California voters are divided over county health sales taxes

from Ana B. IbarraCalMatters

This story was originally published by CalMatters. Sign up for their newsletters.

California voters are split on whether they want to pay more in sales tax to support health care: Los Angeles County’s measure clings to a narrow lead, while Contra Costa County suffered a defeat that experts attributed to growing anxiety about the cost of living.

In Los Angeles, Measure ER, which proposes a half-cent sales tax for the next five years, was leading Tuesday night with 50.59 percent of the vote. The measure requires a simple majority to pass. Supporters estimate that this tax, which would not apply to groceries and drugs, could generate $1 billion a year.

Voters in the county have historically supported taxation to fund public initiatives, said Mike Bonin, executive director of the Pat Brown Institute for Public Affairs at California State University, Los Angeles. But Measure ER proved a tough sell.

Even among Democrats and progressives, Bonin said, there is fatigue over the measure’s regressive nature — meaning sales taxes tend to fall harder on lower-income residents than the wealthy. “It’s hard for people and that’s why there was some resistance to it, which is why I think it took until (Monday) to get over the hump,” Bonin said.

In Contra Costa, Measure B would impose a five-eighths tax, generating about $150 million a year. Voters rejected the measure, with 57 percent of voters opposed at the last count.

“We’re in a tough time for middle-income people,” said Mark Yoffe, president of the Contra Costa Taxpayers Association, which led the campaign against Measure B. “I think the fact that gas went up to $6 during the campaign was probably a wind (at) our backs.”

The results contrast with Santa Clara County, where voters last fall approved a sales tax with 57 percent of the vote.

Why the counties turned to the voters

Both measures were a response to the federal spending package passed by Congress and President Trump last summer. Due to changes in Medicaid, also known as Medi-Cal in California, counties are bracing for a surge in the number of uninsured people. And as people lose coverage but continue to seek care, safety net providers lose significant revenue. In Los Angeles, sales tax money would also support the county’s public health, Planned Parenthood services and emergency preparedness.

Coalitions of safety net providers backed the measures, warning that without new revenue they could be forced to cut hours, lay off staff or close facilities.

“There’s no getting around this,” Louise McCarthy, CEO of the Los Angeles County Association of Community Clinics, said on election night. “This is a situation that is being forced upon us. No amount of local solutions made this happen, and no amount of local, no-revenue solutions can solve the problem we’re in now.”

New ratings from the UC Berkeley Labor Center project that 2.2 million more Californians will be without health insurance by 2030 due to Trump’s spending bill and the state’s recent actions. That would nearly double the state’s uninsured rate to 14.7 percent and erase much of the state’s progress over the past decade in getting everyone insured. Counties that run clinics and hospitals say federal policies and funding cuts — and insufficient support from the state — have left them with big budget holes and looking for new ways to generate revenue.

Los Angeles County Supervisor Holly Mitchell, who introduced Measure ER, called the sales tax a “last resort,” saying the county already had a hiring freeze, limited overtime and used emergency reserves. The county estimates it will lose about $2.5 billion over the next three years due to federal cuts.

The measure was opposed by some cities, anti-tax groups and County Supervisor Catherine Barger, who represents the region’s sprawling northern end neighborhoods. Lancaster and Palmdale lead the nation sales tax rates of 11.25%, and in Contra Costa County, sales taxes in Pinole and El Cerrito in Contra Costa have reached 10.25%. Both counties are required Legislative approval to pursue new sales taxes because their measures exceed state limits.

The sales tax measures came as half Californians pointed to the cost of living as a major government problem.

Susan Shelley of the Howard Jarvis Taxpayers Association, which opposed both measures, said the proposals were misleading. Because supporters structured the measures as general sales taxes — meaning counties can legally use the funds as they see fit — instead of targeted health care taxes, they required only a simple majority, rather than the two-thirds threshold that would require a special tax.

For other counties that may consider taking similar measures to voters: “I hope this sends the message that people are taxed enough,” Shelley said.
Jim Mangia, CEO of St. John’s Community Health, said the county will use the sales tax revenue as intended: for health care.

“This is a temporary solution, and we will not stop fighting for the long-term federal funding that Angelenos deserve,” he said.

Counties are pressing the state for help

Contra Costa County operates one hospital and 11 clinics. Supporters of the measure estimated it would face a deficit of at least $1 billion over five years due to funding losses, though opponents disputed those figures.

County Supervisor John Gioia said revenue from the tax would protect critical services and help provide for people. Under Trump’s budget bill, counties will soon have to check people’s Medicaid eligibility every six months instead of once a year, and adults without children will face new work reporting requirements.

Gioia said the tax could have funded additional eligible workers and supported the county’s program that provides essential health care services to people without insurance options.

Los Angeles and Contra Costa looked to Santa Clara County as a model. Voters there approved a similar measure last November; it went into effect in April, and county officials expect it to generate roughly $337 million a year. The the county distributes those dollars to emergency services, cardiac care, mental health and maternity services, among other areas.

But even that revenue covers only one-third of Santa Clara’s projected deficit, said County Executive James R. Williams. The county is still cutting and reorganizing staff and services to balance its budget.

“We have been very clear, from the very beginning, when we put this emergency measure on the ballot, that we expect over a billion dollars a year in lost revenue as a direct result of ‘federal spending cuts,'” Williams said. The missing link, he said, “is that the state must do its part.”

The California State Association of Counties is evaluating the federal cuts will cost the 58 counties up to $9.5 billion—a price local officials say they can’t handle on their own. The association has been pushing for additional state funding for months without much success. Gov. Gavin Newsom and lawmakers have until next week to finalize the 2026-27 budget.

“For most California counties, raising local taxes to absorb the impact of (federal cuts) is not feasible,” said Graham Knauss, the association’s chief executive officer. “And the fact that counties are even being forced to consider this is unacceptable.”

Kristen Huang contributed to this report.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.