HOUSE SPEAKER EMERITA NANCY PELOSI and the San Francisco Community Clinic Consortium, a partnership of nonprofit community health centers, held a virtual briefing this week on federal impacts to local health care from the One Big Beautiful Bill, President Donald Trump’s legislation recently passed by Congress.
The bill, which Trump signed into law on July 4, includes nearly $1 trillion in Medicaid cuts over the next 10 years and could displace 11.8 million Americans from their health care coverage, according to the American Hospital Association.
In San Francisco, almost one-third of the population is on Medi-Cal, California’s Medicaid program, according to SF Community Clinic Consortium CEO Johanna Liu, who was moderating the discussion Thursday.
Liu said the expansion of Medicaid allowed community health centers to have more modern, high-quality and coordinated care that included the expansion of services like dental care, mental health, vaccinations, colon cancer screenings, nutritional help and substance abuse treatment. The law would affect about 255,000 San Francisco residents, including 5,000 patients with the consortium.
“Why create financial problems for community health centers when politicians on both sides of the aisle have lauded our well-documented success providing cost-effective care,” asked Liu. “How could it help to have more uninsured people getting care in the most expensive possible setting, the emergency room, instead of the least expensive setting, that community health center?”
Pelosi talked about a three-step strategy to combat the law: intensify the litigation toward Trump and his administration, develop legislation to undo parts of the law and mobilize public opinion against it.
“We want to make sure that when we win this next election — I’m talking civics here, not politics — when we win this next election,” said Pelosi, “that they know that we’re ready to purge ourselves of this sinful, filthy, dirty, rotten, hateful, lousy, ugly legislation.”
The San Francisco Community Health Center, located in the Tenderloin, provides care for about 5,000 San Francisco residents annually. SF Community Health Center chief medical officer Dr. Dan O’Neill discussed the impacts of the law on trans, gender-diverse individuals and HIV patients and resources, in addition to stressing the importance of access to basic health care for addressing homelessness and addiction. Nearly all patients the center serves are enrolled in Medicaid and are at risk of losing coverage because of the law.
“Health care is a human right, and the cruel and deliberate purpose of [the law] is to take that right away by creating unnecessary barriers to accessing care for the most disenfranchised and underserved people, predominantly queer and low-income people of color,” O’Neill said.
O’Neill described how new Medicaid eligibility requirements under the law would exhaust clinicians and providers with administrative tasks, instead of delivering care and preventing hospitalizations and emergency room visits.
“These needless requirements to conduct eligibility redeterminations every six months instead of annually — alongside the new work requirements — are no more than a ploy to push patients off their coverage, resulting in harm and death, not saving,” he said.
Before the law goes into full effect, O’Neill provided insight on how SF Community Health Center and the consortium are communicating with patients, giving them plenty of lead time to ramp up resources in eligibility and enrollment. He noted that the law will create roadblocks for people on Medicaid, challenging them to get back on after being disenrolled.
We want to make sure that when we win this next election — I’m talking civics here, not politics — when we win this next election,” said Pelosi, “that they know that we’re ready to purge ourselves of this sinful, filthy, dirty, rotten, hateful, lousy, ugly legislation.”
House Speaker Emerita nancy pelosi
Ellen McInnes, a care coordinator at the San Francisco-based Native American Health Center, says that the law will directly impact the community covered by Medi-Cal among their patients, such as families, older people, those struggling with mental illnesses, living with disabilities and experiencing homelessness.
“The care we provide goes beyond the four walls of an exam room. Our work is rooted in deeply holistic health care delivery,” McInnes said. “We are indigenizing healing spaces, prioritizing cultural humility and making room for practices and traditions that restore identity, belonging and dignity.”
Many of her patients are coping with the anxiety of what will happen to them and their support systems in receiving comprehensive medical care.
“People withdraw, they get sicker, and our communities suffer,” said McInnes.
Pelosi encouraged people to demand more from local and state representatives.
“Nothing is more eloquent to a member of Congress than the voice of his or her own constituent,” she said. “We’re calling into these districts to say, this is what you have done. We know that now there’s some opportunities to mitigate for that damage, and we want to make sure you’re aware of that.”