A half-cent sales tax on San Diego County's Nov. 3 ballot could raise $400 million to $450 million a year. Supporters say the money would fund healthcare, sewage cleanup and public safety.

Measure B, formally titled the Protect San Diego County's Health and Safety Act, landed on the ballot after the Board of Supervisors voted 3-2 on June 25 to place it before voters. Supervisors Nora Aguirre, Terra Lawson-Remer and Monica Montgomery Steppe voted yes. Supervisors Jim Anderson and Jim Desmond voted no.

The measure's backers argue it would serve as a local buffer against federal cuts to Medi-Cal, California's low-income health insurance program. The measure's findings state that federal cuts to Medicaid, the Affordable Care Act and SNAP "will lead to over 150,000 San Diegans losing healthcare and food they need to survive and stay healthy." County data shows 784,959 people receive Medi-Cal benefits countywide.

At a Wednesday, Sept. 9, roundtable hosted by the "Yes on B" campaign at the Hospital Association of San Diego and Imperial Counties, La Jolla-area Medi-Cal recipient and mother of three Champagne Alexander described what the program means for her family.

"Medi-Cal has been security for me and my family," Alexander said, according to KPBS. "I know for a fact without it, we would have had to make some choices between rent and health."

Nick Macchione, chief health officer at UC San Diego Health, said at the same event that he worries about people who cannot meet new federal work requirements or navigate the system. He said delayed care harms individuals and that when people lack access, disease "can spread and does spread" across the whole county.

Under the measure's expenditure plan, no more than 60% of revenue would go to healthcare, nutrition and children's services. That bucket includes a 22% share of total revenue earmarked for childcare and early childhood programs, administered by the First 5 Commission of San Diego County. Up to 22.5% would fund Tijuana River sewage mitigation, with at least 20% of that share dedicated to infrastructure. The remaining 17.5% would support public safety, wildfire prevention and crisis response.

The ballot resolution requires annual independent audits and creates an 11-member Citizen Oversight Committee. Members cannot simultaneously hold elected office. The measure also bars spending on elected officials' salaries, management bonuses, lobbying contracts or renovation of county administrative offices.

All revenue would stay in San Diego County. The tax has no expiration date and would remain in effect until voters repeal it.

No organized opposition campaign has emerged publicly. Supervisors Anderson and Desmond voted against placing the measure on the ballot, but neither has made a public statement opposing the measure's substance.

Polls open Nov. 3.