Bramson: A measure for community health

When people talk about ending homelessness, the conversation almost always starts with housing. And for good reason—without a safe, stable home, it’s nearly impossible for anyone to rebuild their life.

But there’s another piece of this crisis we don’t talk about enough: health. You can’t recover from homelessness if you can’t access health care. You can’t stay housed if an unexpected medical bill wipes out your savings. And right now, that fragile balance — between health and housing — is under serious threat.

That’s why this November’s Measure A is so important. It’s not just another line on the ballot. It’s a decision about what kind of community we want to be — and whether we’ll protect the lifeline that keeps tens of thousands of our neighbors healthy, stable  and alive.

Santa Clara Valley Healthcare — our county’s public hospital system — is the beating heart of the local safety net. Four hospitals, 15 clinics, and mobile outreach programs that serve anyone, regardless of income or insurance status. Every day, this system provides emergency care, mental health treatment, substance use recovery, and preventative services to nearly half a million residents. For many, it’s the only option they have.

But here’s the problem: federal cuts to Medicaid funding have created a billion-dollar hole in our county’s health budget. That’s not a typo. $1 billion — gone. Those are the dollars that keep emergency rooms open, trauma units staffed and mobile clinics on the streets. Without them, we risk devastating cuts to the very services that save lives and prevent homelessness every day.

Measure A is how we fight back. By approving this local funding measure, voters can ensure Santa Clara Valley Healthcare continues to do what it’s done so well for decades — care for everyone. Measure A protects critical programs that connect health care and housing. It keeps our homeless health care teams in the field, our behavioral health programs running and our hospitals equipped to respond to growing needs. It’s not just a health care investment — it’s a strategy to keep people stable and safe.

Think about what happens when someone loses access to care. A small infection turns into a hospitalization. A missed therapy session spirals into crisis. A family forced to choose between paying rent or a medical bill ends up on the brink of eviction. We’ve seen it happen, time and again. Preventing those outcomes isn’t just the right thing to do — it’s the fiscally responsible thing to do. Every dollar we spend keeping people healthy and housed saves us many more down the line in emergency care, shelters and public safety costs.

This is what makes Measure A a smart investment: It doesn’t just patch a budget gap, it strengthens the foundation of our community’s health and housing systems. It ensures that the people providing care — from nurses and doctors to outreach teams and case managers — can keep doing their work without interruption. And it guarantees the doors of our public hospitals stay open to everyone, not just those who can afford private insurance.

Let’s be clear — this isn’t charity. It’s common sense. Because when our health care system fails, we all pay the price. Longer ER wait times. Reduced trauma coverage. Fewer resources for mental health and addiction recovery. And an even steeper climb for those trying to escape homelessness.

Voting yes on Measure A is how we choose a different future. It’s how we say that in Santa Clara County, we take care of each other. That no one’s health — or life — depends on their income. That we’ll stand up for the systems that make this community safe, healthy and humane.

When you fill out your ballot, remember: Housing and health are two sides of the same coin. Measure A keeps both strong. Vote yes — for our hospitals, for our neighbors and for a county that believes everyone deserves a chance to heal and to belong.

San José Spotlight columnist Ray Bramson is the chief operating officer at Destination: Home, a nonprofit that works to end homelessness in Silicon Valley. His columns appear every second Monday of the month. Contact Ray at [email protected] or follow @rbramson on X.