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When Congress celebrated July 4 by enacting House Resolution 1 (known as H.R. 1 or the “One Big Beautiful Bill Act”), experts warned of massive impacts on Medicaid programs nationwide and the more than 70 million people who rely on them.

H.R. 1 cut nearly $1 trillion from Medicaid, the largest funding reduction in the program’s 60-year history. The nonpartisan Congressional Budget Office estimates that by 2034, as many as 10 million individuals nationwide will become uninsured as numerous new eligibility rules are imposed in Medicaid and ACA programs.

The Medicaid program, known as Medi-Cal in California, covers more than half of the state’s children, 2.2 million seniors and people with disabilities, 1 in 5 working Californians, and millions of other people with low incomes. H.R. 1 is expected to cut $30 billion a year in federal funding from Medi-Cal, reducing overall access to care and possibly pushing some safety net providers into dire straits, according to the California Budget and Policy Center. Up to 3.4 million state residents could lose coverage, the center said. As the uninsured population rises, more medical bills will go unpaid, cutting revenue for California’s health care safety net.

Join my guests today who will explain the impact this will have on rural healthcare in California and the effect on anesthesiology services.

Charley Yan is a fourth-year medical student at UC Davis with a background in Medicaid policy. Before medical school, he helped drive California’s Medicaid expansion efforts and has since analyzed coverage and safety-net policies across multiple states.

Mary Morales is an anesthesiologist at Stanford. She is the current vice chair of the CSA Justice, Equity, Diversity, and Inclusion committee (JEDI).

Naileshni Singh (pronounced Na-Lesh-Knee Sing) is a pain interventionalist with a background in Anesthesiology from the University of California, Davis. She is the current chair of the California Society of Anesthesiologist's Justice, Equity, Diversity, and Inclusion committee (JEDI).

Resources:

https://csahq.org/2025/09/02/federal-funding-cuts-threaten-rural-californias-health-anesthesia-care/

https://www.chcf.org/resource/how-massive-federal-cuts-will-create-unprecedented-challenges-medi-cal-patients-providers/

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Dr. Ludwig Lin (@LudwigLin) of CSA’s Vital Times Podcast catches up with one of the Match 2026 viral stars - Shay Taylor Allen (@Shayy.Taylor), a MS4 at Howard University School of Medicine, whose clip of herself jumping up and down in celebration when she matched to her first choice of Yale Anesthesiology Residency. As the first episode in a CSA Vital Times podcast arc about job crafting within Anesthesiology, Drs. Lin and Taylor Allen talk about her journey through life and medicine, and the important mentors, allies and champions who helped her innate resilience in clarifying and achieving her goals. #Jobcrafting #ShayTaylorAllen

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Welcome to another episode of Vital Times.

In January 2026 the American Society of Anesthesiologists (ASA) and the Society for Pediatric Anesthesia (SPA) issued an updated joint communication regarding severe neurologic complications, including stroke and death, in healthy young adult (oldest reported so far is 36) and pediatric patients of Venezuelan ancestry following routine general anesthesia. There have been about 36 known or suspected cases worldwide although that number seems to be regularly increasing. The majority of cases have occurred in South American countries, with six reported in in the United States and eight in Europe. Genetic testing on a subset of the patients found a genetic mutation in mitochondrial DNA, known as the ND4 mutation. (for an interview with the physician and mother listen here https://www.instagram.com/reel/DUb4tYGjfdM/?utm_source=ig_web_copy_link .

In July 2025, anecdotal communications from South American anesthesiology societies described cases of patients having severe complications from general anesthesia. Despite incomplete and emerging clinical and scientific information, ASA and SPA felt the severity of the cases warrant an expert opinion communication to inform anesthesiologists and their patients.

Detailed family histories of patients who were recently affected revealed that all were of Venezuelan heritage and several had family members who also had adverse outcomes after an otherwise uneventful anesthetic. Four anesthesiologists at the leading edge of this newly discovered condition joined the show today to explain how it was discovered, what is known and what we can do about it.

Dr. Jim Fehr is the past President of the Society for Pediatric Anesthesia, and the Division chief of Pediatric Anesthesia at Stanford Lucile Packard Children’s Hospital. He is one of the coauthors of the joint statement, a member of the Society for PEdiatri Anesthesia’s Wake Up Safe initiative and very involved with Patient Safety.

Dr. Veronica Zoghbi is a Venezuelan pediatric anesthesiologist and Director of Pediatric Regional Anesthesia at the University of Miami in Miami, Florida. South Florida and Miami have one of the highest concentrations of people from Venezuela in the USA. She and our other 2 guests are members of VAPOR (Venezuelan Anesthesiologist Perioperative Risk Reduction)

Dr. Claudia Bruguera Torres is a pediatric anesthesiologist from Venezuela and Assistant Professor at Cincinnati Children's Hospital.

Dr. Luis Rodriguez is a Venezuelan Pediatric Anesthesiologist from Miami FL, and currently serves as the Vice President for the Florida Society of Anesthesiologists

Finally, if complications occur in patients with the ND4 mutation, anesthesiologists should report the case to their institutions’ patient safety organization and the Anesthesia Incident Reporting System of the Anesthesia Quality Institute.