SAN PABLO -- More than $400,000 has poured into the campaign backing a big new parcel tax on West County residents aimed at saving Doctors Medical Center hospital, but supporters know they face an uphill climb wooing two-thirds of voters in the already heavily taxed area.
"It's going to be very close either way," said Contra Costa County Supervisor John Gioia, who is campaigning hard to reach resident groups. "The two-thirds threshold is always hard to reach, but we've done it before."
Having done it before is part of the challenge facing Measure C, a mail-in ballot that would put a 14-cent-per-square-foot tax on developed property in West Contra Costa to generate an estimated $20 million annually for the hospital, which is hemorrhaging more than $1.5 million every month.
Parcel taxes passed in 2004 and 2011 already pump $10.9 million annually into the hospital, but have proved insufficient to keep the facility solvent.
The hospital's chronic budget shortfalls stem from its role as a health care safety net, meaning most of its patients are covered by Medicare and MediCal, which provide reimbursement rates that do not cover the full costs for service, Gioia said.
The mail-in ballots are scheduled to arrive in mailboxes of the roughly 107,000 registered voters in the district this week, and must be returned by May 6.
Proponents believe the mail-in ballot gives the tax its best chance to pass, avoiding a general election ballot in November expected to be crowded with other revenue measures. Also, a May election ensures that the collection of taxes will begin by July 1, Gioia said.
Even if the latest tax is successfully added to the two previous levies, hospital officials still need to secure millions in bridge funding to make it to November, when the first parcel tax payments start coming in.
There is no guarantee that the hospital will be able to remain open long term.
The tax would sunset if the hospital closes.
Meanwhile, West County voters have grown increasingly burdened as school district bonds, hospital taxes and other levies have crowded their property tax bills in the last decade.
On a 1,200-square-foot house in Richmond assessed at $210,000, for example, a homeowner faces about $4,100 in various taxes annually, with nearly $2,000 of that for special taxes and other local assessments.
The biggest single source of taxes is the West Contra Costa Unified School District, which gets more than $700 annually from the owner of the $210,000 house thanks to a series of bonds and parcel taxes passed since 2000, mostly to fund new school construction.
Contra Costa as a whole has the fourth-highest county property tax by percentage in California, according to Propertytax101.org, a watchdog website, and West County might even be higher than the county average.
"The district is in one of the poorest parts of the county, and the heaviest taxed," said Wendy Lack of the Contra Costa County Taxpayers Association, which opposes Measure C. "I think taxpayers there have reached the saturation point and will say enough is enough."
But the consequences of not passing the tax could be dramatic. According to a county study commissioned in 2011 and updated this year, the hospital's closure would trigger a "health care crisis" that would mean significantly longer wait times at other area emergency rooms and longer ambulance transport times.
Those fears have unleashed a torrent of campaign spending by groups hoping to pass the tax and avert closure.
According to County Registrar of Voters campaign documents, the biggest contributors to the campaign supporting the tax are the San Pablo Lytton Casino and Kaiser Permanente, which gave $250,000 and $150,000, respectively.
Kaiser, which operates a 15-bed emergency room in Richmond, is expected to be deluged with emergency patients if Doctors closes. Others that have given money include local labor and physicians groups. Doctor CEO Dawn Gideon also gave $1,000, according to campaign documents.
Perhaps most important, opposition funding has not emerged. A handful of volunteer anti-tax advocates have posted "No on Measure C" signs in some local neighborhoods, but big business and labor coalitions have not come out against Measure C.
Gioia, who also serves on the hospital's board, said he will campaign hard in favor of the measure for the next month. Supporters expect about 40,000 voters to cast ballots. "It's my highest priority," Gioia said. "I will do whatever it takes."
But whether the funding and efforts by Gioia and others prove sufficient remains to be seen, even though the campaign has hired Whitehurst/Mosher Campaign Strategy & Media, a highly-regarded San Francisco-based consulting firm.
It all adds up to tall odds to save the hospital, supporters concede.
"It doesn't take much opposition to keep you from getting to two thirds of voters," Gioia said. "It takes more money to get the measure passed than to defeat it."