Healthcare policy debates in Washington, D.C., often sound distant and abstract. In San Diego County, that reality is inching closer into focus with no positive outlook.
The implementation of Trump’s “Big Ugly Bill,” commonly known as H.R. 1, is a reminder that when federal rules change, the consequences are not just deliberation on a dias, but felt in clinics, pharmacies and emergency departments across our region. It also paints the grim picture that if people lose access to care because systems fail to adjust, that is not an unfortunate side effect. It is a policy choice.
H.R. 1 is already set to create significant instability. Residents will encounter coverage interruptions, confusing eligibility requirements, and delays in care that put their health at risk. For someone managing diabetes, cancer treatment or serious mental illness, even a short lapse in coverage can undo months of progress.
San Diego County has a responsibility to respond. As the public steward of programs like Medicaid and SNAP benefits, the county serves as the safety net for residents who have nowhere else to turn. That mandate must go beyond providing services within hospital walls. We must include innovative ways to maintain continuity of care when outside forces create instability.
Doing so requires acknowledging an important truth about the limitations of local government. In the ideal world, the county would be able to provide healthcare for all people, but the county is simply not equipped to absorb the responsibilities of the federal government.
The county’s role is not to assume permanent responsibility for federal failures, but to prevent temporary disruptions from causing lasting harm. However, I don’t believe it is responsible to allow patients to fall out of care because of paperwork or shifting rules. I believe that is something we can and must do.
Through engagement with community-based organizations, providers and residents, one thing is clear. The current system was not built for smooth transitions. It functions more like a relay race where the baton is frequently dropped between agencies and programs. Communities have been compensating for these systemic gaps for years, often with limited resources and little recognition. These organizations understand what works because they have been doing the work long before this moment.
That history matters. San Diego’s community partners have helped residents navigate enrollment, stay connected to care regardless of status, and manage systems that are complex and daunting when you’re simply in need of care.
This understanding informs my vision for the Safety Net Bridge Program. The idea is simple but powerful. By leveraging strong community partnerships with local healthcare providers, community clinics and food recovery programs, the county can ensure that coverage transitions do not result in care interruptions.
The Safety Net Bridge Program reflects a broader commitment to equity and prevention, ensuring that residents who lose benefits under new federal eligibility rules can continue to access essential health, food and social services. Preventing a lapse in care is almost always less costly and more humane than responding after a crisis occurs.
More importantly, the Safety Net Bridge Program signals what kind of county San Diego chooses to be. We must ask ourselves, are we the agency that shrugs at systemic gaps, or one that plans for them?
Acting as a temporary bridge during periods of instability is both fiscally responsible and morally sound. It keeps people connected to primary care and behavioral health services and prevents small problems from becoming medical emergencies.
H.R. 1 did not create the fragility in our healthcare system. It exposed it. San Diego County now has the opportunity to show that when systems shift, people do not have to fall. The Safety Net Bridge Program demonstrates that with partnership, creativity, and a clear sense of responsibility, the County can ensure that healthcare remains a foundation residents can stand on.
Monica Montgomery Steppe is a member of the San Diego County Board of Supervisors and a longtime community advocate focused on equity, public safety and economic opportunity. She is a resident of Skyline.
