Williams: Protecting our health care is the smartest investment we can make

Fiscal responsibility is about more than balancing a budget, it’s about making smart, strategic investments that protect our community for the long term.

Here in Silicon Valley, we know being enterprising means leveraging every resource to its greatest potential. Your county government has embraced that ethos — stewarding limited public dollars to maximize returns, strengthening our safety net and safeguarding the well-being of nearly 2 million residents.

But that model is now under serious threat.

A sweeping set of federal budget cuts under H.R. 1, also known as the “Big Beautiful Bill,” will strip away over $1 billion a year in federal reimbursements to Santa Clara Valley Healthcare. These are not abstract numbers. These are the dollars that keep our hospitals open, our emergency rooms staffed and our health care system functioning.

Make no mistake, this fiscal crisis is not of Santa Clara County’s making. Unlike the federal government, your county government must, and does, balance its budget every single year. For every 12 cents the county invests locally in health care, 88 cents comes back through external revenues such as Medi-Cal, Medicare and commercial insurance. We’ve built a system that turns 12 cents into a dollar’s worth of care. That’s not just responsible, it’s remarkable.

Those investments have built something unique: one of California’s most efficient, high-performing public health care systems. Santa Clara Valley Healthcare operates four hospitals and 15 health centers that together serve as the backbone of our local safety net. Our hospitals are not only the largest provider of care to the one in four residents who depend on Medi-Cal, they also deliver more Medicare-funded hospital services than any other provider in the county.

We operate two of the region’s three trauma centers, which handle roughly 80% of all trauma cases, and run one of only three comprehensive burn centers between Los Angeles and the Oregon border. Every 11 minutes, a 911 call in Santa Clara County results in a patient being transported to one of our hospitals. If something unexpected happens — a car crash, a fall or a fire — our hospitals are often the ones saving lives.

It’s worth remembering that just a few years ago, three hospitals in our county — O’Connor, St. Louise and Regional Medical Center — were at risk of closure. As the private sector walked away, the county stepped in. Without that action, our region would have lost hundreds of much-needed emergency room beds, putting thousands of lives at risk. Instead, the county’s facilities are now thriving and full, serving nearly half of all emergency visits in the county.

We’ve done all of this without one penny in increased local tax rates by leveraging external revenues, making smart fiscal decisions, keeping a balanced budget and maintaining a AAA credit rating.

But these federal cuts are truly unprecedented, delivering the largest reduction to Medicaid in history. Since Medicaid, known as Medi-Cal in California, represents our largest single source of revenue, the functioning of our entire health care system is at stake. The shortfalls facing the county are stark and immediate, with more than $500 million in losses expected next year and growing to $1.3 billion annually. No amount of belt-tightening can offset that kind of blow.

That’s why we’re pursuing a three-part plan: making significant budget reductions while protecting critical services; seeking state partnership to mitigate the outsized impacts on public hospitals; and pursuing additional local revenue to preserve critical services.

Fiscal responsibility isn’t about doing less, it’s about protecting what matters most. Our hospitals are not luxuries, they are lifelines that everyone depends on. If we don’t actively work to protect them, the human and economic costs will be immeasurable.

When others have walked away, we’ve stepped up as a community to protect local access to care. Because in Santa Clara County, we don’t turn our backs on each other. We take care of our own. That’s what fiscal stewardship means, and it’s what this moment demands of us once again.

James R. Williams is the county executive for Santa Clara County.