Health care access and the erosion of programs that provide a “social safety net” for the San Joaquin Valley’s poorest residents were the focus of an event that drew hundreds of community leaders and advocates to rally at Fresno State on April 2.
Equity on the Road 2026, spearheaded by the Sierra Health Foundation’s San Joaquin Valley Health Fund, highlighted the challenges confronting the region in the wake of last summer’s passage of H.R. 1, a federal law that sliced hundreds of billions of dollars from the federal Medicaid health program for low-income residents.
Other issues included equity in education, economic opportunities, housing and access to digital technology.
Equity on the Road is an offshoot of annual Equity on the Mall rallies held each year at the state Capitol in Sacramento.
“For the past 11 years, we’ve gathered annually at the state capitol. We started taking equity on the road in 2024 and we will continue, because it is so important to be in community,” said Reyna Villalobos, managing director of regional programs for the nonprofit Center at Sierra Health Foundation.
“Equity on the Road and Equity on the Mall are all about building movement,” she added. “It’s about a building people-powered movement, and we must continue this journey, not alone, but together. This is about unity. It’s about coming together in partnership and allyship with our elected officials.”
Noe Paramo of Modesto is co-chair of the San Joaquin Valley Health Fund’s IHHEEL Policy Committee. The acronym stands for Immigration, Health, Housing, Education, Environmental justice and Land use, and represents a comprehensive platform of issues that the organization strives to keep in the forefront of legislative action in Sacramento.
In an interview Thursday with the Central Valley Journalism Collaborative, Paramo said undocumented workers toiling in agriculture and other industries “pay their taxes, property taxes, local taxes, gas taxes, Social Security, and they do not get anything in return. … They aren’t eligible for unemployment insurance benefits, they’re not eligible for cash assistance. And the safety net is being torn apart, like access to food and access to health care.”
“They’ve been here five years, 10 years, 15 years, 20 years without any type of immigration reform, contributing to the economy with nothing in return, and they are being scapegoated,” he added.
Challenges confront the Valley’s immigrant community
“We’re at a crossroads in our Central Valley with what’s happened at the federal level,” Paramo said, referring to H.R. 1, the package of federal legislation backed by President Trump and passed by Congress last summer. The bill, referred to by backers as the One Big Beautiful Bill Act, included cuts to Medicaid, the Supplemental Nutrition Assistance Program – formerly known as food stamps – and other services and programs aimed at assisting low-income families.
In California, Medicaid falls under the Medi-Cal program, while CalFresh represents the state’s SNAP benefits.
Those funding cuts, as well as additional belt-tightening of the state budget, are being felt “in the San Joaquin Valley, where we’re going to see our residents, particularly our non-citizen residents, undocumented residents, falling off Medi Cal and now have to rely on emergency rooms or go without care,” Paramo told CVJC.
“Here in the San Joaquin Valley, where we have hundreds of thousands of farm workers, 300,000 farm workers, and many of them are undocumented, and they contribute to the agricultural economy through the billions of dollars,” he added. “And the agriculture industry benefits from farm workers being on Medi-Cal, and once you take them off Medi-Cal we don’t expect the agriculture economy, the agriculture industry, to pick up their health care or provide health care benefits to them.”
In a community panel Thursday, farm laborer Rufino Amador Reyes told of his troubles since losing Medi-Cal coverage last fall.
A native of Honduras, the 59-year-old Amador Reyes works on a pistachio farm in the Delano area in Kern County. “I do everything from irrigation, spraying the grass and applying fertilizer,” he said through an interpreter.
“I am sick,” he added. “I have diabetes. I work with the condition of Valley Fever, I went through COVID-19 and many other medical issues that I am having.”
Reyes had Medi-Cal coverage for about a year, but was dropped in November and now has no medical benefits. He held up an empty prescription pill container for his diabetes medication. Under Medi-Cal, he said, he could get a 90-day supply of his pills, but after losing Medi-Cal, he went to a pharmacy for a refill several weeks ago and learned that without insurance, his medication could cost $1,080. He said that on his farm worker salary, he cannot afford his medication on top of his regular living expenses.
“I am one of millions of people in the same situation,” he said in a plea to federal and state legislators, “and you are sentencing us to just have our conditions get complicated, way, even more complicated, and you are sentencing us, putting us to the limits of having to decide whether to work or stop working because of the deterioration of our health.”
Resilience of the Valley’s communities
Chet Hewitt, founder and CEO of The Center at Sierra Health Foundation, praised the work of community advocates over the past 11 years since the first Equity on the Mall event. In his remarks to the crowd, he encouraged a sense of resilience and hope even as immigrant communities are demonized by some elected officials.
“We know the horrible immigration enforcement and the threats that hard-working families are showing up in communities in unprecedented ways,” he said.
“This [immigration] issue is not a new one,” he added. “But the way we seem to have gone about responding to it is more terrible than anything I’ve seen in the past. But we don’t come to this work afraid of challenge, nor without a history of being able to successfully confront it.”
“We choose to be more hopeful than fearful, and we continue to work hard for the things that we know are right,” he said. “I want us to be in a celebratory mood despite the times we’re in. I want us to celebrate our successes while being conscious of the challenges we have in front of us.”
The California Endowment, a private, nonprofit foundation that supports health equity efforts throughout the state, is a significant supporter of projects such as the Sierra Health Foundation. Its board chairperson, Dr. Kathlerine Flores, also underscored the Valley’s ability to face difficult challenges.
Flores said she grew up in Fresno in a family of migrant farmworkers that traveled the state for work.
“This region is rich in culture, resilience and people who work hard for their families and their communities,” she said. “It’s also a region where too many of our neighbors and our families have faced pollution, have faced barriers to health care, [and] limited educational and economic opportunity.”
“The inequities are real, but they are not inevitable,” she added.
In the face of federal policies, Flores said, The California Endowment has doubled its commitment over three years to supporting continued benefits for low-income and immigrant communities.
“Specifically, our vision is to keep Californians enrolled in CalFresh and Medi Cal,” she said. “With work requirements and more frequent [eligibility] redeterminations, it will be essential to ensure that as many Californians can stay enrolled in these programs.”
Under Trump, elected officials foresee limited progress
Staffers for Democratic members of the Valley’s Congressional delegation said they don’t anticipate much success in reversing actions taken by President Trump and Republicans who represent the majority party in both the House of Representatives and the Senate.
“I think it’s a really difficult time, obviously, in the federal government for funding,” said Kathy Mahan, regional director for U.S. Sen. Adam Schiff. “With the current administration we’ve seen quite a bit of cuts to the budget or rollbacks of grants to organizations.”
For all of the upheaval to Medicaid, SNAP and other safety net programs from H.R. 1, the bill contained a sliver of good news for the Valley, said Larry Salinas, district deputy chief of staff for Rep. Jim Costa, D-Fresno.
“There is one aspect that comes to fruition, and that is the Rural Health Transformation Program, which is going to allocate about $50 billion over five years,” Salinas said. That program is aimed at helping states to improve healthcare access in rural communities.
But an analysis by KFF, a nonprofit health policy, information, and news organization, indicates that the $50 billion is just over one-third of the estimated loss of federal Medicaid funding from H.R. 1 in rural areas of the country.
Salinas said California is getting about $233 million in the first year of the five-year program.
“That’s about the most significant piece of that legislation in terms of helping address the health disparities,” he said.
But with H.R. 1’s deeper Medicaid cuts, and the subsequent expiration of some tax credits to subsidize the cost of insurance premiums under the Affordable Care Act, “we’re seeing it trickle down that the beneficiaries of that bill were not you,” Salinas told the crowd. “They were other folks, and that’s what we have to continue to get across to our policymakers.”
“It’s going to take federal, state and local [cooperation], because the impacts are trickling down tremendously,” he added.
Dr. Joaquin Arambula, a Fresno Democrat who is barred by term limits from seeking re-election to represent the 31st Assembly District in the state Assembly, said that budget wrangling in Sacramento is also a matter of pushing and shoving over spending priorities, even with Democrats holding a majority in both the Assembly and the state Senate.
“in Sacramento, it becomes a game of zero sum, where they’re going to want to rob Peter to pay Paul,” Arambula said. “They’re going to have to take from education. They’re going to take from health care. They’re going to take from CalFresh. And those of us who are poor here in the Central Valley are going to be the ones who suffer the most.”
With his term in the Assembly drawing to a close at the end of 2026, Arambula said he supports a proposed ballot initiative for a California Billionaire Tax Act, a one-time, 5% tax on individuals with a net worth of more than $1 billion to help pay for health, education and food programs.
“I represent a bunch of poor people, and I don’t have a single billionaire that lives in my district,” Arambula said, “and we need to make sure that we’re taking care of those who are putting food on our table to such abundance but have nothing left for themselves.”
Whether or not the billionaire tax makes it to the November 2026 ballot remains an open question. Putting the initiative on the November ballot will require almost 875,000 valid voter signatures. According to the California Secretary of State, June 18 is the final day for county election officials to verify a random sampling of petition signatures and certify those results with the Secretary of State.
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.
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