Florida and California go their own ways on healthcare

Good morning, and welcome to the Essential California newsletter. It’s Tuesday, May 23. I’m Noah Bierman, a reporter for The Times based in Washington.

Florida Gov. Ron DeSantis is planning to open a presidential bid this week by making the case that his peninsula on the Atlantic is a model conservative city-state, a red fortress thwarting blue states such as California.

It’s not a new stance for DeSantis: His attempts to push his state further to the right have drawn him into a public rivalry with Gov. Gavin Newsom on a growing number of topics as each governor seeks to raise his own state’s profile ahead of the 2024 election. DeSantis has mostly emphasized culture war issues — whether and when to teach children about systemic racism and gender; whether it was right to shut down schools and require masks and vaccines during the pandemic; how to treat corporations that have adopted liberal stances on the environment and the aforementioned gender issues.

His strategy represents a marked shift from how governors used to run for president — showing off how their state has handled the budget, taxes, the economy and services to their constituents. Beyond questions about his tactics and personality, his candidacy will test whether the old issues still matter in a Republican Party that has been transformed by former President Trump’s media-driven style of populism.

This week, I tackled one of those bread-and-butter issues: healthcare. I traveled to a low-income clinic outside of Miami, where nearly half the patients have no insurance. I met people who have gotten catastrophic illnesses such as heart failure that probably would have been treated in 40 other states.

Florida’s social safety net — or lack thereof — has gotten surprisingly little attention in the run-up to DeSantis’ presidential bid. But it’s a policy area that shows some of the starkest differences between his state and most of the rest of the nation, including California.

Florida is one of just 10 states that have not signed on to an Obamacare expansion that allows more low-income people to qualify for Medicaid. The latest two to do so, North Carolina and South Dakota, have Republican-led legislatures. South Dakota, where Republicans outnumber Democrats 2 to 1, approved a ballot measure to do so in November.

“Many people, including me, expected that by now, more than a decade after the passage of the Affordable Care Act, the symbolism of Obamacare would have faded and more states would take advantage of the option,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “But that hasn’t happened everywhere.”

As a result, Florida has the nation’s third-highest rate of uninsured people under 65, 15.1%.

DeSantis seldom discusses healthcare, even though he was a leading Obamacare opponent when he served in Congress. His memoir published this year barely mentions it, speaking mostly about healthcare in the context of the pandemic. Opposition to Obamacare, once a driving force in Republican politics, appears to have faded. But DeSantis has still apparently determined that there is little to no political upside to expanding Medicaid using largely federal money.

California has moved in the opposite direction. Before Obamacare, more than 20% of the under-65 population lacked insurance. Now, it’s down to 8.1%, according to the latest comparison data from 2021. The state is trying to shrink that number even further by adding undocumented people to the Medicaid rolls, without the federal matching money that states get for other forms of Medicaid expansion.

It’s costly, and Gov. Gavin Newsom is struggling with a $31.5-billion budget deficit.

Is it worth the cost? It’s the kind of debate we used to have. But so far, we aren’t.

You can read the full story here: DeSantis wants to ‘make America Florida.’ That could mean many more uninsured.

And now, here’s what’s happening across California from Ryan Fonseca:

Note: Some of the sites we link to may limit the number of stories you can access without subscribing.

L.A. STORIES

It’s been more than 50 years since the last truly U.S.-made watch began ticking. But an Inglewood-based watchmaker and the $70,000 timepiece he’s spent years developing could change that and revolutionize the industry. Los Angeles Times

The Sisters of Perpetual Indulgence show their support during the gay pride parade in West Hollywood in 2016.

(Richard Vogel / Associated Press)

It looks like the Dodgers are confessing their sins. The team has reinvited the Sisters of Perpetual Indulgence to the team’s Pride Night game next month, less than a week after disinviting the nonprofit charity amid targeted email campaigns from conservative Catholics opposed to the queer group. The ball club faced heavy criticism from LGBTQ+ and civil rights groups for its shunning of the Sisters, whose members often perform in drag as nuns. Before the invitation was announced, the Sisters were invited to attend the Angels’ Pride Night at the Anaheim stadium. Los Angeles Times

POLITICS AND GOVERNMENT

Indigenous tribes are demanding that the California Department of Transportation stop construction on a planned highway expansion in the Owens Valley after dozens of human remains were found on the site. It’s unclear if the state will heed tribal officials’ calls as it seeks to complete work on a nearly $70-million project. Los Angeles Times

Workers from California warehouses, delivery trucks and restaurants say heat is hazardous at their job sites, with some suffering heat stroke while working indoors. They’re urging Cal/OSHA to set indoor heat rules, but business groups are pushing back on some of their proposals. CalMatters

California Atty. Gen. Rob Bonta told the San Francisco Chronicle he’s “seriously considering” entering the race for governor in 2026. Should he decide to run, he’d face a growing field, as both Lt. Gov. Eleni Kounalakis and former Controller Betty Yee already have announced their bids. San Francisco Chronicle

HEALTH AND THE ENVIRONMENT

After months of negotiations, California and the six other states that depend on the Colorado River announced a new agreement to cut back on water use over the next three years. My colleague Ian James reports that the deal “represents a major milestone in the region’s efforts to grapple with the Colorado River’s decline.” Los Angeles Times

The Santa Ynez groundstar is smaller than a penny.

(Kristen Nelson via California Native Plant Society)

A tiny, elusive California plant has been rediscovered at Vandenberg Space Force Base. The Santa Ynez ground stars are smaller than a penny and believed to grow only in Santa Barbara County. Los Angeles Times

CALIFORNIA CULTURE

Wondering what’s driving the California exodus and where former residents are headed? This series of charts helps explain who’s moving and where, with a focus on the Bay Area. Mercury News

Disneyland’s long-running “Fantasmic” show will be “on hiatus through at least Labor Day,” park officials announced, after an inferno destroyed the 45-foot animatronic dragon during a performance in April. Fire effects have been removed from other shows at the Anaheim theme park. Orange County Register

AND FINALLY

Today’s California landmark is from Laura Shamas of Pacific Palisades: the lowly Badwater Basin in Death Valley National Park.

Badwater Basin in Death Valley National Park, photographed in February 2012.

(Laura Shamas)

Laura writes:

What are California’s essential landmarks? Fill out this form to send us your photos of a special spot in California — natural or human-made. Tell us why it’s interesting and what makes it a symbol of life in the Golden State. Please be sure to include only photos taken directly by you. Your submission could be featured in a future edition of the newsletter.

Please let us know what we can do to make this newsletter more useful to you. Send comments to [email protected].