In July 2025, President Trump and Republicans enacted H.R. 1, aka their disastrous “One Big Beautiful Bill Act.” I voted against it because it cut critical services for millions of vulnerable Americans to pay for tax cuts for wealthy individuals and corporations that don’t need them.
Below, I’ll walk you through my biggest concerns about this legislation and how it hurts San Diegans – both today and for years to come. The impacts from H.R. 1 are real, from healthcare access to clean energy to our national finances, and it’s important you know where these cuts are happening. In the meantime, I'll continue fighting to expand affordable healthcare, build a cleaner and more resilient energy future, protect San Diego families.
- Medicaid and Food Assistance Cuts
H.R. 1 cuts over $1 trillion out of Medicaid, which will lead to more than 17 million people losing their health coverage, according to the non-partisan Congressional Budget Office. California’s 50th district is one of the least reliant on Medicaid (“Medi-Cal” here) - yet 21% of our residents rely on it for their healthcare. Medicaid is also a critical funding source for the solvency of San Diego hospitals, with some in our district receiving upwards of 25 percent of their revenue from it.
Simply put, cutting Medi-Cal won’t stop health problems- It will end primary care for a lot of people. This will cause patients to show up at the emergency rooms because a preventable problem went untreated, costing the hospital more, delivering worse health outcomes, and raising all of our insurance rates.
CA-50 Medicaid Facts:
- 156,100 people in the district rely on Medicaid for health coverage—that’s 20 percent of all district residents.
- 34,700 children in the district are covered by Medicaid.
- 17,700 seniors in the district are covered by Medicaid.
- 64,900 adults in the district have Medicaid coverage through Medicaid expansion—that includes pregnant women who are able to access prenatal care sooner because of Medicaid expansion, parents, caretakers, veterans, people with substance use disorder and mental health treatment needs, and people with chronic conditions and disabilities.
- At least five hospitals in the district had negative operating margins in 2022. These hospitals would be especially hard-hit by cuts to Medicaid. For example:
- Scripps Mercy Hospital had a negative 25.3 percent operating margin—and nearly 22 percent of its revenue came from Medicaid.
- Sharp Coronado Hospital had a negative 3.5 percent operating margin—and over 36 percent of its revenue came from Medicaid.
- University of California San Diego Medical Center had a negative 2.4 percent operating margin—and nearly 19 percent of its revenue came from Medicaid.
- There are 54 health center delivery sites in the district that serve 529,944 patients.
- Those health centers and patients rely on Medicaid—statewide, 69 percent of health center patients rely on Medicaid for coverage.
- Health centers will not be able to stay open and provide the same care that they do today, with more uninsured and underinsured patients. They are already operating on thin margins—in 2023, nationally, nearly half of health centers had negative operating margins.
- Medicaid cuts put health centers at risk, including:
- Family Health Centers of San Diego
- Neighborhood Healthcare
- North County Health Project
- San Diego American Indian Health Centers
- St. Vincent De Paul Village
The bill also cuts nearly $200 billion in food assistance for hungry families. In San Diego, that will harm many of our schoolchildren - who need food to learn - and many working families, including active-duty military. I’ve heard from countless San Diegans and food banks that resources are constrained as SNAP cuts take effect.
- 156,100 people in the district rely on Medicaid for health coverage—that’s 20 percent of all district residents.
- Energy
The bill rolls back clean energy tax credits that were passed under the Inflation Reduction Act. American companies had begun to plan, permit, and start construction on enough projects utilizing these credits to power 227 million homes. Without these tax credits, too many of these projects won't be completed.
The demand for energy is skyrocketing, driven by AI data centers, increased manufacturing, and the electrification of things like cars and generators. Now more than ever, we need this additional supply of power to help lower electricity costs, prevent blackouts, and meet this additional demand. Without it, prices will skyrocket by as much as $400 per household annually. Also, we will lose 175,000 jobs in the clean energy industry, and we will fall behind China and our competitors in the AI race.
- Debt and Deficit
With an additional $4 trillion in borrowing over the next 10 years, this the single most expensive piece of legislation in U.S. history. According to one estimate, the bill is more expensive than both Covid-19 response bills and the original Trump tax cuts combined. You may be thinking to yourself, “I thought the Medicaid cuts were necessary to cut our deficit spending.” No. They aren’t being used to offset our annual deficits. The cuts are used to offset the cost of the revenue loss from the extension of tax cuts. And as steep and painful as the cuts are, they don’t even come close to paying for the full price tag of just this bill! The bill includes a $5 trillion increase in the country’s debt limit so we can borrow the money to pay for the remainder of this bill for years to come.
This is a huge transfer of wealth from the young to the old. Today, interest payments on the national debt are more than what we pay for Medicaid, Medicare, or defense, and this will only make that worse. That debt also means interest rates for houses, cars, and business loans stay high, keeping prices elevated for everyone. If we don't address this now, our kids will be stuck with the bill for our spending.
- Immigration and Deportation
The bill allocates $75 billion to Immigration and Customs Enforcement, or ICE, making it larger than most militaries in the world. As I've pointed out before, we agree that the border should be secure and that violent criminals should be deported. But the mass deportation that this bill will fund - in addition to being heartbreakingly cruel - will hollow out our workforce and raise labor prices. That means more inflation, not less. It would be much wiser and cheaper to agree to allow enough legal immigration to address our workplace storage while continuing to enforce at the border.
Since the bill became law, ICE’s bloated budget has led to chaos and fear in our communities and the unacceptable death of two American citizens in Minneapolis and dozens of people in ICE custody.
- Republicans Caving
My Republican colleagues stated that if we didn’t pass this bill, Americans would face the largest tax increase ever. However, this is the way the GOP set this up when they voted for the tax cuts in 2017 and set them to expire in 2025. Second, it didn't have to be an all or nothing deal. We could have maintained lower taxes for the middle class while allowing taxes for the highest earners, who can afford to contribute more, to go back to where they were just a few years ago. We could have avoided a whole lot of pain for lower income people without bankrupting the country.
I know it’s difficult to stand up to your own party in the middle of a reconciliation process like this. I know, because I did it myself in 2021. I took a lot of criticism, but I did what I thought was best for San Diego. I made our bill better and made sure we passed it. I was disappointed that so few of my Republican colleagues, who know better, did not work this bill for what they said they believed in. Some promised they wouldn’t cut Medicaid, or demanded the retention of energy incentives, or lamented about debt and deficit, but in the end they all folded.