The Alameda County Board of Supervisors voted Tuesday to approve a plan to help keep the county’s public health system afloat in the face of devastating federal budget cuts.
Supervisors voted unanimously to direct county staff — including the county administrator, auditor, controller and the interim health director — to find a way to help the Alameda Health System avoid implementing a proposal to save millions of dollars annually via layoffs and service cuts.
AHS is the county’s independently operated safety-net health care provider and is largely funded with federal Medicaid reimbursements that were gutted by the Republican-controlled Congress and signed into law as H.R. 1 by President Donald Trump, who called it “The One Big Beautiful Bill.”
In order to cope with the loss of federal dollars, AHS administrators proposed slashing 200 jobs across the system and closing vital mental and behavioral health services at Oakland’s Wilma Chan Highland Hospital and Fairmont Hospital in San Leandro.
At Tuesday’s meeting, with the understanding that AHS would at least temporarily step back from its layoff plan, supervisors agreed to help the hospital system find ways to mitigate the cuts.
While the county doesn’t make budget decisions for AHS, it does provide some funding and plays a pivotal role in the complex system of public financing that keeps it operational.
Making adjustments
As part of its vote Tuesday, the Board of Supervisors agreed to find “adjustments to the behavioral health contract payment schedule and terms,” to adjust AHS’s line of credit with the county and to consider “alternate service models” related to its mental health outpatient programs.
“We should all keep in mind that the reason we’re here is largely, almost exclusively, it is because of H.R. 1,” said Supervisor David Haubert. “It’s not because of anything we have done internally or that AHS has done internally. They have constraints that are imposed upon them by the federal government.”
Still, Supervisor Nate Miley said he thought that AHS executive bonus packages should have been addressed earlier and scolded AHS CEO James Jackson for moving the health care system’s headquarters from Highland Hospital to Jack London Square in Oakland after the county spent nearly $1 billion on earthquake retrofits.
“When you do that and then we move forward and we’re looking at reductions, it just doesn’t look good,” Miley said.
In addition to the staff help, supervisors voted to form an ad hoc committee with supervisors Nikki Fortunato Bas and Miley that will work with AHS, union leadership and other stakeholders to address the health care system’s projected budget problems for the 2027-28 fiscal year.
‘Just beyond words’
As required by state law, Jackson initially presented the layoff plan to supervisors at a meeting last week, and the board continued that meeting until Tuesday.
“What we’ve heard in the intervening time is that the supervisors and the county leadership is prepared to step in with us and so we’re not having to resolve this by ourselves and I’m just beyond words to try to express my appreciation for that,” Jackson said.
County staff were also directed to report back to the supervisors about any progress made on their directives at the March 17 board meeting.
In a letter to supervisors from January, Jackson said that without some kind of plan, AHS will run out of cash by August.
“We’re here by design,” said Supervisor Elisa Marquez. “This is a deliberate attempt from the federal administration to be very surgical and cause more pain.”