More than 300,000 Alameda County residents received health services from the county in 2010. Of the 100,000 people enrolled in indigent care, two-thirds were seen at Highland Hospital.

Highland is the only trauma center in Alameda County where anyone, regardless of income or insurance status, can be treated for gunshot wounds or injuries sustained in automobile accidents. In fiscal year 2009-2010, more than 76,000 people received emergency care.

The county’s ability to provide this level of service may be in jeopardy if aspects of Gov. Jerry Brown’s budget proposal are crafted without real input from the county. The proposed realignment, a process of shifting responsibility for certain government programs from the state to counties, sounds appealing. However, we fear that the state will dump the responsibility for safety-net services on our doorstep without a sustainable, long-term funding plan.

The state has already taken more than $3.4 billion in operating capital from Alameda County over the last 12 years, which contributed to a $152.4 million deficit in 2009-2010.

In this climate, the county is struggling to provide services. After slashing $30 million from the Social Services Agency’s budget in 2010, the county managed to serve more than 45,973 individuals on CalWORKs, 6,249 on General Assistance, 205,927 individuals on MediCal and 110,382 on food stamps.

This past year, more than 40,000 citizens received mental health services despite $40 million in cuts to the health care budget.

Our labor unions sacrificed their annual cost of living allowance and increased their contributions toward health coverage and retirement plans. Our employees tripled their case loads. The county is now banking cases for probationers who should have routine supervision. Because of overcrowding in state prisons, as many as 950 inmates may be released into Alameda County over the next three years. Many will have no housing, no jobs, and no access to health services.

Now Brown is proposing a “vast and historic” government restructuring.

The first round of realignment in 1991 produced mixed results. In the 1990s, hundreds of mental health patients were transferred from state facilities back to Alameda County. While many patients landed in supportive community-based programs nearer to their families, others fell through the cracks. Today, some of those individuals live on the streets or in county jail.

As Chair of the Alameda County Budget Committee, I can tell you that we are running out of solutions.

With realignment, counties would assume a greater share of responsibility precisely at a time when the economy is slow and county needs are skyrocketing. Brown’s revenue solutions — tax extensions that voters must approve in June — are hardly reliable sources of long-term funding.

All levels of government — from Brown down to utility district elected officials — are coming to you, the taxpayer, for additional revenue. We need a more coordinated and sustainable process for financing government at all levels.

I have already scheduled a number of public meetings as we struggle to keep the lights on in Alameda County. We are eager to partner in the design process as the governor and Legislature formulate a plan to close the deficit and transfer services to local government. But we cannot fulfill our legal and moral obligation to aid our neediest citizens if Sacramento’s realignment plan redirects the downward spiral of perpetually ballooning budget shortfalls to local governments.