☆ Should new state healthcare policy justify a rapid tax hike for Santa Clara County? (2/4)
SC Supes say the sky is falling on the county hospital system, and the only way out is yet another tax hike. But SVTA Board Member Elizabeth Brierly wonders how catastrophic this so-called funding emergency really is. She warns that Measure A is a “regressive sales tax on the working poor who don’t rely on the county, who have insurance, and who follow the rules.” An Opp Now exclusive Q&A.
[Editor’s note: Congress’s “One Big Beautiful Bill Act” changes federal Medicaid reimbursements by trimming certain match rates and penalizing states that fund full-scope benefits for undocumented adults. In response, California’s budget halts new enrollment of undocumented adults in 2026, though emergency and maternity care remain and current enrollees keep coverage. The law also adds work or volunteer requirements for many able-bodied adults beginning in 2027. Santa Clara officials warn these changes will mean fewer federal dollars to offset uncompensated care, and have placed Measure A, a five-eighths-cents per dollar emergency sales tax, on the ballot to protect the county hospital system.]
Opportunity Now: So, California changed the Medi-Cal rules so that soon the state will stop enrolling undocumented immigrants for full scope health coverage, and able-bodied adults will have to pass a work requirement to qualify for health coverage under Medi-Cal.
The Santa Clara County Board of Supervisors is saying that because of the lost funds that stem from these changes to the program, they need to hike the countywide sales tax.
Is this just fear mongering, or will this sales tax address a legitimate county budget problem?
Silicon Valley Taxpayers Association: It will not, because the $1.65 billion tax increase is unrestricted and can literally be spent on anything. There are zero guardrails to ensure the money would be spent as marketed. On the federal reimbursement changes for noncitizens and work/volunteer requirements there is an informative webinar from the California Department of Healthcare Services.
The new work requirements are to put in 80 hours of work, volunteerism, or even going to school, in a month before you apply for Medi-Cal, and the same in the month before renewing coverage. That’s 20 hours a week, for just a month before and during enrollment, just 160 hours a year and with numerous exemptions.
ON: And people who are pregnant, disabled, elderly, and parents of young children are not required to undergo the new work requirements?
SVTA: That's correct.
ON: But even so, surely there is still going to be some funding lost from the changes. Without the Measure A sales tax increase, how will people’s vital healthcare get paid for?
SVTA: The overwhelming majority of people do not utilize county social welfare services. Most residents locally and statewide receive health care through private insurance, Medicare, or their employer.
This is a regressive sales tax on the working poor and small business.
ON: But the healthcare system is complex and interconnected, won't funding cuts impact everybody?
SVTA: The county will tell you, ‘Well, if reimbursements are limited to annual inflation (CPI), it's going to create a ripple effect through the system, increasing health care costs for everyone out there.’ For eligible reimbursements it is not a cut but simply capping the growth at CPI.
The political campaign is portraying this as if this money is going to keep the county hospital system open. It's going to stay open if Measure A fails. It's just going to not provide certain services determined by the state legislature. These include certain services to foreign nationals and people that don't meet those work or volunteer hour requirements. Again, that’s based on the California state legislature. If the legislature wants to continue funding these services, it can do so from the $340 billion state budget.
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