SAN DIEGO — Brett Tande, CFO of Scripps Health, is urging healthcare leaders to shift their focus from federal to state-level advocacy as Medicaid uncertainty and state regulatory requirements converge, according to a January 2026 HealthLeaders cover-story excerpt.

Tande said federal policy changes referenced in the article, the One Big Beautiful Bill Act, OBBBA, could hit California especially hard, making state action the practical lever for stabilizing the safety net. “OBBBA is going to hit… particularly significant here in California,” Tande said in the HealthLeaders excerpt. “The question is, at the state level, do we want to rethink what’s been occurring to make sure we don’t artificially manufacture a public health crisis?”  

The excerpt also points to California mandates—including seismic safety compliance and revenue-limiting health affordability laws—as overlapping pressures that can compound the impact of Medicaid reductions. Taken together, these factors represent a crossroad for safety-net systems, as they weigh capital investment, operational partnerships, and service-line priorities amid constrained federal budgets and new state-level regulations.  

Tande argued that states are the “obvious place” to seek relief from requirements that could amplify federal cuts. “The states are the obvious place to go to for reconsideration of regulatory requirements that will exacerbate the cuts from OBBBA,” he said.  

The excerpt also signals possible consolidation and partnership pressures. Tande said financial strain may force systems to shed losses in chronically under-reimbursed areas. “You’re trying to offload losses and give the keys to someone who has figured out how to make those things run better operationally,” he said.