Election 2026: Measure CC hospital tax would raise $12.4 million a year for MarinHealth ER, ICU
Marin’s only trauma center would get money for a larger emergency room and expanded intensive care under Measure CC, a 30-year parcel tax on the Nov. 3 ballot that would cost the owner of a 2,000-square-foot house $280 a year.
The Marin Healthcare District, which owns MarinHealth Medical Center, estimates the tax — 14 cents per square foot of building — would raise about $12.4 million a year. By Ark calculation, the owner of that 2,000-square-foot house would pay $8,400 over the life of the tax. There are no exemptions for seniors or for low-income owners. The measure’s backers say state law bars healthcare districts from offering a senior exemption.
Measure P, a separate countywide parcel tax on the same ballot, would charge 5 cents a square foot for 15 years to subsidize childcare and raise pay for childcare workers. If both measures pass, a property owner in the healthcare district, which includes Tiburon, Belvedere and Strawberry, would pay 19 cents a square foot between them — or $380 a year on a 2,000-square-foot house in the first year. Measure P’s share could rise each year with inflation; Measure CC’s is fixed. The county and the healthcare district project the two would raise about $24.9 million a year combined.
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Measures CC and P are both special taxes, and the CC ordinance carries a clause saying that if it and a conflicting measure both pass, only the one with more yes votes takes effect. County Counsel Brandon Halter said the county does not believe CC would knock out P because the same clause lets measures that can be harmonized both take effect, and the two “impose separate taxes for different purposes and do not appear to impose inconsistent requirements.” A court would decide the question if it were challenged, he said.
Measure O, a $115 million Reed Union School District bond on the same ballot, would add to what Tiburon and Belvedere owners pay if it passes. It is levied on assessed value rather than building size, at an estimated peak of $30 per $100,000, or $300 a year for each $1 million of assessed value. Strawberry is outside the Reed district.
Like Measure P, Measure CC qualified by petition, which means it passes on a simple majority rather than the two-thirds a district-sponsored special tax would need.
The ordinance restricts the money to seven uses: expanding and modernizing intensive care, trauma and triage; adding emergency room capacity; meeting health and earthquake safety standards; adding patient rooms; upgrading operating rooms, labs and imaging; keeping enough doctors, nurses and specialists on staff; and improving mental health, addiction and suicide prevention services. It bars spending on district or hospital administrator salaries and benefits, and it allows the district to borrow against the tax — to issue bonds for capital work and use the 30 years of revenue to pay the principal and interest.
If it passes, the measure can be repealed or amended only by another vote of the district’s voters.
Only one person filed ballot arguments against the measure: public-health physician Clay Hess, a candidate for the district’s Division 1 board seat on the same ballot, who signed both the argument against and the rebuttal.
He argues the hospital is not in trouble: He cites MarinHealth’s $661 million in 2024 revenue, a $24 million surplus and $23.6 million in gifts. From the district’s own August metrics, he cites a rising nursing headcount, a primary-care waiting list that fell from 3,000 to zero and turnover of 2%.
Jason Ruben, medical director and chair of MarinHealth’s emergency medicine department and a signer of the argument in favor, called the August staffing numbers “a positive trend in nursing recruitment and retention” but said they “represent a point-in-time measure of current staffing and should be considered in that context.”
Hess argues that the oversight the measure promises is advisory and unenforceable, that the district can bond against the tax and lock the revenue in, and that a per-square-foot levy makes a modest house pay like a large one.
“A child starting kindergarten this fall will be mid-30s when Measure CC expires,” his argument opens.
Hess did not respond to a request for comment by The Ark’s press deadline.
Replacing MarinHealth’s Redwood Pavilion, which the district expects to be more cost-effective than retrofitting it to meet state seismic requirements, is estimated at $350 million to $550 million, depending on scope and on how much the hospital and donors contribute, Jill Kinney, MarinHealth’s vice president of marketing and communications, said for the district in a written response.
The district “anticipates that bond financing would be necessary,” she said, with the amount, timing and structure left to its board. The district did not say how much of the tax it would put toward the replacement or whether the new building would be finished before the state’s Jan. 1, 2030, seismic deadline.
Supporters make the case on proximity. Their argument says MarinHealth is the county’s only designated trauma center, the county has one major freeway and traffic can stretch the trip to the nearest hospital in San Francisco or Sonoma past an hour. Emergency room visits have risen nearly 25% over the past decade, the ordinance’s findings state, and some of the hospital’s operating rooms were first built more than 70 years ago, with the last phase of its earthquake safety work still unfunded.
The argument in favor was signed by Ruben, a MarinHealth Foundation board member; Rep. Jared Huffman; the League of Women Voters of Marin County; nurse Andrew Apolinarski; and the North Bay Leadership Council. The rebuttal to the argument against added emergency room physician Annie Yuan, nurse Katherine Boescheni and Marin Professional Firefighters, IAFF 1775.
Ruben said his understanding is that the proponents chose 30 years because it is the most common term for a measure that pays for major hospital construction, as it is for nearly every school and college construction bond.
“A 30-year financing period is commonly used for major public infrastructure projects because it allows the cost of long-lived facilities to be spread over the period in which those facilities will serve the community,” he said.
He said that while the measure’s language is broad, “the intent of the district would be to utilize the parcel tax proceeds for capital purposes,” including construction, earthquake safety work, emergency department capacity, patient rooms, and operating room, lab and imaging upgrades.
Hess also points to Measure F, the $394 million bond district voters approved in 2013, arguing that only $33 million has been retired while $593 million remains owed through 2047, $232 million of it interest. The district puts the debt lower. It said it has repaid about $35.2 million in principal on the bonds, issued in 2015 and 2017 to build the Oak Pavilion, and still owes about $358.8 million in principal and $216.8 million in interest — about $575.6 million in all.
Hess’s argument also says “a director and a taxpayer advocate said on the record that petition gatherers told them the hospital would close if they did not sign.” Ruben said the campaign told him of “an isolated incident where a signature gatherer departed from the approved messaging and shared incorrect information,” and that it addressed the matter immediately with the company it hired to gather signatures. He said he knows of no later incidents.
Reach Executive Editor Kevin Hessel at 415-435-2652.