Dan O’Neill speaks at SFCCC Press Conference on HR-1 with speaker Emerita Nancy Pelosi
“We will never stop fighting for the dignity and health of our Trans communities, our unhoused communities, our folks struggling with substance abuse, and our communities living with HIV. We will not be silent and will remain unwavering in this fight.”
- Dan O’Neill
July 10, 2025
Comments by Daniel O’Neill, MD, MBA, Chief Medical Officer at San Francisco Community Health Center
Hello and thank you Speaker Emerita Nancy Pelosi for your words and steadfast advocacy for the health of our City, all California residents, and the American people.
My name is Dan O’Neill, and I have the privilege to serve as the Chief Medical Officer for the San Francisco Community Health Center, a Federally Qualified Health Center located in the heart of San Francisco’s Tenderloin Neighborhood and a member of the San Francisco Community Clinic Consortium.
Our health center is often known as the “safety-net of the safety-net,” providing primary care, dental, and mental health services to more than 5,000 San Franciscans annually. Approximately a third of our patients identify as trans or gender-diverse and another third are unhoused. Importantly, nearly all the patients we serve are Medi-Cal-enrolled and thus at risk of losing their coverage due to the passage of HR-1.
At SF Community Health Center, we have an unwavering commitment to the Trans community. In addition to providing gender affirming care, we operate a stand-alone drop-in and resource center, as well as a 75-bed emergency shelter for the Trans community. In its final form, HR-1 remains a direct affront to the health and safety of Trans and gender-diverse individuals.
SF Community Health Center also began as an HIV organization in the late 1980s and now specializes in HIV prevention and treatment for a large portion of the City’s HIV community. With Medicaid being our nation’s largest HIV care provider, covering over 40% of those living with HIV, HR-1 will effectively torpedo our efforts to end the epidemic locally and across the country.
Health Care is a human right, and the cruel and deliberate purpose of HR-1 is to take that right away by creating unnecessary barriers to accessing care for the most disenfranchised and underserved—predominantly queer and low-income people of color. It is a targeted assault on the health, dignity, and futures of millions of people and a deadly rollback of essential care. It aims to stop the progress of the Affordable Care Act in its tracks by burdening our clinicians with time spent on administrative paperwork instead of delivering high quality care to keep our communities healthy and safe, thus avoiding unnecessary hospitalizations and emergency rooms visits.
These needless requirements to conduct eligibility redeterminations every six months instead of annually, alongside the new work requirements are no more than a ploy to push patients off their coverage, resulting in harm and death—not savings. In a healthcare system that is already strapped, we should be prioritizing our resources to provide lifesaving care. But instead, HR-1 will make resources more scarce; create a more burdensome administrative system; and most critically, place a heavy toll on our providers, who are already spread too thin managing the complexity of our patients and the incredible stressors they face in their day-to-day lives.
A healthy and productive society starts with access to basic health care and prevention. For an ounce of prevention is certainly worth a pound of cure, and the Affordable Care Act has spent over decade delivering on this promise to the American People. How can a person struggling with addiction and living with HIV work without first accessing the most basic care and services to address their needs of food, shelter, and mental and physical health? This requirement is simply absurd and not reality based. But HR-1 still demands this “work” as a precondition to receive essential, life-saving care.
If any of us were to sit for moment with patients seen at the San Francisco Community Health Center and in the surrounding streets of our Tenderloin neighborhood... If you were to take the time to hear their stories, you would see what true resilience and what real hard work actually looks like – when against all odds, our patients strive to be cured of disease, to gain freedom from addiction, to be safely housed and fed, and to live each and every day with dignity, safety, and security that their most basic needs will be met.
But all of these stories start with access to health care that HR-1 seeks to deny. We will never stop fighting for the dignity and health of our Trans communities, our unhoused communities, our folks struggling with substance abuse, and our communities living with HIV. We will not be silent and will remain unwavering in this fight.
Thank you again, Speaker Emerita Pelosi, for fighting along with us and for us.
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