On July 30, the head of Santa Clara County’s largest healthcare foundation set up the “Save Our Local Hospitals” campaign committee. A week later, the County Board of Supervisors approved a plan to raise county taxes. Then, a week after that unanimous vote, the county’s largest physicians’ union contributed $250,000 to the pro-sales tax organization. The timeline, according to campaign disclosure documents, was a perfect one, two, three.

While the “Save Our Local Hospitals” campaign in support of the partial-cent sales tax increase was described in an Aug. 22 social media post following weeks of county-hosted press and community meetings, Fair Political Practices Commission forms show the organization was formed by Valley Healthcare Foundation President Michael Elliot, well ahead of the public vote.

A week before the measure came before supervisors as a 24-hour emergency item at a special meeting, Elliot wrote “Sales Tax Measure in Santa Clara County: TBD (To Be Determined)” under the list of proposed measures on the form.

Elliot’s actions ahead of the vote proved useful, as public discussion of a proposed local sales tax was unannounced until hours before the supervisors’ mid-afternoon meeting.

Elliot said he could not remember when he informed County Executive James Williams of his campaign, but said he does not believe he influenced county leadership’s decisions.

“James is certainly aware of a committee existing now,” Elliot said. “That’s not a conversation you have with a county executive, that you’re forming a political committee.”

Williams did not return this media organization’s calls regarding Measure A.

The Valley Healthcare Foundation had $18.3 million in assets according to the nonprofit’s latest publicly accessible financial records. Elliot said everyone working in the county’s healthcare system knew a sales tax ballot measure would be proposed, which is why he launched the campaign ahead of any county actions.

“There is really no scenario where we go without a temporary source of local revenue, we get through these next five years without having to potentially close hospitals in an emergency,” he said.

County Executive James Williams drafted the proposed tax increase and received unanimous approval from the Board of Supervisors to place the item on the Nov. 4 ballot.

The first big contribution to the pro-tax campaign, $250,000, came from Valley Physicians Group. The group played a role in shaping public discussion surrounding the proposed ballot measure.

Dr. Rachel Ruiz, chair of the physicians’ union, said the group supports the sales tax increase because county hospitals need a safety net to protect the health care system from the projected $1.3 billion in federal healthcare funding cuts from H.R.1.

“Everyone's going to have to make sacrifices, whether it's time, whether it's money, whether it's vacation, whatever it is, we need to make sacrifices,” she said. “But in a way that also isn't stretching someone to the point where they quit and leave, definitely.”

The group made its $250,000 contribution to “Save Our Local Hospitals” on Aug. 14—nearly equivalent to the median salary of a Valley Physician Group-represented worker, said Ruiz.

The county’s most highly compensated employees are Valley Healthcare doctors. The top 20 make an average of $1 million per year in salary and benefits.

Though the proposed sales tax increase alone will not solve the county’s billion-dollar shortfall, Ruiz said Valley Physicians Group-represented workers would not respond positively to a possible salary reduction.

According to Transparent California, Ruiz earned $510,203.22 in salary, overtime and benefits in 2021, though her compensation has been in the $246,318 to $336,694 range in subsequent years. She describes her salary as being on the lower end of the pay scale for her position.

She said the proposed ballot measure, set to generate $330 million over five years if passed by voters this November, is the county’s best hope to save all essential services within the hospital system.

“We want a seat at the table … because we're on the ground, working in clinics, and we can tell you where things where healthcare workers can make things more efficient,” Ruiz said.

Santa Clara County Employee Management Association contributed $75,000 to the pro-sales-tax committee, according to FPPC filings. Association representative Adam Cole said the union supports the tax initiative because represented workers share the same concerns. KMA Emergency Services, dba WestMed Ambulance Service, has contributed $100,000, and Abode Services of Fremont has contributed $50,000, according to FPPC filings.

The county’s largest nurses’ union, the Registered Nurses Professional Association and the county Democratic Party also have endorsed the sales tax increase.

“This is an issue that really affects Santa Clara County, specifically in California, more than a lot of our other counties here,” Cole said. “We’re now a four-hospital system and then over one dozen clinics throughout the community — we are one of the cornerstone healthcare providers.”

Overwhelming support from county leaders has so far failed to sway elected officials like San Jose Mayor Matt Mahan, who is dealing with a fiscal crisis in his own city, and U.S. Congressmember Zoe Lofgren.

“I don’t think this sales tax increase is a great choice,” Lofgren said at a county town hall earlier this month. “I do think it’s a better choice than closing the emergency rooms, so I’m going to vote (yes).”

Supervisor Betty Duong, who also expressed initial reservations about the proposal during the Aug. 7 emergency meeting, has since said she believes it to be necessary for the sake of both insured and non-insured residents.

The proposed sales tax is a general purpose sales tax, which means spending from its revenues is not limited to a specific purpose, such as health care. The sales tax increase on the Nov. 4 ballot requires only a simple majority of county voters to pass.

If approved by voters, the countywide rate would rise to 9.75%. Under the plan, purchases made in San Jose and Milpitas, which impose additional city sales taxes, would be taxed at 10%. Campbell businesses would collect 10.5%—the county’s highest rate—while Los Gatos consumers would pay 9.875%.

Aug. 7 was the final day to add measures to that ballot, which will also include a special election for County Assessor. County officials said the higher taxes are needed to close a projected billion-dollar budget shortfall they attribute to the federal government’s “Big Beautiful Bill.”

Regardless of the ballot measure, Duong said the county will have to take a hard look at consolidating healthcare services to ensure the most vulnerable residents are taken care of.

“Whether you live in Palo Alto, and go to Stanford Hospital or Willow Glen and go to Good Sam, you will face crowded emergency rooms, longer wait times for healthcare services because of the (federal cuts) ripple effect,” Duong said.

Note: This article was updated to remove an incorrect reference to the Union of American Physicians and Dentists.