Myths v Facts

Fact

The $300 million figure is a cumulative total projected through 2029 — not an annual loss. Supervisor Candace Andersen, the lone no vote, flagged this error before the vote. County staff had posted that the county faced “$307 million ongoing” annual losses; after the Contra Costa Taxpayers Association pointed out the error, staff confirmed the figure is cumulative across four years.

The Board then revised the ballot ordinance’s Recital H the same day it voted, correcting “annual revenue losses exceeding $300 million” to “cumulative revenue losses of an estimated $239 million by 2029.” This is not a rounding difference — framing a four-year cumulative total as annual makes the gap appear seven to eight times larger.

A separate figure in the county’s own budget slides is a projected $1.074 billion cumulative deficit. This does not represent funding cuts alone — it compounds in the county’s own assumed 3% annual expenditure growth over six years, even as revenue stays flat. Much of the projected deficit is driven by the county’s own spending trajectory, not by federal or state funding reductions.

Fact

The county’s own budget materials are titled “HR1 and State Budget Impacts.” Looking at the actual figures from the March 3 presentation: the cumulative state legislative impact is approximately $187 million, while the federal component totals $322 million. That means roughly 37% of the projected revenue loss comes from California state decisions — not from Congress.

Lumping state-driven cuts together with federal cuts and attributing everything to Washington gives voters a misleading picture of where decisions were actually made and, crucially, who could reverse them. Sacramento controls the state portion. Voters and state legislators could address it without a new countywide sales tax.

Fact

Disproportionate Share Hospital (DSH) payments are federal supplemental payments made to hospitals that serve a high share of Medicaid and uninsured patients — hospitals like Contra Costa Regional Medical Center. DSH cuts have nothing to do with HR1. They were originally mandated by the Affordable Care Act in 2010, on the theory that expanding health coverage would reduce uncompensated care. Congress has since delayed those cuts more than a dozen times on a bipartisan basis.

Critically, the county’s own March 3 budget presentation acknowledges this at the bottom of its assumptions box: “As of February 2026, DSH cuts were delayed until 10/1/2027.” This pattern of repeated, bipartisan postponements has now stretched across four presidential administrations. There is every reason to expect Congress will address DSH cuts again before they take effect — and no basis for attributing them to HR1 or the current administration.

Fact

HR1 passed through budget reconciliation, which required only a simple Senate majority. A future Congress can modify, delay, or repeal any of its provisions by the same process. Congressional midterms in November 2026 will determine control of the House starting in January 2027.

Many of HR1’s most significant Medicaid changes do not fully phase in until 2027 or 2028, meaning a course correction is politically possible before the largest impacts are felt. As the county’s own budget table shows, the federal legislative impact in FY25-26 is $0. Committing Contra Costa taxpayers to five years of higher sales taxes based on projections that may never materialize is premature.

Fact

California voters may be asked in November 2026 to approve a one-time 5% wealth tax on the roughly 200 billionaires living in the state, specifically designed to offset Medicaid cuts. Sponsored by SEIU-UHW and backed by U.S. Sen. Bernie Sanders and Rep. Ro Khanna, the measure is collecting signatures to qualify for the ballot. If it qualifies and passes, it is projected to raise approximately $100 billion directed primarily toward health care.

Supervisor Gioia dismissed waiting for this option, but the county’s own corrected figures show HR1-related losses in 2026 and 2027 are limited and phased in gradually. The county has time to monitor both the November ballot and Congressional developments before committing to a permanent five-year tax structure.

Note: The billionaire tax faces real opposition, including from Gov. Gavin Newsom, and its passage is uncertain. But it is a genuine alternative worth assessing before locking voters into a five-year sales tax.

Fact

A significant portion of projected Medi-Cal enrollment and cost increases involves coverage for undocumented immigrants, which California funds through state-only dollars. Asking those enrollees to share some costs through modest deductibles and copayments — as most insured Americans already do — is a reasonable policy conversation the county has not had publicly.

Such cost-sharing would not eliminate coverage but would reduce the county’s net costs. Rather than asking all residents to pay a higher sales tax on every purchase, the county could explore whether those receiving services can contribute to them, consistent with standard practice in most health plans. No serious analysis of this option has been presented to voters.

Fact

More frequent eligibility checks are a commonsense program-integrity measure. People die, move out of state, find employment above the income threshold, or gain employer coverage — and programs that only check once a year continue paying for ineligible enrollees for months.

HR1 requires semi-annual redeterminations starting in 2027 and mandates quarterly cross-checks against the Social Security Death Master File to remove deceased enrollees. These are data-matching tasks that can and should be automated, limiting the burden on enrollees and county staff. Accurate eligibility rolls preserve resources for those who genuinely qualify.

Fact

The HR1 work requirement — officially a “community engagement requirement” — is far more flexible than critics suggest and carries an extensive list of exemptions. It applies only to non-disabled adults aged 19–64 enrolled through the ACA Medicaid expansion, and can be satisfied by any combination of employment, job training, school enrollment (at least half-time), or volunteer work — 80 hours per month total.

Fully exempt are: pregnant women and new mothers (up to 12 months postpartum); parents and caregivers of children age 13 or younger; foster youth under 26; veterans with a total disability rating; people who are medically frail (including those with mental illness, substance use disorders, or physical and developmental disabilities); people receiving SSI or SSDI; anyone already meeting SNAP or TANF work requirements; and people in substance use treatment programs.

The people most likely to be affected are able-bodied working-age adults without young children. A legitimate concern, supported by experience in Arkansas and Georgia, is that some eligible people may lose coverage due to paperwork complexity. The county and state should focus on automated verification and clear outreach to minimize that risk — not use it as a justification for a permanent tax increase.

Fact

The county’s own budget slide confirms that most major impacts are deferred. The federal legislative impact in FY25-26 is $0 — the losses ramp up only in FY26-27 and beyond. DSH cuts are delayed until October 2027 per the county’s own presentation. Work requirements do not begin until January 2027. Six-month eligibility redeterminations also start in 2027. The county has absorbed about $24 million in the current fiscal year — a real but manageable figure relative to its reserves.

The Board voted to place Measure B on the ballot the same day it had to correct its own central financial figure from an annual to a cumulative number — and to reduce it from $307 million to $239 million. That is not a sign of a well-developed case for urgent action. Asking voters to approve a five-year countywide tax based on projections the county itself had to revise — before federal rules are finalized, before the November 2026 ballot is set, and before a new Congress is seated — is putting the cart well before the horse.