Health care experts and workers say the passage of the One Big Beautiful Bill Act of 2025, President Donald Trump’s signature legislative achievement that passed Congress on Thursday morning and slashes billions in spending for Medicaid, will put between three to eight million Californians at risk of losing healthcare. The state could see up to $22.3 billion in federal funding vanish as a result.
It will hit San Francisco hard: As many as 238,000 residents — 29 percent of the city’s population — are enrolled in Medi-Cal, California’s version of the program, according to the San Francisco Health Plan.
The vast majority of those residents, 180,000, are enrolled through the San Francisco Health Plan, one the city’s options for Medi-Cal enrollment. A full 10 percent of those, 17,896 people, will be forced off Medi-Cal due to Trump’s bill and Gov. Gavin Newsom’s recent move to freeze new enrollments of undocumented adults in healthcare, according to an estimate from the San Francisco Health Plan provided to Mission Local.
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Trump’s law creates new requirements: Recipients between 19 and 64 must work a minimum of 80 hours a month to qualify for Medicaid, and must undergo an enrollment assessment twice a year instead of once a year. Caregivers of those 14 and younger, people with disabilities, and pregnant women are exempt.
It’s unclear how many of the 58,000 San Franciscans enrolled in Medi-Cal outside the San Francisco Health Plan plans will fail to qualify.
Another target: San Francisco’s immigrants. As of June, the San Francisco Health Plan had 44,632 members with unsatisfactory immigration status. Under Trump’s new law, California will be penalized $4.4 billion in federal funds for using state dollars to provide non-emergency care for undocumented immigrants.
“As we begin to understand the scope and implications of these federal cuts, we are committed to working with our providers, advocates, and leaders on strategies that will protect health care access for our 180,000 members,” read a statement from the San Francisco Health Plan.
Healthcare experts expected the cuts to be felt throughout the medical system, and warned that hospitals and clinics dependent on Medi-Cal payments would be especially hard hit.
“This bill proposes the biggest cuts to Medicaid in the 60 year history of this program,” said Laurel Lucia, a deputy executive director at the U.C. Berkeley Labor Center. “Not only will Medi-Cal enrollees in San Francisco have to worry about their coverage, but hospitals, clinics and other health care providers could see cuts as a result of this bill.”
Shannon Udovic-Constant, a pediatrician based in San Francisco and the president of the California Medical Association, said the cuts to Medicaid will have a ripple effect across the system. As people lose insurance, she said, they use emergency rooms more, making waiting times longer.
“Something as simple as preventative care for high blood pressure or diabetes or even asthma will exacerbate because people will have to wait and only get care in the emergency room,” said Jennifer Esteen, a registered nurse and a vice president of SEIU 1021, which represents workers at San Francisco General. “Preventable illnesses will become extreme emergencies.”
And if clinics and hospitals are “losing that revenue” from Medi-Cal patients, “they’re going to be forced to make tough choices, like potentially reducing services, potentially laying off staff, and in some cases, potentially closing their doors altogether,” said Udovic-Constant. “These providers operate on already really thin margins and rely on Medicaid dollars to continue offering services.”
San Franciscans rely on a network of nearly three dozen neighborhood clinics that provide health care access to low-income communities.
Denisse Porter, the associate chief medical officer at the Mission Neighborhood Health Center, one of those clinics, said that in 2024 about 71 percent of the clinic’s funding was reimbursement from Medi-Cal.
“We are very concerned about what is going on and what the challenges that these changes in Medicaid are going to have on our communities,”she said.
The city-owned hospitals, Zuckerberg San Francisco General and Laguna Honda, will be impacted: In 2023, 52 percent of discharges at San Francisco General were paid by Medi-Cal, representing 13.1 percent of total revenue, according to sums provided by the hospital to the state.
At Laguna Honda, in 2023, 79 percent of discharges were paid by Medi-Cal and 40 percent of its total revenue came from the program.
The San Francisco Department of Public Health, which oversees both hospitals, wrote on June 20 that the “department is currently assessing potential impacts, but remains committed to protecting and promoting the health of all San Franciscans.” The department wrote to Mission Local.
Esteen from SEIU 1021 said employee layoffs are also a concern.
The city’s healthcare industry amounted to 12 percent of its total workforce in 2023. “There’s no way to predict today where those cuts will take place, but we can anticipate them without question,” said Esteen.
“I think it’s really important that right now we use our platforms to reassure patients and to reassure the community that we’re here for your physical and mental health,” said Porter.
OSCAR PALMA
Oscar is a reporter with interest in environmental and community journalism, and how these may intersect. Some of his personal interests are bicycles, film, and both Latin American literature and punk. Oscar’s work has previously appeared in KQED, The Frisc, El Tecolote, and Golden Gate Xpress.More by Oscar Palma
