Trump’s Big Beautiful Bill to Cost San Francisco $400 Million, End Care for Thousands

President Donald Trump’s One Big Beautiful Bill Act is expected to cut hundreds of millions of dollars annually from San Francisco’s budget, with up to 50,000 people potentially losing access to public benefits.

That’s according to a new report from the San Francisco Department of Public Health and Human Services, which estimates the federal budget could cost the city up to $400 million annually once fully implemented in 2038.

“Our economy is recovering, and we made real progress eliminating hundreds of millions of dollars every year from our structural deficit,” Mayor Daniel Lurie said in a statement. “But these changes at the state and federal level represent a real threat to San Francisco, to our residents and to our budget.”

Signed into law on July 4, the Big Beautiful Bill, as it’s officially known, strips federal funding for a variety of public healthcare programs and the Supplemental Nutrition Assistance Program, while cutting taxes for the wealthiest Americans by tens of thousands of dollars.

The Department of Public Health stands to lose $315 million in 2027–28 alone, and the city’s Department of Human Services, which administers CalFresh, the state’s food stamp program, estimates it will lose $81 million annually. Around 21,000 San Franciscans could lose food benefits by 2027 if they do not have an income, largely due to newly imposed work requirements.

About 112,000 San Franciscans receive food assistance through CalFresh, according to the report.

“The strict work and paperwork requirements are really about layering on a whole lot of red tape,” said Tanis Crosby, executive director of the San Francisco-Marin Food Bank, adding that CalFresh and other SNAP programs already have income limits and work requirements. “This will all make a big administrative entanglement and create more burden and disinventive for people who need and deserve benefits to even apply.”

Between 25,000 and 50,000 San Franciscans are also projected to lose access to Medi-Cal, the report shows. Undocumented residents are particularly vulnerable to the cuts, and starting in January, Medi-Cal recipients will have more hurdles to jump through for benefits, including verifying their eligibility every six months rather than once per year.

The city is already charting out mitigation strategies, including keeping residents enrolled in benefits programs. It is also looking to expand programs like Healthy San Francisco, a city program that provides health coverage for residents who are not eligible for Medi-Cal and Medicare.

“Despite these actions, the City and County will face difficult financial decisions, and we will need to prioritize programs, services and staffing,” the report reads.

The dramatic projections come after the city earlier this year cut millions from its own budget in order to balance an $800 million shortfall.

“We are really concerned about what this means for people who are just struggling to make ends meet,” Crosby said. “We have among the highest rates of food insecurity … There is a lot of opportunity for bold change that we can make within our state.”

Lurie’s budget, passed earlier this year, anticipated federal cuts and included $400 million in reserves to help combat future shortfalls. The city is now preparing to start developing its next annual budget.

“Over the next several months, I will work with the Board of Supervisors, community leaders, and residents across the city to ensure we take care of San Franciscans and deliver another responsible budget that supports our residents and strengthens our recovery,” Lurie said.