Health Commission approves DPH budget after hours of public pleas to protect community programs

The San Francisco Health Commission on Feb. 6 approved the Department of Public Health's two-year budget proposal, advancing the plan to the city controller and mayor's office for review.

DPH Chief Financial Officer Jenny Louie and Deputy Finance Officer Emily Gibbs presented a balancing package that relies on a mix of near-term revenue updates and expenditure savings. Louie said the department is aiming to meet an internal first-10% general-fund reduction target of about $93 million over two years and will submit the proposal to the mayors office and controller on Feb. 21 for the next stage of review.

Gibbs described revenue initiatives the department expects will generate about $71 million in 2024-25 and grow to roughly $110 million in 2025-26, including updated baseline revenue for the health network, a pending federal/state change to an enhanced payment program, and expanded billing for behavioral health services. She also outlined $21.5 million in planned expenditure savings in 2024-25 that would grow to about $25 million the following year—measures that include eliminating about 75 vacant full-time-equivalent positions, consolidating administrative real estate, and reducing recurring COVID testing and vaccine budgets.

"We are looking at a package that has about 80% of the way to meeting those initial targets with revenue initiatives, and then the last 20% is with expenditure initiatives," Deputy Finance Officer Emily Gibbs said during the presentation.

Public commenters voiced strong opposition to potential cuts. Steven Spano, an attorney with the AIDS Legal Referral Panel, said cuts to community-based organizations would be "a cut to the bone" for services that support people living with HIV and other vulnerable residents. "We simply cannot afford to make cuts to these essential services," Spano said.

Nurses and union representatives described operational strain at hospitals and long-term care facilities. "On my unit alone this year we missed 4,795 rest breaks," said Megan Green, a nurse at Zuckerberg San Francisco General, detailing overtime and break failures and warning that contracting out security or other functions could worsen care continuity.

Commissioners acknowledged the public testimony and thanked staff for detailed materials and outreach. After discussion, a motion to approve the presented budget was moved and seconded; the commission conducted a roll-call vote and each commissioner present voted yes. The commission approved the DPH submission and directed staff to continue refining contingency proposals with the mayor's office and controller.

Next steps: DPH will submit the budget package to the city controller and mayor's office on Feb. 21; citywide contingency and negotiating work will continue through March-May, after which the mayor's proposed budget will go to the Board in June and July.

Votes at a glance: the commission approved the budget by roll call with all commissioners present voting in favor; the formal roll-call was recorded in the meeting minutes.