Case Study

Healthcare Measure

Seton Healthcare District


The Seton Medical Center in Daly City offers a comprehensive range of important medical services to the culturally and ethnically diverse communities of southern San Francisco and northern San Mateo County. This includes critical mental health services, programs for at-risk youth, and care for the elderly—all of which is made available to un-insured and under-insured, in accordance with their mission. In 2011, Seton provided more than $14 million in unreimbursed costs to care for Medi-Cal, uninsured, and low-income patients.

The aging medical center was also facing significant funding needs, and had no clear path of approaching them. In order to remain open as an inpatient facility, Seton was required to replace its existing seismically non-compliant inpatient tower completely. Meanwhile, San Mateo County’s budget was suffering an annual deficit of at least $28 million.

What We Did

Seton Healthcare DistrictTBWB teamed up with the Seton Medical Center to examine how voters could help secure critical funding for the Medical Center. In order to pass a funding measure from which the proceeds would be dedicated to the Medical Center, voters would have to approve a tax measure at a 66.7% approval rate. Polling showed decent voter support for a funding measure, but this approval rate seemed out of reach.

Alternatively, a general sales tax, which would benefit Seton but include no built-in guarantees on how the funds would be used, would only need to be approved by a majority of voters in the County.

Many San Mateo County voters, particularly in the southern portion of the County, do not identify with or even recognize Seton Medical Center. By working closely with the San Mateo County Board of Supervisors along with public service providers and stakeholders throughout the county, TBWB and Seton were able to create a county-wide general sales tax measure that would both meet Seton’s funding needs, and appeal to  the other medical and emergency services needs of Southern San Mateo County.

The campaign for Measure A relied on broad support from stakeholders in health, public safety, education, parks and open space, and more from all over San Mateo County. Engaging the southern portion of the county and showing voters that Measure A was important to their communities was essential.

TBWB designed regionalized mailers for Measure A, so that the campaign also could convey the specific messages that would resonate with each voter set throughout the county and explain why the measure was important to each region in the county.

On Election Day Measure A passed with over 65% approval.