The future of a tax that pumps more than $100 million each year to bolster Alameda County's health care safety net is to be decided by voters on Tuesday.

Measure AA is the only countywide measure on next week's ballot. It asks voters to extend a half-cent sales tax from its 2019 expiration to a new sunset date of 2034.

The low turnout expected for Tuesday's sleepy primary election could be an asset or hindrance to Measure AA supporters, who need a strong showing from dedicated liberal voters and union members in the county's urban north. They also need to convince suburban voters in southern and eastern Alameda County that the historically Oakland-centric public health network benefits them, too.

Measure AA would be the successor to Measure A, the health care funding initiative that 71 percent of county voters approved in 2004 to rescue a public hospital system that was in poor shape at the time.

This year, as in 2004, the tax measure requires at least 66.7 percent approval to pass. If it loses, Alameda County health officials are likely to try again in 2016.

As with Measure A, three-quarters of Measure AA revenue would go directly to the operating budget of the Alameda Health System, the public consortium that runs the bustling Highland Hospital in Oakland, along with John George Psychiatric and Fairmont hospitals in San Leandro and three community clinics in Hayward, Newark and Oakland. The consortium, formerly known as the Alameda County Medical Center, also took over San Leandro Hospital last year and Alameda Hospital earlier this month.


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The balance would continue to be allocated by the Alameda County Board of Supervisors, which has used the money to fund an array of community-based primary care clinics, school health centers, jail mental health services and other programs pledging to care for the indigent, uninsured, children and seniors throughout the county. The supervisors also have provided about $4 million to supplement services at two private nonprofit hospitals: St. Rose Hospital in Hayward and UCSF Benioff Children's Hospital Oakland.

"Measure A in many ways can be likened to insurance," said Bradley Cleveland, manager of the Measure AA campaign. "We need to fund the trauma center and the emergency rooms. Hopefully, you won't have to use them."

Wary of breaking rules prohibiting public employees from political advocacy, executives who run the Alameda Health System -- the biggest beneficiary of the measure by far -- have been mostly silent about it.

In financial reports, however, the hospital system has made clear that it depends on the tax revenue for 15 percent of its overall budget.

"While we also seek to diversify our payer mix, were Measure A funds to be reduced or unavailable, AHS would face significant hardship in sustaining basic health care programs and services," stated a form submitted last year by the hospital system to the Measure A Citizen Oversight Committee and the Alameda County Health Care Services Agency.

Among the effects anticipated if the tax expires in 2019: increased wait times in the Highland emergency room and at surgical centers; reduction or elimination of HIV services, dental services, physician training programs and health education; a shift to acute care from preventive services; closure of some outpatient clinics; and layoffs of medical workers.

Pediatrician Dr. David Ferrazares gives 4 year-old Daniel Guttierez from San Leandro a checkup at La Clinica Fruitvale Village in October 2013 in Oakland,
Pediatrician Dr. David Ferrazares gives 4 year-old Daniel Guttierez from San Leandro a checkup at La Clinica Fruitvale Village in October 2013 in Oakland, Calif. (Laura A. Oda/Bay Area News Group Archives)

Unconvinced by the dire warnings is David Mix, a resident of the Oakland hills who wrote the lone argument opposing the measure on Tuesday's ballot. Mix said he does not believe there has been enough independent oversight of how Measure A money is spent since the tax was adopted in 2004.

"They cried poor and they got the public to support it for 15 years as a temporary measure," Mix said. "Now they want to extend it for another 15. It was supposed to be temporary to get them out of their slump."

Hoping to show the tax renewal will improve the health of the entire county, Measure AA supporters have been drawing attention to tax-funded medical programs that serve residents of the Tri-Valley, where only 53 percent of voters supported the 2004 measure. They have also tried to build more electoral support in Hayward, which has a mayoral election Tuesday, and Fremont, where voters are also being asked to support a school funding measure.

"Does Fremont get a lot of money from it? No," said Cindy Bonior, CEO of the Fremont Chamber of Commerce, which recently endorsed Measure AA. "But if we don't continue to support the public health safety net ... it will denigrate the services we get now."