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California’s Medi-Cal sales tax playbook is spreading but inviting skepticism

April 10, 2026

In the words of Rahm Emanuel, politicians should never let a crisis go to waste – even when they’re fake. In 2025, Santa Clara County supervisors pushed a sales tax measure citing the Medicaid cuts in the federal One Big Beautiful Bill Act as a fiscal emergency requiring immediate voter action. The ploy worked. Voters approved Measure A, a five-eighths-cent general sales tax with 57% in support.

This success by healthcare unions, hospital systems, and politically aligned county supervisors created a template that other counties are attempting to replicate.

The June 2 primary ballot will test how far that script can travel. In Los Angeles County, voters will weigh Measure ER, a temporary half-cent sales tax increase introduced by Supervisors Holly Mitchell and Hilda Solis and approved 4-1 for the ballot, with Supervisor Kathryn Barger as the lone dissenter. In Contra Costa County, voters face Measure B, a 0.625% countywide sales tax increase that proponents are pitching with similar apocalyptic framing about collapsed Medi-Cal funding. The two measures will serve as the most important early referendum on California’s tax appetite before November’s even larger electoral slate arrives.

The playbook is consistent across both counties. Step one: point out HR1’s Medicaid cuts and warn that public hospitals will close without a local backstop. Step two: invoke urgency to foreclose alternatives. Step three: place a general-fund sales tax on the ballot before voters have time to scrutinize the numbers. The Restore Healthcare for Angelenos coalition, which championed Measure ER alongside Supervisor Mitchell, made clear it would have launched a signature campaign to reach the November ballot anyway if the supervisors had declined to act.

But, the strategy is showing cracks in Los Angeles. A poll conducted between March 10 and March 15 found Measure ER trailing among LA city voters, with 47% opposed and 45% in support — a warning sign given that city residents are typically more favorable to tax increases than county voters at large. Affordability concerns appear to be registering even among constituencies that ordinarily rubber-stamp local revenue measures.

To date, there isn’t any public polling available in Contra Costa, but that county’s Measure B is facing active opposition. The Contra Costa Taxpayers Association found that county staff had presented what they characterized as $307 million in ongoing annual revenue losses from HR1 — a figure that turned out to be a four-year cumulative projection. The Board corrected the tax ordinance on the same day it voted, changing the language to reflect “cumulative revenue losses of an estimated $239 million by 2029.”

Litigation is going even further. After winning modifications to the ballot label to remove argumentative and prejudicial language, taxpayers are suing the measure proponents over their ballot argument. The lawsuit, Minor v. Connelly, alleges that Measure B proponents — including a County Supervisor — submitted ballot arguments containing verifiably false claims, among them the claim that “Measure B will keep the Contra Costa County Medical Center open” despite the measure’s ordinance committing not a single penny to that specific purpose. Proponents also cited a $1.5 billion figure derived by multiplying the already-corrected $307 million by the five-year life of the tax — a number the Board had explicitly repudiated. The case is pending in Contra Costa County Superior Court.

Even setting the litigation aside, the underlying fiscal argument deserves more skepticism than the Board of Supervisors showed. The county reported $1.1 billion in unreserved general funds — more than three times the level financial experts recommend counties carry. A portion of the funding cuts attributed to HR1, involving so-called “Disproportionate Share Hospitals,” were actually mandated by the Affordable Care Act in 2010, and have been delayed by Congress more than a dozen times across four presidential administrations. Those cuts are likely to be delayed again.

Defeating Measure B may be harder than defeating Measure ER. The Bay Area’s political environment is more uniformly favorable to new government revenue than in Los Angeles County, where a broader ideological spectrum creates real opposition coalitions. Santa Clara’s 57% yes margin is a strong indicator, and the institutional money behind healthcare unions and hospital systems dwarfs what any local taxpayer group can assemble in weeks. But the fact that advocates secured a last-minute correction to the ballot’s own recitals, and are now litigating the proponents’ arguments in court, changes the narrative. This is no longer just a debate about federal policy. It is a debate about whether California counties can be trusted to tell voters the truth about why they need more of their money.

The answer to that question, in June and again in November, may determine whether the Medi-Cal county tax model rolls out to a county near you.

Jon Coupal is president of the Howard Jarvis Taxpayers Association.

Orange County Register

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California’s Medi-Cal sales tax playbook is spreading but inviting skepticism

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