Democratic San Francisco Mayor Daniel Lurie warned on Tuesday that President Donald Trump‘s “one big, beautiful bill” will cost the northern California city hundreds of millions of dollars every year for the next decade, starting in 2027.
Lurie has made tackling San Francisco’s deficit a priority during his first year in office, approving a two-year budget that has already made “painful” cuts to city contracts and the municipal workforce.
“Our economy is recovering, and we made real progress eliminating hundreds of millions of dollars every year from our structural deficit,” Lurie said in a written statement in response to the report released by the city’s public health and human services department. “But these changes at the state and federal level represent a real threat to San Francisco — to our residents and to our budget.”
The “one big, beautiful bill” slashed funding for federal benefits, including the Supplemental Nutrition Assistance Program and Medicaid, and also made it more difficult for people to qualify for the programs. Like other local and state governments, San Francisco has been left scrambling to fill the gaps as thousands of Americans who rely on the benefits find themselves unsure if they will still get them.
The Department of Public Health and the Human Services Agency’s report warned that San Francisco is on track to lose as much as $315 million a year by fiscal 2027 due to two major shifts: direct federal program cuts under the Trump administration that will reduce the flow of tax revenue back to states, and new federal rules designed to make it more difficult for low-income residents to qualify for safety-net programs. The annual loss is projected to climb to $400 million by 2038.
The report estimated that between 25,400 and 50,500 San Franciscans could lose Medi-Cal coverage by 2027, while nearly 20,000 residents may lose CalFresh benefits. Those reductions would significantly affect the budgets of the Department of Public Health and the Human Services Agency, which rely on these programs to provide healthcare, employment assistance, and food aid to low-income communities.
The Department of Public Health expects to lose $90 million to $180 million per year starting in fiscal 2027-2028 due to more people losing eligibility and cuts to Medi-Cal payments and safety-net funding, according to the analysis. The Human Services Agency would lose $26 million per year in federal funding, as the federal share of CalFresh administrative costs will be reduced from 50% to 25%.
Tuesday’s report also pointed to several strategies the city could pursue to manage the looming funding gap.
The Mayor’s Office of Innovation is partnering with both the Human Services Agency and the Department of Public Health on new technology aimed at reducing paperwork and helping residents stay enrolled in assistance programs. The report noted that Healthy SF, the city’s healthcare initiative for low-income residents who don’t qualify for Medi-Cal, could also serve as a backstop for those who stand to lose federal benefits.
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During the 2025 budget negotiations, Lurie and San Francisco Supervisor Connie Chan, who chairs the Budget Committee and is running for Rep. Nancy Pelosi’s (D-CA) House seat, secured a $400 million reserve to help shield the city from federal funding reductions. However, that deal was designed to offset one-time cuts, not the deficits that will hit programs such as food assistance and Medi-Cal in the years ahead.
Lurie, who earned widespread praise last month for helping orchestrate a plan to get Trump to call off plans for a federal deployment to San Francisco, said he would 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.”
