as a potentially affected population, the county won’t be able to calculate the true health care loss for several years, when restrictions are fully in place.
“We don’t know what the actual number will be, because it all depends on when we get to 2027,” Singh said. “How many folks are exempt? There’s a lot. There’s an exemption on work requirements, but then they also have to comply with the double renewals … if they don’t comply with the renewals, they’ll be discontinued.”
Current exemptions on work requirements include individuals making above $580 a month, Singh said, and a majority of San Mateo County MediCal residents work. Documentation requirements have been tightened to update requirements every six months, but potential litigation that requires additions or removals to the restrictions makes eligibility calculations even more tenuous.
Singh advised anyone confused about upcoming changes to their health plans to contact the county’s Human Services department directly.
“Things are changing, but it might not be for everyone,” he said. “The message we’ve always given is, please contact us so we can serve you and what your needs are. Regulation changes happen constantly, and we adapt to it.”
Per the Health Plan of San Mateo website, the county also offers a health insurance plan, dubbed Access and Care for Everyone, that’s available for eligible low-income adults age 19 and up who don’t qualify for other health insurance.
Note to readers: A previous version of this story incorrectly stated that those currently benefitting from enhanced premium tax credits would receive a 212% increase when credits expire. The increase sits at 112%, and the story has been corrected.
(1) comment
So San Mateo County has what, a population of 750,000 and 22,000 (3%) will see an increase in costs? How many of these 22,000 are non-Americans and shouldn’t be on the ACA? Let’s get them out of the program, locally and nationwide, and let’s get rid of Obamacare. Give money directly to consumers so they can pick and choose their coverage.
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