Craig Wagoner, CEO of Community Regional Medical Center in Fresno, California, has written that lengthy contract negotiations between health insurers and healthcare providers have resulted in patients being left 'out-of-network' due to ongoing disputes. This comes as federal changes designed to slow the growth of healthcare spending have led to a 15% reduction in Medicaid funding, and $1 trillion in cuts nationally over the next decade. California legislation increased the minimum wage for healthcare workers to $25 per hour, which will add $100 million annually in labor costs and will only grow. Insurance companies are pushing for rates that don't keep pace with rising costs, while private health insurers increasingly rely on cumbersome prior authorizations, payment denials, paying less for services and slow reimbursement. These practices add administrative costs, strain cash flow, and threaten fiscal stability.