Members of the campaign behind Measure ER claimed victory Wednesday, saying the half-percent sales tax in Los Angeles County would help keep hospitals and clinics from collapsing under federal cuts to Medi-Cal.
Although votes are still being counted, by Tuesday evening, Measure ER had won the support of 50.59% of L.A. County voters, the majority it needs to pass.
The sales tax increase is expected to raise about $1 billion a year to fund the region's safety net healthcare system, which faces cuts from the Trump administration's One Big Beautiful Bill.
“We saved the healthcare safety net in Los Angeles County,” said Jim Mangia, president and CEO of St. John's Community Health, at a news conference Wednesday. “We won, but it was close.”
Measure ER will raise L.A. County’s sales tax temporarily from 9.75% to 10.25%. The county would start collecting the 0.5% sales tax Oct. 1. It will will sunset in 2031.
Cuts and changes under the "One Big Beautiful Bill Act" signed into law last year will cost the county's health departments about $800 million annually, while stripping hundreds of thousands of health coverage, according to Los Angeles County projections.
Accountability
The Board of Supervisors voted in February to put Measure ER before voters. L.A. County Supervisor Holly Mitchell, who introduced it, vowed Wednesday to ensure the revenue it generates is spent as promised.
“For me, today is not a celebration, but more so a declaration of our commitment to be accountable to the public, whether you voted for or against Measure ER,” Mitchell said at the news conference.
It’s a general tax, not a special tax. That means the revenue will go into the county’s general fund and is not legally earmarked for healthcare.
However, county supervisors approved a spending plan for the Measure ER revenue. It allocates 45% to fund care at nonprofit clinics for uninsured low-income residents, 22% to keep county hospitals and clinics running and smaller shares to the Department of Public Health and Planned Parenthood clinics.
The measure also establishes a nine-member oversight advisory committee to recommend, review and report publicly how the money is used.
Kathryn Barger was the lone county supervisor to vote against sending Measure ER to voters, citing cost-of-living concerns. In a statement Wednesday, Barger said her responsibility moving forward is ensuring Measure ER follows through on its promises to voters.
“Taxpayers deserve to know how these funds are being spent, whether promised outcomes are being achieved,” Barger said. “I will be a strong advocate for rigorous oversight and fiscal responsibility every step of the way.”
Affordability concerns
On Election Day, Measure ER had been trailing with about 47% of the vote, but the sales tax shifted into the leading position as votes were counted in the coming days.
“I know how important this victory has been, and it has been a nail-biter,” said county Supervisor Hilda Solis.
The main backer of the ER campaign was St. John’s Community Health, a nonprofit that operates a large network of health clinics in Southern California. The campaign, Restore Healthcare for Angelenos, raised about $9.7 million and had the backing of community clinics and healthcare workers’ union SEIU 721.
The No on ER campaign committee, led by the L.A. County Taxpayers Association, raised less than $10,000, according to L.A. County campaign finance filings.
Aidan Chao, chairman of the taxpayers group, said the close race shows rising tax fatigue among L.A. County voters.
“This is by no means a resounding endorsement of measure ER from Angelenos,” Chao told LAist Monday. “We are disappointed that special interests spent $9.7 million — vastly outspending us — to pass a tax that will hurt working-class Angelenos the most.”
Measure ER’s supporters say the tax increase is warranted, to prevent the collapse of the local healthcare system.
“We found ourselves in a situation where we had to ask an already over-taxed community, in the midst of runaway inflation and affordability crisis, to tax themselves yet again,” Mangia said. “ We would not allow healthcare to be ripped away from the people who need it the most.”
He said the current threats to L.A.'s healthcare system aren't just the federal cuts. California moved to freeze new Medi-Cal enrollment for undocumented adults starting in 2026 and add premiums in 2027.
“This was a crisis created by both the feds and the state,” Mangia said. “ Measure ER was a grueling and expensive campaign, but we're not tired yet. This is just the beginning.”
