The Incredible Shrinking Revenue Loss

The figure used to justify Measure B has already been revised downward — from a $307 million annual loss to a $239 million cumulative figure that already accounts for a Congressional DSH delay. And given that Congress has postponed those same hospital cuts more than a dozen times before, the number is likely to shrink again before Measure B taxes expire.

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How the revenue loss figure has changed

1
The Original Claim — before March 3, 2026

County materials: “$307 million in ongoing annual losses”

$307M / year

Before the March 3 Board of Supervisors vote, county materials — including content posted on the county website — described the projected loss as $307 million in ongoing annual losses. At that rate, the five-year cost to the county would approach $1.5 billion. This figure was prominently cited by Measure B supporters as proof of an emergency requiring immediate tax action.

2
Corrected the same day the Board voted — March 3, 2026

CoCoTax identifies the error; Supervisor Andersen cites the finding and votes No; staff revises Recital H

$239M cumulative through FY 2028–29

The Contra Costa Taxpayers Association identified that the $307 million figure was a cumulative four-year total, not an annual loss. Supervisor Candace Andersen, the lone no vote, cited this finding in her remarks before the board voted and gave it as a key reason for her opposition. County staff confirmed the error on the record. The board revised Recital H of Resolution 2026-40 — the document placing Measure B on the ballot — changing the figure to “cumulative revenue losses of an estimated $239 million by 2029.”

It is important to note that the corrected $239 million figure already incorporates a Congressional delay of Disproportionate Share Hospital (DSH) payment reductions to September 30, 2028, enacted by the Consolidated Appropriations Act of 2026 (H.R. 7148) and signed into law in February 2026 — weeks before the board vote. The $239M is not a pre-DSH-delay number; the DSH delay is already baked in.

Framing a four-year cumulative loss as an annual loss makes the funding gap appear seven to eight times larger than it is in any given year. The board voted to place Measure B on the ballot anyway — using the corrected figure that was a fraction of what voters had been told.
3
What comes next — the most likely prediction

Congress will almost certainly delay DSH cuts again before 2028 — shrinking the figure further

$239M → lower still

DSH cuts were first mandated by the Affordable Care Act in 2010. In the 15 years since, Congress has delayed them on a bipartisan basis more than a dozen times, across four presidential administrations and multiple changes in House and Senate control. They have never once actually taken effect.

The current deadline is September 30, 2028. There is no reason to expect this deadline to be treated differently from all the previous ones. Hospitals that serve large Medicaid and uninsured populations — including safety-net hospitals like Contra Costa Regional Medical Center — have powerful Congressional advocates on both sides of the aisle, and the political incentives for another extension remain exactly what they have been for 15 years.

Bottom line: The $239 million figure assumes DSH cuts finally land in 2028. If Congress delays them again — as it has every single time before — the cumulative revenue loss justifying Measure B drops further. Voters are being asked to commit to five years of higher taxes based on a figure that is almost certainly going to be revised downward again before those taxes expire.

Document: Contra Costa Health Presentation — March 3, 2026

Contra Costa Health budget forecast presentation slide from March 3, 2026 board meeting
Slide from the March 3, 2026 Contra Costa Health budget forecast presentation (RES-2026-40). Note the timeline of impacts: federal impacts are zero in FY 2025–26. Tax collection under Measure B begins October 2026 — a year before most cuts take effect. The footnote already acknowledges DSH cuts are delayed to 10/1/2027; the subsequently enacted Consolidated Appropriations Act pushed that deadline to 9/30/2028.

Document: Revised Measure B Ordinance — March 3, 2026

Revised Measure B ordinance showing corrected Recital H, March 3 2026
The revised Resolution 2026-40, showing the corrected Recital H. The language was changed from “$307 million in ongoing annual losses” to “cumulative revenue losses of an estimated $239 million by 2029” — on the same day the board voted to put Measure B on the ballot.
A

Why this matters for voters

The ballot argument for Measure B was written after these corrections. Voters deserve to know that the figure used to justify the emergency has already been cut by more than 90% on a per-year basis — from $307 million per year to roughly $60 million per year — and that even the corrected figure rests on a DSH deadline that Congress has never once honored.

A county that holds over $1.1 billion in unreserved general fund reserves can absorb $60 million per year in health funding losses without asking every shopper in Contra Costa to pay a higher sales tax for five years. And if DSH cuts are delayed again — the overwhelming historical likelihood — even that figure falls further.

The right question for voters is not “should we protect health services?” — of course we should. The right question is: did the county give us accurate numbers, and is a five-year countywide sales tax the right tool for a problem whose actual size is still shrinking?

B

The timing mismatch is still unaddressed

Per the county’s own March 3 budget slide, federal legislative impacts on health services are zero dollars in FY 2025–26. Work requirements under HR1 begin in January 2027 at the earliest. DSH cuts are delayed until at least September 2028 — and, based on history, likely longer.

Measure B taxes start collecting in October 2026 — before any of the major HR1 provisions take effect. Voters would be locked into five years of higher taxes to address a problem whose actual scope is still being determined by Congress, the courts, and state regulators.

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