Pay or Die: The scare tactics behind LA County’s Measure ER tax increase

Measure ER in Los Angeles County is a one-half percent sales tax increase to pay the cost of providing full health insurance to illegal immigrants. 

It was placed on the ballot by a 4-1 vote of the Board of Supervisors, with only Kathryn Barger in opposition. Proponents, led by Supervisor Holly Mitchell, insist that this tax increase is necessary because of federal cuts to funding for healthcare. They say the money will be spent on a specific list of healthcare needs, and the tax is only temporary.

In fact, there have been no “cuts” to federal funding. There have been changes to ensure that only eligible individuals receive federally funded benefits. Under U.S. law, federal Medicaid funds can’t be used to pay for healthcare for illegal immigrants, except emergency and pregnancy-related care. 

California’s government decided to cover the cost of providing all income-eligible illegal immigrants with full-scope Medicaid (called Medi-Cal in California) at state expense.

It broke the budget so badly that Gov. Gavin Newsom recently closed the program to new adult enrollments and also added a monthly premium charge.

At the same time, the federal government has cracked down on states that are gaming the system to draw down extra federal dollars through the device of a “provider tax.” The states that collect these taxes, including California, essentially return the money to the health care providers in the form of a payment that qualifies for partial federal reimbursement. 

A provision in the One Big Beautiful Bill, H.R. 1, caps or phases out reimbursements tied to this type of tax. Other provisions require some adults on Medicaid to redetermine their income eligibility every six months instead of annually. Starting next year, the law requires some Medicaid enrollees to document work, job training or other types of “community engagement” in order to remain eligible. The bill also made certain categories of legally present immigrants, such as refugees and asylees, eligible for restricted-scope Medicaid (emergency and pregnancy care only) instead of full-scope coverage. 

In May 2025, the federal Centers for Medicare and Medicaid Services (CMS) implemented increased federal oversight to stop what the department’s news release called “misusing federal Medicaid dollars to cover health care for individuals who are in the country illegally.” CMS administrator Dr. Mehmet Oz said Medicaid “is not and cannot be a backdoor pathway to subsidize open borders,” reminding states they “have a duty to uphold the law and protect taxpayer funds.” 

CMS began “focused evaluations of select state Medicaid spending reports (CMS-64 form submissions)”  and “in-depth reviews of select states’ financial management systems” along with “assessing existing eligibility rules and policies to close loopholes and strengthen enforcement.”

These are the changes that California politicians are calling “cuts” to federal funding. CMS says the purpose is to ensure the financial stability of the program. Proponents of Measure ER also cite the need for financial stability, except their plan calls for raising taxes.

State law says local sales taxes in any area cannot exceed a total of 2%, on top of the state sales tax rate of 7.25%. Local governments get around this limitation by asking the Legislature to pass a “special statute” to exempt new sales tax increases from the cap. Measure ER needs one of these, so L.A. County asked Assemblyman Isaac Bryan to introduce a bill to make the tax increase legal.

On Thursday, that bill was on the Assembly floor. “The people of Los Angeles County are asking for the right to decide for themselves if they want to take care of their neighbors, and I think we should give them that right,” Bryan told fellow lawmakers.

AB 1768 passed the Assembly by a vote of 54-12. It was immediately sent over to the Senate for rapid consideration. 

Measure ER is a sales tax increase to pay for full-scope health care for “neighbors” who are not eligible for federally funded, full-scope Medi-Cal.

This is happening in other counties, too. AB 1768 authorized a sales tax increase of 0.625% in Contra Costa County, on the June ballot as Measure B. Last November, Santa Clara County jammed Measure A, an “emergency” sales tax increase, onto the special election ballot with Proposition 50. It was approved by 57.25% of voters.

All three of these sales tax increases have been pitched to voters as necessary to keep hospitals open, but if the money was earmarked for that purpose, these would be “special taxes” requiring a two-thirds vote, 66.67%. Instead, these are general taxes, requiring only 50% plus one vote to pass. The money may be spent for any purpose.

Apparently, polling showed that these taxes could not get the support of two-thirds of voters. Even a majority vote may be a challenge for Measure ER, judging from the over-the-top scare tactics in the proponents’ advertising. One digital ad for Measure ER shows a photo of a body on a slab in the morgue, toe tag hanging. “When hospitals and clinics close,” the copy reads in all caps, “everyone pays the price.”

It has come to this. Pay or die.

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Aside from cost, there is a scarcity of doctors to treat Medi-Cal enrollees. If L.A. County has 1.3 million more people on the program than are eligible for it under federal law, eligible recipients who rely on Medi-Cal are unfairly subjected to unreasonably long waits for care.

Voters deserve to know the full truth. They’re being asked to pay higher taxes because illegal immigration has broken the health care system.

Write [email protected] and follow her on X @Susan_Shelley

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