Top image: Sobrato Pavilion, Santa Clara Valley Medical Center. Photo: Cristiano Tomás / CC BY-SA 4.0 via Wikimedia Commons

The federal health care cuts that Santa Clara County has been bracing for are not scheduled to hit in full until 2027. The county’s public hospitals say the effects are already arriving.

Uninsured hospital admissions at Santa Clara Valley Healthcare, the county-run safety-net system, averaged about 125 a month in the fiscal year that ended in June and have since doubled to about 250 a month, CEO Paul Lorenz told The Mercury News, according to a summary by the Bay Area Brief. Emergency room visits by uninsured patients at the system’s four ERs rose from about 2,300 in January to 2,600 in July, a 13% increase. The system plans to spend at least $25 million more this year on subsidized care.

“We’re just seeing the beginning of what we see as a major problem for access to healthcare,” Lorenz said.

What supervisors will consider

The Board of Supervisors’ Oct. 20 agenda includes a report on revising the county’s Primary Care Access Program and transitioning it to a program called Valley Care, according to a summary of the agenda compiled from county meeting documents; agenda attachments describe Valley Care as an uninsured local access program for Santa Clara Valley Healthcare. The same meeting includes a report from the County Executive on state and federal budget developments and a monthly operational report on the Valley Homeless Healthcare Program. The board will also hear a Caltrain presentation on the rail system’s “No External Funding Scenario,” a reminder of how many of the region’s public systems are planning for funding shortfalls at once.

Agenda summaries do not show the details of the Valley Care redesign, and the program’s eligibility rules, costs and capacity will be the important questions when it reaches the board.

How the county got here

The pressure has been building all year. In June, supervisors unanimously adopted a $14.7 billion budget that closed a $787 million deficit, San José Spotlight reported. The county preserved public health positions and added four satellite primary care clinics, but closed three mental health clinics, eliminated 668 positions, most of them vacant, and added 237.

“This year’s massive deficit was not a crisis of our own making,” Supervisor Susan Ellenberg told the Spotlight, attributing it to the loss of funding under the federal spending law known as H.R. 1 and anticipated state reductions. The Spotlight reported that H.R. 1 creates $1 billion in annual losses for the county, hitting Medi-Cal and food aid among other programs.

What has kept the hospital system stable so far is local money. Measure A, the five-eighths-cent sales tax county voters approved in November 2025, generates roughly $340 million a year, and supervisors directed all of it to the health system, according to the Bay Area Brief. The health system’s budget is about $4.7 billion, roughly a third of the county’s total, making it California’s second-largest public health care system, the Spotlight reported.

The cliff ahead

The larger changes are still to come. Beginning in 2027, federal rules will require some Medi-Cal adults without young children to work, volunteer or attend school part time, and some members will have their eligibility checked every six months rather than annually, the Bay Area Brief reported. California will also freeze new Medi-Cal enrollment for undocumented immigrants in January and start charging them at least $30 a month next summer. Medi-Cal enrollment in Santa Clara County has already fallen from about 425,000 in 2024 to about 355,000, according to county social services figures cited by the Brief.

County Executive James Williams has projected a $500 million shortfall in fiscal 2027-28, $805 million in 2028-29 and $930 million in 2029-30, according to the Spotlight. “No county can shoulder unprecedented federal funding losses alone,” he said.

The long view

Silicon Valley’s wealth tends to obscure how many residents depend on the public health system. As people lose Medi-Cal or employer coverage, they don’t stop getting sick; they move from clinics to emergency rooms, where care is costlier and arrives later. The county’s bet is that a redesigned local access program can catch them earlier.

Measure A bought time, not a permanent fix. The real test for the Board of Supervisors over the next three budget cycles is whether it can rebuild a local safety net, largely with local money, to fill the gap left by federal retrenchment, and how many other services it will have to give up to do so. The Valley Care redesign is the first concrete step in that effort.

Sources: Bay Area Brief, summarizing The Mercury News (Oct. 12, 2026); San José Spotlight (June 23, 2026); Santa Clara County Board of Supervisors agenda for Oct. 20, 2026, via SimpleCity’s summary of county meeting documents.