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Supporters of a new Los Angeles County half-cent sales tax rallied Wednesday to celebrate what they framed as a historic win for the region’s cash-strapped healthcare system.

After a rocky election night that showed the tax lagging, supporters claimed victory Tuesday after the latest vote tally pushed Measure ER further over the 50% margin needed to pass. The measure would impose a new half-cent sales tax countywide, with the proceeds going toward local hospitals and clinics hit by federal funding cuts.

Jim Mangia, the chief executive of St. John’s Community Health who helped craft the measure, summed up the campaign as “grueling and expensive.”

“We had to ask an already overtaxed community — in the midst of runaway inflation and [an] affordability crisis — to tax themselves yet again,” he told a crowd of supporters Wednesday.

L.A. County already has a sales tax of 9.75%, and some cities add their own on top. Measure ER passing would raise the countywide sales tax to 10.25%, with some individual cities having a sales tax of more than 11%, according to the California Department of Tax and Fee Administration.

Despite a recent winning streak for sales taxes in L.A. County, some political observers had forecast doom for the measure, which came at a time of skyrocketing gas prices and cost-weary voters.

The largely informal opposition had consisted mainly of local cities that warned another sales tax would disproportionately burden the poorest residents and force shoppers across the county border in hopes of finding lower costs. Some city leaders had also dinged the county for misusing homelessness money generated from a previous sales tax and argued this new pot of dollars would be handled no better.

But supporters were able to eke out a narrow victory, according to the latest election returns, by emphasizing looming hospital closures and the temporary nature of the tax, which is set to sunset in five years.

“It’s a lifesaver to carry us through the storm we’re all in,” said county Supervisor Holly Mitchell, who led the push within the Board of Supervisors to get the measure on the ballot.

County leaders in February voted 4-1 to put the tax on the ballot after federal legislation threatened to pull health insurance from the poorest residents, leaving the already cash-strapped county to foot the bill for their care. Officials say cuts in the One Big Beautiful Bill Act are expected to slash more than $2 billion from the county’s budget for health services over the next three years.

“It’s disgusting what’s going to happen to our residents,” said Supervisor Hilda Solis, who championed the measure alongside Mitchell.

The tax, which begins Oct. 1, comes at a time of budget-tightening for the county amid rising labor costs and a $4-billion sex abuse settlement that is set to be paid out over the next five years.

Officials estimate the tax will bring in about $1 billion per year, which will go to clinics, hospitals and Planned Parenthood services that supporters say are at risk of closure without a new source of cash.

A similar proposed healthcare sales tax in Contra Costa County, meant to generate $150 million a year, was soundly rejected with about 57% of voters opposing the measure, according to votes tallied as of Wednesday.

The looming impact of federal Medicaid cuts has reignited a long-simmering, costly battle between California’s medical industry and one of its largest health worker unions.

SEIU-United Healthcare Workers West, with about 120,000 members, has put forward two ballot initiatives to cap the pay of medical executives and require community clinics to spend the bulk of their revenues on patient care.

The California Hospital Assn. has responded with its own ballot proposal that would make it tougher for unions to spend money on political initiatives in the future. It would require approval by a union’s rank-and-file membership for any spending of $1 million or more on statewide measures, or $100,000 or more on local ones.

The competing measures, which have drawn enough verified signatures to qualify for the November ballot, come at a time when the rising cost of healthcare is emerging as a top voter concern.

The Service Employees International Union affiliate has seized upon affordability angst to resurrect a proposal for a cap on healthcare executive compensation, which it has failed to achieve multiple times before. The proposed measure garnered more than 1 million petition signatures.

“This initiative reflects the serious crisis we face and that affordability is a real thing,” said Vikas Saini, president of the Lown Institute, a Massachusetts-based healthcare think tank. “I think it also reflects grassroots anger and a desire to do something.”

Mikey Vaughn, a certified nursing assistant at Cedars-Sinai Medical Center, said the hospital often lacks supplies and staffing levels that he and his colleagues need in order to do their jobs effectively and without undue stress, despite its reputation as the go-to place for the rich and famous.

“The executive pay initiative would, I hope, be used to hire staff and to actually provide better resources for our patients,” he said. Vaughn is also a member of SEIU-UHW’s executive board and political committee.

Thomas Priselac, then-president and CEO of Cedars-Sinai Medical Center, made $8.8 million in fiscal year 2024, according to the organization’s most recent available federal tax filing. Kaiser Permanente’s CEO, Gregory Adams, made nearly $13 million in 2024. Warner Thomas, head of Sutter Health, made just under $12 million.

Cedars-Sinai spokesperson Duke Helfand said the hospital would be unable to recruit and retain physicians, nurses, and specialists if the measure passed, dramatically impairing its ability to provide healthcare.

“Such a scenario would be disastrous not only for Cedars-Sinai but for hospitals across Los Angeles and California,” Helfand said.

The union wants to cap compensation at $450,000 a year for senior hospital and medical group executives, as well as other administrative and managerial staff. However, the initiative does not stipulate how dollars diverted from payroll must be spent.

The union has dubbed the latest proposal the Health Care Executive Compensation Act of 2026. A coalition of medical industry heavyweights opposing it — hospitals, physicians, and clinics, among others — has rebranded it the Health Care Endangerment Act.

Carmela Coyle, CEO of the hospital association, called the measure a cynical political ploy.

“It’s bad policy and it’s going to have bad consequences across California,” she said.

Glenn Melnick, a healthcare economist at the University of Southern California, said even if the initiative were fully implemented and pay cuts enacted, he doubts it would reduce the cost of healthcare for patients.

SEIU-UHW does not have an estimated total amount the initiative would claw back from pay packages that exceed the limit.

Opponents of the initiative note that it doesn’t just target executive pay; it would affect medical practitioners who are also managers. That could include chief medical officers and chief nursing officers, as well as heads of surgery, emergency rooms, oncology, obstetrics, cardiology and other specialties, they say.

It would be up to each hospital, health system and physician group to report which staff members exceed the cap and by how much.

Ultimately, who is subject to the pay cap “probably will have to be battled out in court,” Coyle said . “That’s why we are throwing everything we can at it.”

The second SEIU-UHW ballot initiative, on community clinics, is already in court. The California Primary Care Assn., which represents clinics, filed a federal lawsuit in April seeking to invalidate it before it reaches the November ballot.

The proposed measure would require federally designated community clinics to spend at least 90% of their revenues on activities directly related to their mission of providing care for low-income populations. If it were to pass, more than 90% of those clinic organizations would be on the hook for penalties totaling $1.7 billion in the first year alone and “would face similarly crippling penalties every year,” according to a report commissioned by the primary care association and conducted by the Berkeley Research Group, an international consulting company.

Louise McCarthy, president and CEO of the Community Clinic Assn. of Los Angeles County, said many pivotal services the clinics provide — such as translation and transportation — would likely not be counted toward the spending requirement.

“They are targeting a group of what they see as employers and we see as the safety net,” she said.

The lawsuit cites the harm to clinics and claims the proposed spending requirement would interfere with federal authority.

Renée Saldaña, a spokesperson for SEIU-UHW, characterized the lawsuit against the initiative as “a really desperate attempt by the clinic industry to try and avoid accountability.”

SEIU-UHW, proud of its political activism, is also behind a controversial billionaire tax proposal that would impose a one-time 5% levy on California residents with fortunes over $1 billion to backfill the funding gap created by federal cuts coming down the pike under Republicans’ One Big Beautiful Bill Act. The law, passed last July and signed by President Trump, is projected to squeeze nearly $1 trillion from the Medicaid health coverage program for low-income people by 2034, including as much as $30 billion annually in California.

The hospital association, the community clinic group and the California Medical Assn., which represents physicians, are neutral on the wealth tax proposal thus far. But Saldaña said all three of the union’s ballot proposals tie into an overarching strategy to counter the widening healthcare disparities caused by the federal law.

“We believe the primary concern of healthcare providers, including executives, should be to serve the community, heal patients, and not be in healthcare just to enrich themselves,” she said on the proposed pay cap.

Over the years, the union has submitted dozens of local and statewide ballot initiatives, including ones to cap the pay of hospital executives, regulate dialysis clinics, and raise the minimum wage of healthcare workers.

The hospital association calculates that SEIU-UHW has spent nearly $125 million on local and statewide initiatives since 2012. But healthcare industry groups have spent far more opposing them. The hospital association data shows that the union spent nearly $36 million on three ballot proposals to regulate the dialysis industry, but dialysis companies poured in $302 million to defeat them, according to state campaign finance records.

The union’s ongoing political efforts “threaten patient access to quality health care,” according to the hospital association’s ballot initiative, which could limit how much unions spend on future ballot measures.

Saldaña hinted at a possible lawsuit should that measure pass, saying “we don’t see the legal viability” of it. The proposal, she said, is an attempt “to silence the front-line healthcare workers.”

Ultimately, a ballot initiative won’t cure the ills that plague healthcare in the United States, said the Lown Institute’s Saini. What’s needed, he said, is “an evaluation and reimagination of healthcare.”

Wolfson writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.

Los Angeles County’s half-cent sales tax to fund healthcare services was trailing Tuesday, with early returns showing a majority of voters rejecting the measure.

The tax — a half-penny of every dollar spent in the county — is meant to prop up local hospitals and clinics that are hemorrhaging funding after recent federal cuts.

The sales tax, which needs a simple majority to pass, would take effect Oct. 1 and last five years. Officials say it would pull in $1 billion annually to help plug the budget holes hitting local hospitals and clinics.

L.A. County health officials anticipate the One Big Beautiful Bill Act, signed into law by President Trump last summer, will slash more than $2 billion from the county’s health services budget within the next three years. Due to eligibility changes, the county will no longer be able to get reimbursements for many Californians who have lost Medi-Cal.

The measure was championed by a coalition of healthcare advocates called Restore Healthcare for Angelenos who warned that mass layoffs and emergency room closures could be imminent if new funding didn’t come fast. The Department of Public Health recently closed seven clinics — a grim sign, supporters said, of service cuts to come.

Voters haven’t rejected a sales tax hike since 2012, when a transportation measure fell just short with 66.1% support. It needed 66.7% to pass.

A majority of county supervisors had supported the new tax proposal, voting 4 to 1 this February to put it on the ballot. But the measure faced significant opposition from local cities, with opponents arguing the sales tax hike would unfairly burden the poorest county residents and encourage people to spend their dollars across the county line.

Supervisor Kathryn Barger, the board’s lone opponent of the tax, said she was concerned it was a “general” tax, meaning the money wouldn’t be earmarked for healthcare costs. Instead, she argued, politicians would have final say over how the money gets spent.

The supervisors have created a plan for spending the tax money, with the largest chunk of the money meant to cover the costs for patients without insurance. The measure also asked voters to sign off on a nine-member oversight committee.

The county currently has a base sales tax rate of 9.75%, and cities impose local taxes on top of that.

May 15 (UPI) — Texas Children’s Hospital plans to create the first “detransition clinic” in the United States as part of a settlement with the state for provided transgender care, officials announced Friday.

Texas Attorney General Ken Paxton announced the settlement, which will also require the hospital to fire and revoke the medical privileges of doctors, as well as pay a $10 million fine.

The hospital will make care at the clinic free of charge for its first five years and offer services for children to detransition to their gender assigned at birth.

Paxton investigated the Houston-based hospital in 2023 for the transgender care services it offered at the same time the state legislature was outlawing gender-affirming care for children.

“I applaud Texas Children’s Hospital for changing course and committing to being part of the solution by agreeing to form a first-of-its kind Detransition Clinic that will provide free care to those who have been victimized by twisted, morally bankrupt transgender ideology,” Paxton said in a statement.

The settlement, he said, is meant to reverse damage caused by “ideologically motivated physicians who harmed patients with their transition care, which the attorney general’s office alleged included the use of false diagnosis codes.

The hospital, in its own statement, said that it had spent the past three years cooperating with the investigation, “navigating an unconscionable campaign of mistrusts and mischaracterizations of gender affirming care.”

It said that multiple internal and external investigations support that the hospital has been compliant with all laws — before and after the state ban on transition care.

“Today, we made the difficult decision to settle with the Texas attorney general and the Department of Justice, closing a chapter that has been wrought with falsehoods and distractions,” the hospital said.

“To be clear — we are settling to protect our resources from endless and costly litigation,” it said. “This settlement will allow us to redirect those precious resources to focus on life-saving care and groundbreaking discoveries of our exceptional clinicians and scientists.”