California voters delivered mixed results on local sales tax measures intended to support health care services, with Los Angeles County’s proposal holding a slim lead while a similar measure in Contra Costa County was rejected.
In Los Angeles County, Measure ER, a proposed half-cent sales tax for five years, was ahead with 50.59% of the vote as of Tuesday evening. The measure needs a simple majority to pass. Supporters have said the tax, which would not apply to groceries or medications, could raise about $1 billion annually.
Los Angeles County voters have often supported taxes for public programs, said Mike Bonin, executive director of the Pat Brown Institute for Public Affairs at Cal State Los Angeles. But this measure faced a tougher political climate, particularly as residents continue to feel pressure from the cost of living.
Bonin said even some Democrats and progressive voters were uneasy about relying on a sales tax, which is often considered regressive because it takes a larger share of income from lower-income households than from wealthier residents.
“This is tough on people, and so there was some resistance to it,” Bonin said, adding that the measure did not move ahead until late in the count.
In Contra Costa County, Measure B would have imposed a five-eighths-cent sales tax expected to generate roughly $150 million a year. Voters turned it down, with 57% opposed in the latest count.
“We’re in a difficult period for middle-income people,” said Marc Joffe, president of the Contra Costa Taxpayers Association, which led the opposition campaign. He said rising gas prices during the campaign likely helped opponents make their case.
The outcomes differ from Santa Clara County, where voters last fall approved a similar sales tax with 57% support.
The Los Angeles and Contra Costa measures were prompted by concerns over federal health care funding changes approved last summer by Congress and President Trump. County officials and health care providers say changes to Medicaid, known in California as Medi-Cal, are expected to increase the number of uninsured residents. As more people lose coverage but continue to need medical care, safety-net clinics and hospitals could lose major revenue.
In Los Angeles County, Measure ER revenue also would support public health programs, Planned Parenthood services and emergency preparedness.
Health care providers backed both county measures, warning that without new funding, clinics could be forced to cut hours, reduce staff or close sites.
“There’s no way out of this,” Louise McCarthy, chief executive of the Community Clinic Association of Los Angeles County, said on election night. “This is a situation that is being forced upon us. No local decisions made this happen, and no local decisions without revenue can solve the problem we’re in now.”
New projections from the UC Berkeley Labor Center estimate that 2.2 million more Californians could be uninsured by 2030 because of Trump’s spending law and recent state policy decisions. That would push California’s uninsured rate to 14.7%, nearly doubling it and undoing much of the state’s progress in expanding coverage over the past decade.
Counties, which operate public hospitals and safety-net clinics, say federal changes and funding reductions are creating large budget gaps. Local officials also say the state has not provided enough support to offset the losses.
Los Angeles County Supervisor Holly Mitchell, who introduced Measure ER, described the tax as a last resort. She said the county had already frozen hiring, restricted overtime and used emergency reserves. County officials estimate federal cuts will cost Los Angeles County about $2.5 billion over the next three years.
The measure drew opposition from some cities, anti-tax organizations and Los Angeles County Supervisor Kathryn Barger, whose district includes the county’s northern exurban communities. Sales tax rates are already among the highest in the state in some parts of Los Angeles County, including Lancaster and Palmdale, where rates are 11.25%. In Contra Costa County, Pinole and El Cerrito have sales tax rates of 10.25%.
Both counties needed approval from the state Legislature to place the proposed taxes before voters because the increases would exceed state sales tax limits.
The votes came as Californians continue to identify affordability as a leading concern. A recent Public Policy Institute of California survey found that half of Californians named the cost of living as the state’s top issue.
Susan Shelley of the Howard Jarvis Taxpayers Association, which opposed both measures, argued the proposals were presented in a misleading way. Because the measures were written as general sales taxes rather than taxes legally reserved for health care, they required only a simple majority to pass instead of the two-thirds threshold required for a special tax.
Shelley said she hopes the results caution other counties against pursuing similar measures.
“I hope it sends the message that people are taxed enough,” she said.
Supporters in Los Angeles County said the money would be used for health care as promised.
“This is a temporary solution, and we will not stop fighting for the long-term federal funding Angelenos deserve,” said Jim Mangia, chief executive of St. John’s Community Health.
Contra Costa County operates one hospital and 11 clinics. Supporters of Measure B estimated the county could face a deficit of at least $1 billion over five years because of funding losses, though opponents disputed that figure.
County Supervisor John Gioia said the tax revenue would have helped preserve core services and keep residents insured. Under Trump’s budget bill, counties will have to verify Medicaid eligibility every six months instead of once a year. Adults without children also will face new work reporting requirements.
Gioia said the measure could have paid for more eligibility workers and strengthened the county program that provides basic health services to residents who have no other insurance options.
Los Angeles and Contra Costa counties looked to Santa Clara County as a model. Voters there approved a similar tax in November, and it took effect in April. County officials expect it to generate about $337 million a year. Santa Clara County is directing the money to emergency services, cardiac care, mental health, maternity care and other programs.
Even so, Santa Clara County Executive James R. Williams said the new tax revenue covers only about one-third of the county’s projected shortfall. The county is still cutting and reorganizing staff and services to balance its budget.
“We were very clear, right from the outset, when we put this emergency measure on the ballot, that we were staring down over a billion dollars a year in revenue losses” because of federal cuts, Williams said. The missing piece, he added, is state support.
The California State Association of Counties estimates federal cuts could cost California’s 58 counties as much as $9.5 billion. County leaders say local governments cannot absorb that level of loss on their own. The association has been asking the state for more funding for months, but Gov. Gavin Newsom and lawmakers face a deadline next week to finalize the 2026-27 state budget.
“For most California counties, raising local taxes to absorb the impacts of federal cuts is not feasible,” said Graham Knaus, the association’s chief executive. “And the fact that counties are even being forced to contemplate it is unacceptable.”
Original source: CalMatters
