It’s safe to say there has been no shortage of discussion lately about the One Big Beautiful Bill Act (OBBBA). While deeply problematic, this legislation is just the latest in a long line of mounting pressures hospitals are being asked to absorb. That reality is why HASD&IC and our member hospitals have been engaged in conversations across the region about what federal policy changes could mean for health care in San Diego and Imperial counties.
Taken on their own, the cuts that OBBBA has enacted for Medi-Cal would be difficult enough. But when added on top of the existing 2030 seismic mandates, ongoing uncertainty around the Hospital Fee Program, redirection of Proposition 35 funds, new cost constraints imposed by the Office of Health Care Affordability (OHCA), and more, the cumulative impact becomes impossible to ignore. Each of these policies may have been enacted separately, but together they could have a devastating effect on hospitals in our region.
At the same time, hospitals are being asked to do more while being told by OHCA to limit spending growth in ways that fail to reflect the realities of health care delivery. Sustained financial strain may force hospitals to make operational adjustments that could have real consequences: service line reductions, care delays, and longer emergency department wait times — resulting in reduced access to care for the patients who depend on us.
Statewide data further underscore the scale of potential impacts related to OBBBA. The California Hospital Association (CHA) estimates that approximately 2.1 million Californians could lose health insurance coverage by 2034, resulting in an additional $2.3 billion in uncompensated care costs for hospitals.
To help stabilize hospitals in financial distress, CHA is requesting a $300 million appropriation for the Distressed Hospital Loan Program (DHLP), along with expedited loan forgiveness for current DHLP recipients and other changes to the program. This critical funding — a budget request that is a companion to Assembly Bill 1923 (Soria, D-Merced) — would support additional relief and protect access to care not just in San Diego and Imperial counties but throughout the state.
That need for support is greater than ever, and as we prepare to recognize National Hospital Week, May 10-16, it is worth remembering that hospitals have always found ways to persevere through difficult circumstances — stepping up for patients and communities even in moments of profound crisis. Hospitals do this not only as providers of care, but as major employers and economic engines that sustain jobs and serve as the pillars of their communities. But resilience should not be mistaken for limitless capacity to absorb compounding policy mandates and financial pressures.
The policies that hospitals are confronting today run counter to our shared goal of sustaining access to high‑quality care in every community. As the legislative session continues and we approach the release of the governor’s May budget revise, thoughtful policymaking at all levels of government is essential if we are to ensure hospitals remain strong, stable, and accessible for generations to come.