Ana B. Ibarra, CalMatters

We tracked California’s lawsuits against Donald Trump. Where the state won — and lost

That revving you hear from Sacramento is the sound of California’s Democratic leaders preparing to sue the tar out of the Trump administration.

We’ve seen this all before.

California sued the Trump administration 123 times between 2017 and 2021, according to Attorney General Rob Bonta’s office. It spent about $10 million a year in doing so. A majority of the lawsuits dealt with environment rules, immigration and health care.

Legal and policy experts expect those same issues to take center stage during Trump 2.0.

That’s why Bonta’s team started to prepare legal briefs months ahead of the election, it’s why Gov. Gavin Newsom called for a special legislative session to “Trump-proof” California, and it’s why state Democrats have agreed to allocate $50 million to fight Trump in court — a move that state Republicans denounced as a “slush fund” for “hypothetical fights.”

Trump lost more than two-thirds of the lawsuits filed against his rules in his first term. His win rate of 31% was lower than that of the three administrations prior, according to an analysis by the Institute of Policy Integrity at the New York University School of Law.

What do California’s past legal skirmishes with the Trump administration 1.0 tell us about the policy battles to come? And how might this time be different?

Many experts say the new Trump administration could be more strategic and wise this time. In his first round, his policy proposals were often rushed through and failed to pass legal muster.

“That’s something we are certainly worried about this second time around, that they’ll make the same policy decisions that are bad from our perspective, but do it again in a smarter way that makes them harder to challenge,” said Eva Bitrán, director of immigrants’ rights and staff attorney at American Civil Liberties Union of Southern California.

Another possible difference: The rules have changed. At the end of the U.S. Supreme Court’s 2023 term, the conservative majority issued a series of rulings that, taken together, make it much easier for people, businesses and aggrieved state governments to challenge federal regulations. At the time, these rulings were seen as a historic victory for the conservative legal movement and big business. Now that Trump is back in office, it may actually make the California attorney general’s job of stymying the Trump agenda easier.

Here’s a look at California’s record in court against Trump.

Environment: Wins on procedure

California prides itself on being a national leader on ecologically-minded rules and aggressive climate action. That brings it into natural conflict with any modern Republican White House, but especially the Trump administration.Roughly half of the lawsuits that the state filed against the Trump administration the first time around were related in some way to the environment.

Winning on administrative procedure. California’s Department of Justice racked up a lot of legal wins early on in Trump’s term. The vast majority of them were over important but relatively narrow policy debates around asbestos oversight rules, big rigs that use old engine components, energy efficiency requirements on freezers and ceiling fans (that was two cases), among others.

As with many other areas of policy, California was able to eke out these easy victories by persuading courts that the Trump administration had rushed rules through without explaining their rationale, providing sufficient evidence or giving the public the opportunity to weigh in. These are violations of the Administrative Procedure Act, which is the bureaucratic equivalent of failing to do your homework.

Though Trump 2.0 may be more careful this time, his pledge to fire thousands of career civil servants may also make the task of writing regulations that pass legal muster that much more difficult.

The waiver wars. One of California’s most successful legal challenges ended with a victory outside the court, said Julia Stein, an environmental law professor at UCLA. After the Trump administration revoked California’s permission to set its own emission limits on car exhaust — which comes from an Environmental Protection Agency waiver of the federal law’s preeminence over state rules — California sued. Then it sued again. Though the legal battle never quite reached a conclusion before Trump left office in 2021, the prolonged regulatory uncertainty was enough to convince some of the world’s biggest automakers to cut a deal directly with California.

Stein said she wouldn’t be surprised if that serves as a template for other regulated industries as California and the second Trump administration inevitably resume their legal battles.

“I think businesses are going to feel like, ‘well, I still need to make investment decisions and I still need to contend with different state regulatory environments and federal regulatory environments and so I might want to start entering into private agreements,’” said Stein.

Waters of the United States. California and other blue states spent the bulk of Trump’s first term beefing in court over how to define a “waterway.”

It was a semantic debate with enormous implications. Since the 1970s, the Clean Water Act has been the main way that federal regulators have battled water pollution. In 2015, the Obama administration expanded the definition of waterways covered under the law to include many wetlands and streams that only pop up during rainstorms. Trump’s Environmental Protection Agency suspended that rule, reintroduced an old one, then came up with a new rule of its own, getting sued at every step. California didn’t end up formally winning in court, but the state did run out the clock in time for President Joe Biden to take over in 2021.

The story doesn’t end there. In 2023, the U.S. Supreme Court backed a narrower definition of the Clean Water Act, effectively taking Trump’s side of things. But California remains its own regulatory bastion; its stringent water quality rules remain in effect.

What’s coming: There’s no shortage of ways that California might disagree with the incoming Trump administration on environmental matters, but the past is likely to be a pretty good guide. Expect the waiver wars to continue. California offered a taste of what’s to come before Biden was even out of office when it abandoned a proposed ban on diesel trucks, anticipating an unwinnable battle with Trump.

Other areas of possible disagreement abound. They include disputes over green infrastructure spending, offshore energy projects, wildfire relief funds, new national monuments created by Biden and limits on the use of academic research to inform environmental policy.

Immigration: Travel bans and sanctuary cities

Thousands of people protested at airports in the first week of the previous Trump administration when he issued an executive order banning people from seven Muslim-majority nations from entering the United States. It kicked off years of battles over immigration enforcement, and California had a mixed record in court.

Travel bans. The Trump administration tried multiple times to enact his order restricting travel from those Muslim-majority nations. California and others sued, arguing that not only was the policy discriminatory, but that it was also bound to harm the economy, businesses and universities.

Trump’s first two attempts were struck down, but in 2018 the Supreme Court upheld his third version of the ban. Biden reversed the order on his first day in office.

“Even in the cases where California lost, like this one, the fact that it took three rounds for the ban to be upheld, that’s helpful,” Bitrán at ACLU Southern California said. “Throwing sand in the gears and slowing them down has a protective effect on California’s immigrant communities, too.”

Sanctuary funding. During the first Trump administration, California passed a “sanctuary state” law to protect undocumented immigrants from deportation. That protection does have exceptions — it does not apply to people convicted of violent crimes or serious offenses, for example.

When Trump said he planned to withhold certain federal dollars from “sanctuary jurisdictions” unless they cooperated with federal immigration authorities, the state, along with San Francisco, sued. That funding included about $28 million for the state of California that supports recidivism prevention, at-risk youth and other law enforcement programs, former state Attorney General Xavier Becerra said at the time. A federal judge sided with California, calling Trump’s order unconstitutional.

Protecting DACA. In what some immigration attorneys call a landmark case, the state and the University of California Board of Regents participated in the defense of the Deferred Action for Childhood Arrivals program, or DACA, which allows immigrants brought to the U.S. as children to stay and work in the country.

While the program does not grant people legal status, it does protect them from deportation. In June 2020, the Supreme Court ruled in favor of the so-called DREAMers, blocking Trump’s plan to end the DACA program. This ruling shielded some 700,000 DREAMers, including about 200,000 residing in California.

What’s coming: Top of mind for immigration advocates is the promise of mass deportations, including Trump’s threat to use the military to carry out raids. A recent raid in Kern County, made waves throughout the state as a preview of what is potentially to come. Axios first reported that Trump plans to issue 100 executive orders on his first day back in the Oval Office, many of which are reported to be centered on immigration enforcement.

Trump could also reinstate a public charge policy from his first term that sought to make it harder for immigrants to get green cards if they use, or were likely to use, safety net programs, such as Medicaid or food stamps.

Legal experts also expect to see more fights around federal funding, restrictions for asylum seekers, and renewed efforts to end DACA or other temporary protected status.

Health care: Obamacare and more

In round 1, Trump tried just about everything to pick away and dismantle the Affordable Care Act, also known as Obamacare. And while he was successful in nixing provisions of it, the health law today continues to stand. Some advocates and experts credit in part California’s move to interfere and defend the law during Trump’s last term for the fact that millions continue to have health coverage.

Defending the Affordable Care Act. Trump’s main attempt to repeal the Affordable Care Act failed when the Senate rejected a bill that would have undone former President Barack Obama’s signature law. A second challenge to the law followed when Texas filed a lawsuit contesting its constitutionality. Because the Trump administration did not move to defend the federal health law, 17 states led by California, intervened to make the case for keeping the Affordable Care Act.

While this was not a challenge initiated by California, advocates say California played a unique and instrumental role in the law’s defense. California essentially “stepped in for a Justice Department that was no longer doing its job on behalf of the nation” and defended the law in court, said Anthony Wright, executive director at Families USA, a consumer health advocacy organization.

In June 2021, the Supreme Court ruled in California’s favor to preserve the Affordable Care Act. Had the decision gone Texas’ way, approximately 20 million Americans, including 5 million Californians, could have lost their coverage.

Health care subsidies. California also went to bat for health care subsidies that help make Obamacare coverage more affordable. In 2017, Trump announced the federal government would stop paying insurers for cost-sharing subsidies that help offset out-of-pocket expenses, like deductibles and copays. Becerra and 17 other state attorney generals filed a lawsuit on behalf of the estimated 6 million Americans who would have been affected by this change.

California placed its lawsuit on hold when marketplaces and insurers found a workaround to offset those losses by increasing premiums on certain plans (but also premium aid), and the case was eventually closed. While this was not a court win, per say, Wright said California’s administrative response was still a win for consumers. “It was a way so that people’s copayments and deductibles didn’t spike to unaffordable levels,” Wright said.

Title X “gag” rule. Title X is a federal program created in the 1970s that provides free or low cost family planning services to people with low incomes. In 2018, Trump proposed a “gag rule” that prohibited clinics receiving Title X funding from performing or referring patients to abortion services. Home to about a fourth of all Title X patients, California along with others challenged the policy change, but a ruling by a federal appeals court judge ultimately allowed it to continue.

Following the rule change, many clinics stopped participating in the Title X program. That meant that the program served about 60% fewer patients between 2018 and 2020, according to KFF, a health policy research center. The Biden administration eventually revoked Trump’s policy.

What’s coming: Health advocates say they’ll be closely watching everything from reproductive choice and access to gender-affirming care to potential cuts or caps on Medicaid spending. Medicaid, better known as Medi-Cal in California, serves close to a third of the state population, and reductions in funding for this program would be deeply consequential.

Funding is the key word. While the state can do a lot to protect Californian’s access to care — as the Legislature has attempted to do with a slate of laws over the last few years — it also depends greatly on federal funding to make that happen, said Amanda McAllister-Wallner, interim executive director at Health Access California, a consumer advocacy group.

“That’s a big takeaway and a big lesson learned from this last time around is we can do a lot here in California to protect consumers, to uphold California values,” McAllister said. “But without the federal funding to guarantee access to health care for folks, it’s really hard to keep people enrolled and to keep people with coverage.”

Money-making L.A. hospitals quit delivering babies. The fight to keep one labor ward open

This story was originally published by CalMatters, nonprofit, nonpartisan media venture explaining California policies and politics.

Detranay Blankenship was 16 weeks pregnant when she found out she was expecting. The days passed quickly, and soon she was 7 centimeters dilated at Martin Luther King Jr. Community Hospital.

The 26-year-old first-time mom wasn’t sure what to expect during labor, but the team at MLK’s maternity ward soon felt like family. Every hour midwife Angela Sojobi bustled in to check on her progress and offer cheerful words of encouragement. When it was time to push, a nurse lowered the lights and flipped on the soothing sound of rain.

After 14 hours of labor, baby Myla made her appearance in the world. “That’s my grandbaby!” Latrina Jackson, Blankenship’s mother, shouted. The family’s cheers rang down the hall.

Blankenship lives just blocks away from MLK, where her labor was cozy and personalized. It was the kind of birth that many parents-to-be hope for, but a decade of widespread cutbacks to maternity care in California has made it almost a luxury. It’s available only because MLK’s leaders are fighting to keep maternity services despite steep financial losses.

Over the last decade, nearly 50 maternity wards have closed across California, with more than half shutting down in just the last four years. Seventeen of them were in Los Angeles County, where maternity ward closures have far outpaced the region’s declining birth rate.

Driving the trend in L.A. are for-profit hospitals owned by multi-state corporations. For-profit companies owned 13 of the 17 hospitals that stopped delivering babies. State data shows more than half closed at a time when the hospital was making millions of dollars for investors. Those who lost the most access were the state’s poorest patients. One hospital that serves predominantly low-income patients was earning 13 times more than the median hospital operating margin in California when it shuttered its labor and delivery ward.

In contrast, government-run and nonprofit hospitals tend to maintain labor and delivery units even if they are losing money overall, according to state data on hospital finances. State law requires nonprofit hospitals such as MLK to address community needs as part of maintaining their tax-exempt status.

Hospitals raking in profits often do so despite losing money on maternity care — the service has long been deemed a money-loser. That’s in part because Medi-Cal, California’s public insurance program which covers half of all births statewide, has had the fifth lowest reimbursement rate for obstetrics in the country, according to the Kaiser Family Foundation. Private insurance pays roughly five times more for an uncomplicated vaginal delivery. Simply put, when for-profit hospitals look at the bottom line and choose to make cuts, one of the first services to disappear is usually maternity care. No law prevents them from doing so.

In the L.A. area, these decisions disproportionately affect low-income Black and Latino communities, a CalMatters analysis found. The closures in L.A. overwhelmingly took place in hospitals where up to 80% of patients had Medi-Cal. These populations have some of the worst pregnancy-related complications and mortality outcomes in the state.

First: Angela Sojobi, the lead midwife at Martin Luther King Community Hospital in Los Angeles, checks on the dilation progress of Detranay Blankenship, who will soon give birth for the first time on March 22, 2024. Last: Latrina Jackson, the mother of Detranay Blankenship, holds her hand as she is about to give birth for the first time at Martin Luther King Community Hospital in Los Angeles, on March 22, 2024. Photos by Jules Hotz for CalMatters The morning after giving birth, Detranay Blakenship holds her child, Myla Sqmone Grace Thimbrel, at Martin Luther King Community Hospital in Los Angeles, on March 23, 2024. Photo by Jules Hotz for CalMatters

The morning after giving birth, Detranay Blakenship holds her child, Myla, at Martin Luther King Community Hospital in Los Angeles, on March 23, 2024. Photo by Jules Hotz for CalMatters

“Marginalized patients, women particularly … have really observed the decline in their care even in a place like California,” said Dr. Laila Al-Marayati, division chief for obstetrics and gynecology at Keck Medicine of USC and Los Angeles General Medical Center.

This is because the state has failed to prioritize women’s health for decades, increasing Medi-Cal obstetrics rates only recently, Al-Marayati said. Hospitals with high numbers of Medi-Cal patients frequently can’t break even on labor and delivery. As a result, maternity care takes a backseat to more lucrative hospital services, leading to the wave of recent closures.

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Residents in southern L.A. have been among the hardest hit. In the last few years they’ve lost two maternity wards: Centinela Hospital Medical Center and Memorial Hospital of Gardena Medical Center. Both hospitals are owned by for-profit corporations and happen to serve the highest proportion of Black Californians in the state.

Their closures mean that MLK now operates one of the last maternity wards in the area. The hospital gives patients access to a midwife-led program celebrated statewide for its healthy outcomes for both mom and baby.

It, too, is at risk.

Last year the hospital ran a $42 million deficit. A recent $20 million grant from Los Angeles County will keep it open until next summer, MLK’s chief executive Dr. Elaine Batchlor said, but it won’t fix the hospital’s primary funding problem: Medi-Cal doesn’t pay hospitals and doctors enough to keep up, she said.

Medi-Cal reimburses MLK about 71% of the cost of delivery, hospital spokesperson Gwendolyn Driscoll said. The hospital loses more than $2 million annually on its maternity ward. Despite the losses, Batchlor said the maternity ward is integral to the hospital’s mission.

“We serve a vulnerable community that has few other options,” Batchlor said. “The financial distress of our hospital threatens that mission, but we will continue to provide the care that we can as long as we’re able.”

California maternity wards closures outpace U.S. trend

Across the country, communities are scrambling to save maternity care. About 3% of U.S. hospitals, mostly in rural areas, have stopped delivering babies since 2011, according to a report by health consulting firm Chartis. California has lost an even greater share: More than 14% of the state’s 337 hospitals ended maternity services during the same period.

Baby Eren, the daughter of parents Stephanie Herrera and Guillermo Saravia. Angela Sojobi, the lead midwife at Martin Luther King Community Hospital in Los Angeles, was the midwife for this birth on March 22, 2024. Photo by Jules Hotz for CalMatters

Baby Eren, the daughter of parents Stephanie Herrera and Guillermo Saravia, at Martin Luther King Community Hospital in Los Angeles on March 22, 2024. Photos by Jules Hotz for CalMatters

Parents Stephanie Herrera and Guillermo Saravia with Baby Eren at Martin Luther King Community Hospital in Los Angeles, on March 22, 2024. Photo by Jules Hotz for CalMatters

Some state lawmakers are trying to slow the loss of services. They’ve characterized what is happening in L.A. as “modern-day redlining” in recent legislative hearings.

“If you start looking at where these are being eliminated, I do think the local counties who are familiar with the communities are going to question why the decisions seem to be made around hospitals that are overrepresented of…people of color,” Sen. Dave Cortese, a Democrat from Campbell, told CalMatters.

Hospitals administrators say the state could make a difference by significantly increasing how much Medi-Cal pays for births to incentivize hospitals to keep these services open.

Last year lawmakers approved a rate increase that went into effect in January, bringing up pay for some obstetric services, but the state’s multibillion-dollar deficit makes further raises unlikely. Gov. Gavin Newsom has proposed canceling additional increases to address the budget gap, something that lawmakers have rejected in a counter proposal.

“I’m not sure how many more conversations we need to have about some of the crises that we have within our health care space,” Assemblymember Akilah Weber, a Democrat and an obstetrician from La Mesa said during a recent budget hearing on Medi-Cal rates. Weber said Medi-Cal rates are “embarrassingly low in the state of California.”

The California Department of Public Health in an emailed statement said it is aware of hospitals that have chosen to reduce or eliminate labor and delivery beds, but that in the last three years the total number of beds across the state has slightly increased. “CDPH is exploring any potential avenues within its authority to promote retention or further increases of these beds, in the interest of making sure maternal care across California remains protected.”

Some experts say it will take federal intervention to slow closures. On top of increasing reimbursement rates, they’ve also suggested putting policies in place that would make it harder for hospitals to close maternity services in already underserved communities.

For now, Cortese is carrying a bill to improve transparency and public notification when a hospital decides to close a maternity ward. Private hospitals aren’t currently required to disclose the reasons for eliminating services, he said. Another bill by Weber would require hospitals to notify the state a year in advance if a maternity ward is at risk of closure due to staffing or financial limitations.

Cortese and Weber say their measures would give the state and local governments information needed to intervene if there are potentially unnecessary closures.

They won’t, however, bring back services that have already been lost in communities like Blankenship’s.

Next to her delivery room, a young couple also covered by Medi-Cal rests while their newborn son sleeps in a bassinet. The mother didn’t think she would be able to deliver vaginally after a previous cesarean section, but MLK gave her the chance that other hospitals wouldn’t. At the end of the hall, a homeless woman living in a nearby shelter labors with a midwife by her side.

“If this community lost the services, I don’t know where these women would go,” midwife Sojobi said minutes after catching Blankenship’s daughter.

The insurance divide

More than 90% of the patients who go to MLK are covered by public insurance programs like Medi-Cal or Medicare. In contrast, most hospitals that still operate maternity wards rely heavily on private insurance. Patients with private insurance represent only 3% of MLK’s patient population.

Thirteen of the 17 maternity ward closures in L.A. County happened at hospitals that serve what the state calls a disproportionate share of low-income patients. Six of those closures happened in areas where shortages of medical providers make it difficult to get any type of health care, a CalMatters analysis of state and federal data shows.

Batchlor and other hospital administrators who serve mainly low-income patients say this creates a problem because public insurance reimburses far below the cost of care. The added expense of 24-hour staffing in a maternity ward makes it a loss leader for most hospitals.

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Although more than 40 hospitals still deliver babies in the county, doctors say the swath of recent closures has caused care delays. The remaining maternity wards have to absorb new patients, sometimes overwhelming them, said Dr. Lisa Moore, a family medicine doctor with Venice Family Clinic, a community health center with clinics throughout the region. Since 2020, the number of babies born at L.A.’s three county-run hospitals has increased by several hundred each year, state data shows.

Medi-Cal patients often bear the brunt of delays. Appointments for pregnant Medi-Cal patients who need scheduled inductions have been increasingly postponed, and some hospitals have stopped taking all but the highest-risk Medi-Cal patients, multiple doctors interviewed for this story said.

“People are angry, and they’re scared often because we’re telling them ‘We need to induce you. It’s not safe for you to continue being pregnant.’ But then they’re also hearing ‘Not yet. There’s no appointment,’” Moore said.

Delays worsen existing maternal and infant health disparities and increase the likelihood of a pregnant patient needing a cesarean section, Moore said.

The role of for-profit hospitals

The high costs of keeping specialized staff available 24/7 combined with relatively low payment and high malpractice risk make labor and delivery particularly difficult for hospitals to maintain, but experts say hospitals can usually recoup losses on other services.

Two hospitals neighboring MLK that recently eliminated labor and delivery were high-earning for-profit facilities.

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Centinela Medical Center, which is owned by national chain Prime Healthcare, averaged a 10% five-year operating margin when it stopped delivering babies in 2023. In contrast, the median five-year average operating margin for all California hospitals was 2%, according to a CalMatters analysis of hospital financial records. Prime Healthcare and its foundation have closed five maternity wards statewide since 2013, the most of any health system in California.

Elizabeth Nikels, a spokesperson for Prime Healthcare, denied that profitability or staffing shortages had anything to do with maternity ward closures at Centinela or its other four hospitals. She instead pointed to declining demand and low birth rates.

Like Centinela, many hospitals cite decreasing birth rates as a reason for eliminating labor and delivery. California’s birth rate has reached record lows and L.A. County is not immune to the trend, but maternity wards are closing faster than birth rate declines.

In 2023, 7,700 fewer babies were born in L.A. County compared to 2020. Maternity wards closed at a faster pace than that decline, forcing remaining hospitals to absorb about 3,800 additional births over three years, according to a CalMatters analysis of hospital utilization records.

“Prime Healthcare’s priority is always community need and patient care. Service line decisions are based on greatest benefit to patients with financial sustainability not a determining factor,” Nikels said in an email.

Centinela consolidated services with St. Francis Medical Center, also a Prime hospital located 10 miles away that delivers almost four times as many babies. In 2022, 732 babies were born at Centinela, state records show, roughly two per day. Another 2,762 were born at St. Francis that same year. Centinela’s consolidation with St. Francis gives patients access to “high quality care with expansive services,” Nikels said.

The other hospital near MLK that stopped delivering babies is Memorial Hospital of Gardena. Owner Pipeline Health System, another national chain, closed Memorial’s maternity ward in 2020. The hospital posted an average annual profit margin of 16% over the five years preceding its closing of labor and delivery services, state records show.

Pipeline owns four hospitals in L.A. County. Only one offers labor and delivery services. Jane Brust, a spokesperson for Pipeline Health System, said it would be “cost prohibitive” for Pipeline to implement obstetrics at its other three hospitals.

Meanwhile, nonprofit hospitals can also be part of large, well-funded systems, such as Kaiser Permanente and Sutter Health, but by law are required to assess the needs of their community and invest in those needs in exchange for their tax-exempt status. The attorney general holds additional regulatory power over nonprofit hospital acquisitions. This is not the case for transactions between for-profit systems.

“These aren’t public entities. They make the decisions in their boardroom, and nobody really knows what the basis was,” said Sen. Cortese.

That means for-profit systems tend to have more leeway in prioritizing the bottom line.

“In order to make money, you have to increase your revenue or decrease your expenses,” said Ge Bai, professor of health policy and management at Johns Hopkins University. “To decrease expenses is to cut off those unprofitable services.”

What do L.A. parents-to-be want

Other experts say policymakers need to look beyond money.

“The bigger public policy question is, should hospital-based (obstetrics) be part of a set of services we feel everyone in California needs access to and should be a certain geographic distance from,” said Kristof Stremikis, director of markets and insights at the California Health Care Foundation.

For communities in the neighborhoods surrounding MLK, Centinela and Gardena, that’s an easy answer, said Gabrielle Brown, maternal and infant health program coordinator with Black Women for Wellness.

After Centinela ended its maternity program, Black Women for Wellness canvassed households within 10 miles of the hospital and held a community town hall to assess the impact. The verdict: Residents of Inglewood, a majority Black and Latino city, felt abandoned, Brown said.

The community was also reeling from the death of April Valentine, a young Black woman who died during childbirth at Centinela nine months before the hospital stopped labor and delivery care. Last year, state regulators fined Centinela $75,000 for lapses in care that led to the death. The hospital has previously denied allegations of improper care and racial bias.

“Instead of improving the services that they offer, they decided to remove them,” Brown said.

Prime spokesperson Nikels said Valentine’s death was not a factor in Centinela’s maternity ward closure.

If MLK were to close, patients including Blankenship and her daughter Myla would have to travel farther for delivery and postpartum services—barriers that often affect whether a pregnant patient sees a provider at all. In urban areas, the next hospital could be a few miles down the highway, but L.A.’s notorious traffic easily makes travel time untenable. They’d also lose the rare access to a midwife.

Patients and providers at MLK are acutely aware of how dangerous those barriers can be. A whiteboard in Blankenship’s room listedher birthing goals, the words “Safe Delivery” handwritten in bold. Frequently, laboring Black mothers arrive at the hospital terrified of what might happen having heard horror stories, midwife Sojobi said. Many never saw a doctor during their pregnancy.

“They look at me and go, ‘Please don’t let me die,’” Sojobi said.

Angela Sojobi, lead midwife at Martin Luther King Community Hospital in Los Angeles, on March 22, 2024. Photo by Jules Hotz for CalMatters

Next year, MLK is adding another midwife to its maternity team. A quarter of its financial loss comes from midwife salaries because Medi-Cal will not reimburse a midwife and an obstetrician working simultaneously, which is how MLK’s team works. The hospital will absorb the additional loss because midwives improve outcomes for communities of color, MLK executive Batchlor said.

For her, the decision to keep labor and delivery open no matter the cost comes down to believing patients deserve it.

“I think it’s leadership, and I think it’s values. I do,” Batchlor said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.