The office of U.S. Rep. Mark DeSaulnier, D-Walnut Creek, hosted a virtual town hall Monday to discuss how H.R. 1, better known as the One Big Beautiful Bill Act, has affected healthcare nationally and locally.
H.R. 1 was signed into law by President Donald Trump on July 4, 2025. The act permanently extended tax cuts from 2017, slashed federal funding to Medicaid, the health insurance program for low-income individuals and families, and eliminated subsidies for Affordable Care Act health insurance, better known as Obamacare.
Town hall panelist Vaishu Jawahar, policy director at Protect Our Care, a national advocacy group for universal healthcare, said that while H.R.1 slashed trillions from Medicaid and the Affordable Care Act, the spending bill doled out billions in tax breaks to millionaires and corporations.
Since the passage of H.R. 1, more than one million Californians have lost their Medicaid or Affordable Care Act health insurance, according to Jawahar. DeSaulnier, who referred to H.R. 1 as the “big, ugly bill,” said that the number one reason for bankruptcy in the country is medical debt.
“If you’re in the top 1%, which means … $8 million a year you made,” said DeSaulnier, a leukemia survivor. “On an average, you’re going to live longer, 10 to 15 years longer, because of your access to healthcare.”
‘Dramatic’ loss of coverage
Panelist Dr. Grant Colfax, a primary care physician and director of the Contra Costa County public health system, explained the downstream effects of H.R.1 at the local level.
Colfax said that the expansion of Medicaid and Obamacare in Contra Costa County was transformative, allowing thousands of residents access to life-saving preventive care. After H.R. 1 was passed, more than 90,000 Contra Costa County residents are now at risk of losing Medicaid coverage, according to Colfax.
“With the impacts of H.R. 1, we are going to go to a situation where people are going to start losing their healthcare coverage dramatically,” said Colfax. “That’s going to result in more people suffering, people coming into the emergency room with more severe illnesses.”
Colfax was concerned about whether Contra Costa County’s 167-bed public hospital and 11 clinics could absorb the anticipated surge in uninsured patients. He projected that over the next five years when H.R.1 will be implemented, the county’s public healthcare system will be nearly $1 billion in debt.
Colfax said that there was “no conceivable way” that local government could make up that deficit.
In anticipation of federal cuts, Contra Costa County had attempted to shore up funding for its local healthcare services with last month’s Measure B, a temporary sales tax increase of 0.625% that would have generated about $150 million annually over five years. Voters rejected the measure on the June 2 ballot.
Colfax said that the county public health system is committed to providing care for all residents and in the challenging years to come will determine which essential health services will be maintained.
‘People will die’
DeSaulnier was blunt about the expected aftermath of H.R. 1.
“People will die because of our healthcare policy,” he said.
DeSaulnier is a co-sponsor of the Medicare for All Act that supports a single-payer national healthcare system. Introduced in the House of Representatives in 2025, the bill currently sits in legislative purgatory.
One frustrated audience member at the virtual meeting said that she had been hearing about Medicare for All for the last 30 years and wondered when Congress would make it a reality.
“It’ll happen when the American public gets as pissed off as the rest of us are and vote for people who will care about other people,” said DeSaulnier.
