The recent passage of the One Big Beautiful Bill Act of 2025 has introduced a wave of concern among healthcare experts and workers regarding its potential impact on California’s healthcare system.
President Donald Trump’s legislative achievement, which was approved by Congress on Thursday, is set to slash billions in spending for Medicaid, threatening to remove healthcare coverage from an estimated three to eight million Californians.
In San Francisco, the situation is particularly dire, with as many as 238,000 residents, or 29 percent of the city’s population, currently enrolled in Medi-Cal, California’s Medicaid program.
The San Francisco Health Plan reports that 180,000 of these residents receive coverage through their network, with approximately 17,896 individuals expected to lose their Medi-Cal benefits due to the new requirements established by Trump’s legislation.
Recent actions by Governor Gavin Newsom, specifically the freeze on new enrollments for undocumented adults in healthcare, add to the growing concerns.
The new law enforces stricter conditions for Medicaid eligibility, mandating that recipients aged 19 to 64 work at least 80 hours a month and undergo enrollment assessments twice yearly, up from the previous once-a-year requirement.
Those exempt from these new criteria include caregivers of children under 14, people with disabilities, and pregnant women.
However, it remains uncertain how many of the 58,000 San Franciscans enrolled in Medi-Cal outside the San Francisco Health Plan will also be unable to meet these new eligibility conditions.
A significant concern is the impact on the city’s immigrant population, as the San Francisco Health Plan currently has 44,632 members with unsatisfactory immigration status.
Under the new legislation, California could face a penalty of $4.4 billion in federal funding for utilizing state dollars to offer non-emergency care to undocumented immigrants.
In a statement, the San Francisco Health Plan emphasized its commitment to collaborating with providers and advocates to protect healthcare access for its 180,000 members while navigating the consequences of the federal funding cuts.
Healthcare experts predict that these cuts will have widespread repercussions across the medical system, particularly affecting hospitals and clinics that rely heavily on Medi-Cal payments.
Laurel Lucia, deputy executive director at the U.C. Berkeley Labor Center, remarked, “This bill proposes the biggest cuts to Medicaid in the 60-year history of this program.
Individuals enrolled in Medi-Cal in San Francisco will be forced to grapple with the uncertainty of their coverage, and healthcare providers could experience significant financial losses as a result of these cuts.”
Jennifer Esteen, a registered nurse and vice president of SEIU 1021, highlighted that as more individuals lose their insurance, they will increasingly depend on emergency rooms for care.
The fallout could lead to longer waiting times and worsened health outcomes, with preventative treatments for conditions like high blood pressure, diabetes, and asthma becoming less accessible.
Esteen elaborated, “Preventable illnesses will escalate into extreme emergencies due to the loss of insurance and access to regular care.”
The financial strain on clinics and hospitals due to revenue losses from Medi-Cal patients may force them to make difficult choices.
Shannon Udovic-Constant, president of the California Medical Association, warned that providers are already operating on razor-thin margins and rely on Medicaid funding to maintain their service levels.
Clinics like Mission Neighborhood Health Center, where approximately 71 percent of funding came from Medi-Cal reimbursement in 2024, are raising alarms over these changes.
Denisse Porter, associate chief medical officer at the clinic, expressed her concerns about the challenges that Medicaid alterations will pose for local communities.
The city-owned hospitals, Zuckerberg San Francisco General and Laguna Honda, are also likely to feel the financial repercussions.
In 2023, 52 percent of discharges at San Francisco General were paid by Medi-Cal, which accounted for 13.1 percent of the hospital’s total revenue.
Meanwhile, Laguna Honda reported that 79 percent of its discharges were covered by Medi-Cal, contributing to 40 percent of its revenue.
The San Francisco Department of Public Health is currently evaluating the potential effects of these changes, committing to the health of all residents.
Esteen pointed out that employee layoffs could emerge as another serious concern, given that the healthcare sector comprises 12 percent of the city’s total workforce.
“While it’s difficult to predict the specific locations of cuts, we can certainly expect them,” said Esteen.
Porter reassured community members, stating, “It is vital that we assure patients of our commitment to their physical and mental well-being during this challenging time for healthcare in San Francisco.”
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