Santa Clara County is urging support for a proposed sales tax increase that it says is critical to keeping its hospital system alive in the face of looming federal funding cuts. The measure, known as Measure A, would add a five-eighths cent sales tax and has been fast-tracked for the November 4 special election ballot. County officials warn that without additional revenue, essential public hospital services, trauma care, and safety net programs could be jeopardized. However, San Jose’s support for the proposal is far from guaranteed, as city leaders have indicated that their backing may come with conditions tied to local homelessness services.
Former San Jose Mayor and current Congressman Sam Liccardo suggested over the weekend that the city may require commitments from the county to devote more dollars to interim homeless shelters within San Jose before offering its support for the tax measure. He pointed out that many of the services provided by the county, including mental health treatment, drug rehabilitation, and casework, are already financed through state and federal funding, and channeling more of those resources into homeless support would be vital. He emphasized that these negotiations are ongoing between city and county leaders.
San Jose Mayor Matt Mahan, who has frequently sparred with the county’s Board of Supervisors, has signaled skepticism toward the tax proposal. Mahan, who has often criticized county health care investments as insufficiently addressing San Jose’s homelessness crisis, was notably absent from a recent county town hall that brought together nearly all of Silicon Valley’s lawmakers to discuss the impacts of federal spending reductions. The mayor’s hesitance underscores the divide between the county and its largest city as both grapple with balancing healthcare access and homelessness priorities.
County leaders have argued that Measure A is necessary to help offset the impacts of H.R. 1, a federal spending bill backed by former President Donald Trump that is expected to slash local revenues by $1.5 billion. They caution that these cuts will directly harm the county’s public hospital system, which operates two of the region’s three trauma centers and the only burn center in the Bay Area. The system is Silicon Valley’s largest healthcare provider for uninsured and working-class residents, with one in four of the county’s nearly two million people enrolled in Medi-Cal. About half of the county hospital system’s patients are covered by Medi-Cal, with the rest relying on Medicare and other payment sources.
Local lawmakers have stressed the stakes involved. Some argue that without new revenue, hospital closures and emergency room reductions are possible, which would further overwhelm already strained services. They also highlighted how federal cuts to programs such as the Affordable Care Act and Planned Parenthood would lead to more residents losing coverage, thereby increasing reliance on county hospitals. Others used the town hall platform to criticize San Jose’s approach to homelessness, arguing that funding should prioritize housing and supportive services rather than policing encampments.
Despite widespread concern, county officials acknowledge that even if Measure A is passed, the revenue—estimated at around $330 million annually—would still not be enough to fully close the funding gap left by federal cuts. County Executive James Williams pointed out that county hospitals provide 750 emergency room visits daily and perform approximately 2,000 surgeries each month. They also handle about half of all 911 transports in the county, underscoring the centrality of the system to public health and emergency response.
The proposal has created a complex political balancing act. On one hand, supporters argue that without additional funding, the county will be forced to make devastating cuts to health services that serve hundreds of thousands of residents, particularly the poor, elderly, and uninsured. On the other, San Jose leaders, representing the county’s largest city, want assurances that resources will also be directed toward pressing local priorities such as homelessness. The city and county have often clashed over responsibilities in addressing these issues, with Mahan pressing the county to do more to help reduce San Jose’s burden.
As the November election approaches, the future of Measure A remains uncertain. County leaders are counting on regional unity to protect the health system from collapse, but political negotiations with San Jose could determine whether the measure gains the critical support needed to pass. The debate highlights not only the financial challenges posed by federal funding cuts but also the broader tensions between local governments over how best to address intertwined crises of health care and homelessness in Silicon Valley.
