A delegation of Santa Clara County leaders told the Sunnyvale City Council on Sept. 9 that a federal law enacted this summer — referred to in county briefings as H.R. 1 or the “1 Big Beautiful Bill Act” — imposes unprecedented cuts to Medicaid (Medi‑Cal in California) and to the national food assistance program (CalFresh), and that those cuts will directly threaten county hospitals, clinics and social‑safety‑net programs.

“HR 1 also known as the 1 big beautiful bill act did get signed into law by President Trump on July 4,” Special Assistant to the County Executive Brian Darrow said as he opened the county presentation to the council. County health system CEO Paul Lorenz and other county staff described immediate and growing fiscal impacts and the county’s steps to respond.

The county estimates the changes could add hundreds of millions of dollars in deficits this fiscal year and more than $1 billion in later years. That is in part because the federal changes freeze or sharply reduce provider‑tax mechanisms and supplemental Medicaid payments that counties used to draw down matching federal funds. The law also establishes so‑called work‑reporting requirements and more frequent redeterminations that federal and state experts say will cause eligible people to lose coverage because of paperwork and administrative churn rather than a drop in eligibility.

County presenters said 1 in 4 County residents — about 465,000 people — rely on Medi‑Cal and that more than 130,000 rely on CalFresh. Paul Lorenz, chief executive of Santa Clara Valley Health Care, said county hospitals provide a disproportionately large share of trauma, burn, psychiatric and specialty services in the region and that the health system trains a large share of the county’s physicians.

“Your public health care system has been in place for 170 years,” Lorenz told council members. He and other county officials said the cuts threaten emergency‑room capacity, specialty services and community clinics, and would likely lengthen ambulance and ER wait times even for privately insured patients.

As one immediate response, the County Board of Supervisors voted unanimously last month to place a temporary 5/8‑cent general sales tax measure — labeled Measure A on the November ballot — to provide near‑term revenue to sustain hospitals and other services while the county seeks state and federal solutions. County staff said the measure would not eliminate the need for internal reductions but would reduce the depth and speed of service cuts.

County officials said the proposal is one of three pillars in their strategy: (1) internal cost‑cutting and efficiencies, (2) state engagement to limit harm to public hospitals, and (3) a local revenue measure. They told council members that counties have limited options for raising operating revenue and that, absent state action, the sales tax was the only realistic near‑term path for operating funds.

Council members pressed county staff on details for Sunnyvale residents: county presenters said roughly 25,000 Sunnyvale residents rely on Medi‑Cal, some 5,300 use CalFresh, and that about 43% of Sunnyvale trauma ambulance transports go to county hospitals. The county said it would work with cities to coordinate outreach and service planning, and it scheduled follow‑up briefings with city staff.

Public commenters and councilors expressed a range of views: several residents urged the council to support the county measure and to publicize the county’s warnings; others opposed a regressive local sales tax and urged the county to use budget discipline or other revenue approaches instead. County staff said polling had shown some public support and said the measure would be temporary and aimed at preventing “devastating” cuts to hospitals and safety‑net services.

County officials asked the city for continued coordination, including sharing information on local shelters, staffing partnerships and outreach for eligibility redeterminations. They noted the county’s hospitals also provide housing‑related behavioral health supports and that cuts could cascade into the homelessness services the city and county jointly run.

Ending: County staff said they would return to cities for more detailed briefings and urged residents and local leaders to participate in the public discussion ahead of the November ballot. “These are unusual times,” Brian Darrow told council members. “It requires an extraordinary response.”