County executive warns of health‑care coverage losses and state budget risks tied to federal cuts

County Executive James told the Santa Clara County Board of Supervisors on Jan. 13 that recent federal and state budget developments are likely to widen coverage losses and increase county fiscal pressure.

James said national reporting indicates about 1.4 million Americans dropped health coverage after Congress failed to extend enhanced premium subsidies tied to the Affordable Care Act. He warned that the county is tracking coverage losses and anticipates downstream impacts if people move to higher‑deductible plans and delay routine care.

On state matters, James said the governor’s proposed budget relies on different revenue assumptions than the Legislative Analyst’s Office and does not include new state funds to backfill the federal HR 1 cuts affecting Medi‑Cal coverage for refugees, asylees and others. He described a proposed state shift that could pass IHSS cost growth to counties and said the county will analyze the fiscal impact and pursue advocacy with legislative partners.

James said public hospitals are a small share of hospitals statewide but serve a disproportionate share of trauma, burn and training functions and that the county will press the state for targeted support. He also noted the county will present a behavioral‑health study session in early February to evaluate service funding risks and options.

Supervisors thanked staff and asked for follow‑up data on how many county residents lost coverage during the open‑enrollment window and options for philanthropy or other external revenue to help residents who face new premiums.