John Muir Health highlights local investment, warns HR1 and seismic mandates could strain services

John Muir Health executives told the San Ramon City Council on Feb. 24 that the health system is expanding local services but faces major financial pressures from federal and state policy changes.

Ashley her, introduced as executive director for primary care and transitions of care for John Muir Health, said the system’s San Ramon outpatient center at Bishop Ranch 15 (12677 Alcosta Boulevard) has provided same-day and next-day care since opening in April 2025 and has served roughly 100,000 patients systemwide, about 10,000 from San Ramon each month. “We are an anchor for our community,” Ashley said.

The presentation outlined planned local investment and service expansion. John Muir Health has committed to more than $150 million in the Tri-Valley over the next decade and is planning a potential phase 2 at Bishop Ranch 15 that could add CT and MRI services and other specialties if internal approvals and funding align.

But the health system also flagged large external risks. Ashley said several policy pressures — an item she and council members repeatedly called “HR1,” underfunded state seismic-safety mandates and projected Medicare funding pressures — could reduce enrollment and revenue. “If all parts of HR1 are enacted, JH will stand to lose over $300 million in revenue,” she said, and added that statewide seismic compliance could amount to about $2 billion in unfunded costs.

Ashley described likely operational effects if revenue and enrollment decline: a rise in uninsured patients, higher emergency-department volumes and longer hospital stays that would strain bed capacity. “These challenges place unprecedented pressures on our health care systems and the boards and management teams that run them,” she said.

Council members pressed for more detail on contingency planning. Council member Adler asked if the system had offset strategies short of federal legislative change; Ashley said she did not have a specific plan to announce and emphasized partnerships and operational efficiency as immediate priorities, and she offered to follow up with more detailed responses from hospital executives.

Other council members asked about mental-health services, disaster readiness and workforce implications. Ashley said John Muir Health operates an acute psychiatric facility that serves youth and adults and that emergency preparedness and high-reliability organization practices were part of the system’s operations; she offered to return with specifics on surge and disaster plans. She also said John Muir Health has internship and volunteer pathways at its hospital campuses and would provide contact information to the council.

No formal action was taken. Staff and council members said they expected follow-up information from John Muir Health on seismic preparedness, financial mitigation options and internship contacts.