What’s at stake

Measure ER asks voters to raise L.A. County's general sales tax by a half-percent for five years to backfill hospital and clinic budgets amid massive federal cuts to Medi-Cal, the state's Medicaid program. The county tax would generate an estimated $1 billion a year for providers that rely on Medi-Cal dollars to pay for patient care. The measure would increase L.A. County's sales tax rate from 9.75% to 10.25%.

Official title on the ballot: The Essential Services Restoration Act for Los Angeles County General Sales Tax Measure

Language you’ll see on your ballot:

Shall the measure to help our community address severe federal cuts enacted by the President and Congress; reduce the loss of essential services, including healthcare for County residents; reduce the risk of closing the County's four public hospitals and numerous clinics, and significant healthcare provider layoffs and other service cuts by enacting a 1/2 percent (0.5%) general sales tax for 5 years, generating approximately $1 billion annually, with independent audits, be adopted?

What your vote means

• A "yes" vote means: You support increasing L.A. County’s sales tax rate by 0.5% for five years to fund community clinics, county hospitals and other safety-net health services.
• A "no" vote means: You do not support increasing L.A. County’s sales tax rate by 0.5% for five years to fund community clinics, county hospitals and other safety-net health services.

Understanding Measure ER

Cuts and changes to Medi-Cal that the Trump administration made under H.R. 1 — the "One Big Beautiful Bill Act" signed into law last year — will cost the county's health departments about $800 million annually, or $2.4 billion over the next three years while stripping healthcare coverage from hundreds of thousands of people, according to Los Angeles County projections.

More than 3.8 million L.A. County residents, or 39% of the population, were enrolled in Medi-Cal at the start of this year. Because of federal cuts and changes, about 1.1 million of them could lose that coverage by 2028, according to an analysis by the U.C. Berkeley Labor Center.

L.A. County’s Department of Health Services, which oversees four public hospitals and about two dozen clinics that serve many Medi-Cal patients, will be hardest hit, the county projects. That department alone expects $700 million in annual revenue loss by 2028-2029. (It had an operating budget of more than $6 billion last year.) Nonprofit health centers and clinics that rely on Medi-Cal revenue in turn anticipate cutbacks, layoffs and closures.

Measure ER proposes a temporary, half-percent, general sales tax in L.A. County that is expected to generate about $1 billion a year to offset those federal cuts. If it passes, Measure ER will cost L.A. County residents an extra half-cent in sales tax on a $1 purchase, an extra 50 cents paid on a $100 purchase or an extra $5 on a $1,000 purchase.

L.A. County’s current sales tax rate is 9.75%. If Measure ER passes, L.A. County’s sales tax will increase to 10.25%.

How we got here

Measure ER is being put before voters at the request of the L.A. County Board of Supervisors. Supervisor Holly Mitchell introduced a motion in coordination with a coalition led by St. John’s Community Health, one of the largest federally qualified health centers in Los Angeles.

They believed the measure had a better chance of success in the June primary election than on a November ballot crowded with other local and tax measures. They also say it’s urgent, with cuts coming in July. Supervisors crafted a spending plan for the sales tax and voted 4-1 in February to put the measure on the June primary ballot. Supervisor Kathryn Barger voted “no” and argued that L.A. County residents already carry a heavy tax burden. 

The history — and context — behind Measure ER

Measure ER is structured as a general tax, not a special tax. That means the revenue technically goes into the county’s general fund with no earmarked purpose.

But L.A. County Supervisors approved a spending plan that allocates 45% of that revenue to fund free low-cost care at nonprofit clinics for uninsured low-income residents, 22% to keep county hospitals and clinics running and 10% to the Department of Public Health for disease prevention and health inspections.

That spending plan is not legally binding, but Measure ER’s proponents vow to deliver transparency and accountability through annual county audits. The measure also would set up a nine-member oversight advisory committee to recommend, review and report publicly how the money is used.

California law puts caps on how much sales tax local governments can stack on top of the state’s base sales tax rate of 7.25%. Measure ER would push the county sales tax rate to 10.25%, right at the legal ceiling. Cities looking to levy their own additional sales taxes would need special legislative approval to exceed the cap.

What it takes to pass

Because Measure ER is a general tax and not a special tax, it only needs support from a simple majority of voters (50% plus one) in order to pass. If it were a special tax, it would require two-thirds approval.

A recent poll shows 47% of likely voters opposing Measure ER and 45% supporting it. If a majority of voters approve Measure ER, L.A. County would begin imposing the additional 0.5% sales tax in October 2026. The tax would sunset in 2031.

What people who support it say 

A coalition of health providers called Restore Healthcare for Angelenos argues that the tax is a temporary price to pay in order to protect L.A. County’s collective health system from total collapse.

The coalition says over a third of residents will lose healthcare in some L.A. County cities without Measure ER. Many health centers anticipate losing about 25% of their Medi-Cal revenue, though estimates vary. As more people lose coverage, clinics will close and healthcare premiums and public health costs will rise for everyone, proponents say, including those with private insurance.

“ I'd say as a countywide safety-net system, this is plan A, B and C,” Dr. Atul Nakhasi, vice president of government affairs at MLK Community Healthcare, told LAist. “We can't keep Angelenos healthy without this.”

Supervisor Mitchell said a sales tax isn’t the ideal way to backfill federal Medi-Cal cuts but argued the county has a responsibility to keep healthcare services available.

“My choices were limited,” she told LAist. “This federal administration prioritized tax breaks over Medi-Cal recipients.”

Key supporters include: St. John's Community Health, Service Employees International Union Local 721, California Community Foundation, Los Angeles County Medical Association and the Planned Parenthood Advocacy Project.

Website: Full list of endorsements here at YesOnER.LA

What people who oppose it say

Officials representing dozens of L.A. County cities from Norwalk to Glendale have come out against Measure ER, along with taxpayer groups and Supervisor Barger. They argue the tax disproportionately burdens low-income residents, with sales tax rates already above 11% in some L.A. County cities.

“Los Angeles County residents are already carrying one of the heaviest tax burdens of any major region in the country, and I believe any ask of taxpayers must come with real accountability and a clear, enforceable purpose,” Barger said.

Many smaller L.A. County cities already are fed up with the aftermath of Measure A, the half-percent county sales tax funding homelessness, which they say their residents pay much more into than they get out of. Many cities also want to use that tax capacity themselves.

“Once local tax capacity is used up at the county level, it becomes much harder for cities to respond to their own fiscal needs,” Annette Ghazarian, spokesperson for the City of Glendale, said.

Aidan Chao, chairman of the L.A. County Taxpayers Association, said he's concerned the measure's general-tax structure gives the county too much discretion over spending and he would have preferred it be designated a special tax.

Key opponents include the California Contract Cities Association, L.A. County Taxpayers Association, L.A. County Supervisor Kathryn Barger and various cities and city officials.

Potential financial impact

According to L.A. County, the sales tax increase imposed by Measure ER would raise approximately $1 billion annually between October 2026 and 2031, for a total of about $5 billion.

Follow the money

St. John’s Community Health has contributed at least $4 million to the campaign committee backing Measure ER, as of early April.

The California Community Foundation, a philanthropic nonprofit, and the Service Employees International Union Local 721 each contributed $200,000. The Los Angeles County Medical Association Political Action Committee gave $50,000. 

As of early April, cities and groups opposing Measure ER have yet to file campaign information with the L.A. County registrar/recorder-county clerk.

Further reading

• LA voters will decide on sales tax increase to cover federal healthcare cuts (LAist)
• Reckoning with state and federal cuts, Los Angeles safety-net clinics push for new tax (LAist)
• Fight or flight? Some California nonprofits won't remain silent in face of Trump budget slashing (LA Times)
• LA County turns to private foundation to backfill public health funding cuts (LAist)
• GOP cuts will cripple Medicaid enrollment, warns CEO of largest public health plan (LAist)