San Jose’s population continued to decline in 2023, according to the latest update from the U.S. Census Bureau. The decrease was the smallest of any year since 2017, a sign of a possible reversal after six years of population losses, a trend that began before the pandemic.

The U.S. Census Bureau estimates San Jose’s population was 969,655 on July 1, 2023, down just over 1,500 residents from the year before. Meanwhile, Fort Worth’s population grew by over 20,000 residents in the same period, ending with nearly 9,000 more residents than San Jose, taking its place as the 12th most populous city, pushing the capital of Silicon Valley down another spot into 13th place.

In a press release announcing the latest city population estimates, Crystal Delbé, a statistician in the Census Bureau’s Population Division highlighted that the biggest growth is happening in the South.

“Thirteen of the 15 fastest-growing cities were in the South, with eight in Texas alone,” Delbé said. Only one California city made the list of the fastest growing places with over 20,000 residents: Lathrop, in the Central Valley about 10 miles from Stockton. Lathrop’s population grew by over 13% to almost 40,000 residents.

In 2004 San Jose reached the top 10, knocking Detroit off the list. About a decade later the city reached the million-resident landmark.

The city held on to that number ten spot for nearly two decades, but in 2017 things started to change.

After years of decline, San Jose dropped out of 10th place when population estimates for July 1, 2022, from the U.S. Census Bureau were released last year. Data for 2021 showed the city slipping below the million-resident marker.

The South Bay city was surpassed in 2022 by Jacksonville, Florida, and Austin, Texas. Those two cities have seen notable population increases in the past few years.

Russell Hancock, CEO of Joint Venture Silicon Valley, remembers the celebrations when San Jose first appeared in the top 10 largest cities in 2005. But he doesn’t fret too much about the recent declines.

San Jose remains the largest city in Northern California, larger than San Francisco and Sacramento.

While San Jose might start seeing population growth again soon, it would be hard to recreate the city’s population explosion that started in the late 1950s, and ended in the 2010s. Early growth was largely due to “smoke and mirrors,” according to Hancock, by annexing whole cities. “It gobbled them up. … It didn’t do it through natural population growth.”

Now San Jose has to rely on immigration to maintain its population and its position as a hub for technology and innovation. “That’s been the Silicon Valley secret sauce for generations,” Hancock said.

Immigration is more important now, partly because local residents are not having enough babies to replace the aging population. “The birth rate in Silicon Valley has been declining for about 10 or 15 years,” Hancock said. “That’s a significant social trend … really, hugely significant.”

When international immigration was disrupted by Trump administration policies, and then the pandemic, Silicon Valley’s population dropped. But now international immigration is returning, and Hancock is among those hopeful that the booming industry around AI technology will be a source of growth in the coming years.

“It wouldn’t surprise me if Silicon Valley’s economy decides to surge again,” Hancock said. “I really do see us on the cusp of that.”

The Bay Area’s two other large cities have already turned the corner. Oakland and San Francisco both showed population increases for 2024, though San Francisco has yet to recover from the dramatic drop in residents it had during the pandemic.

One possible reason the South Bay hasn’t seen a return of growth: stubbornly high rent in San Jose.

Abby Raisz, a senior research manager at the Bay Area Council, a nonprofit group that promotes business and economic development, has looked at changes in median rental costs. In the year ending July 1, 2023 rent dropped 7.4% in Oakland, and 3.7% in San Francisco. San Jose saw just a 1.6% drop in the same time. This pushes people to move out of cities like San Jose into nearby areas with cheaper rent.

“The people moving out of these big cities tend to be lower-income folks, much more so than wealthy folks,” Raisz has found in her research, and they are renters more than homeowners.

San Francisco and Austin both had about 806,000 residents in 2010, but since then Austin has boomed, growing by over 173,000 residents in that time, while San Francisco grew by 76,000 through 2019, and then dropped over 72,000 residents, ending up just above 2010 population levels.

“More people doesn’t necessarily mean better quality of life. … In fact, there are a lot of people who would make the opposite argument,” Hancock said. Losing representation in the state Legislature and Congress is the main negative consequence Hancock could identify. “You get less representation in the halls of government, and that’s significant.”

Biden, who landed at Moffett Field on Thursday evening, planned to meet and greet Silicon Valley’s tech elite at two megawatt fundraisers on Friday: one in Portola Valley at the home of venture capitalist Vinod Khosla, and the other with former Yahoo CEO Marissa Mayer in Palo Alto.

“You come to the ATM of California to tap into the dollars from tech zillionaires,” said David McCuan, a political science professor at Sonoma State. “The only thing that matters is money, cash, dollars. M-C-D.”

California has proven to be the Democrats’ largest cash cow state — bringing in $60 million to Biden and affiliated organizations and political action committees that support him since the election cycle began last spring, amounting to nearly 25% of all his fundraising nationwide.

San Francisco alone contributed some $23 million, while the Oakland and San Jose metro areas both added more than $3 million each. Menlo Park, where fundraising host Khosla has his office, is responsible for donating $10.6 million, while Portola Valley — a small town of 4,200 where he lives — accounts for $1.4 million, the 11th highest amount when broken down by ZIP code across the country, according to the Open Secrets political website that tracks presidential campaign donations.

Some of Biden’s most prolific donors do more than open their own pocketbooks. They bring their friends — and their checkbooks. For that, they are given a snappy moniker by the campaign: They are called “bundlers” and show up on a list all their own.

Their names are familiar: During the 2020 campaign when Biden first faced Trump, numerous Silicon Valley luminaries each raised at least $100,000 for his campaign and outside groups, according to Open Secrets. They include LinkedIn founder Reid Hoffmann, who hosted a top-dollar fundraiser for Biden at his Los Gatos home last year; Steve Westly, who held a fundraiser at his Atherton home; venture capitalist John Doerr; and veteran Democratic fundraiser Susie Tompkins Buell. Since 1990, records show that they and their spouses have contributed millions of dollars to federal candidates, parties and political action committees.

It’s not difficult for Biden to find friends in California and the Bay Area, which reliably have supported him and other Democrats. The president supports clean technology to combat climate change, the business model of numerous Silicon Valley startups, and he championed the CHIPS and Science Act that allocates $52 billion in federal money to manufacture computer chips in the U.S.

“It shouldn’t surprise anyone that he is wanting to raise money in Silicon Valley to continue to garner support from those who agree with those policies,” said Oakland-based political strategist Doug Linney.

Indeed, Donald Trump, who is on trial in a hush money scandal in New York, reportedly met with oil industry executives last month and offered them a “deal,” according to the Washington Post: Raise $1 billion for his campaign in exchange for his promise to dismantle Biden’s clean energy agenda that encourages electric vehicles, solar energy and wind power.

“Maybe Trump is just saying it out loud,” said Linney, who supports Biden. “But I don’t see anything technically wrong with trying to get support from people who believe in the same issues and positions.”

Although Biden might have attracted Silicon Valley billionaires, his motorcade heading to the fundraisers likely will be passing protesters who disagree with his support of Israel in the midst of a war with Hamas. Those protesters are mostly young, a key demographic that Biden would need to beat Trump in a close race.

So far, Biden’s re-election campaign has raised $129 million and spent $90 million, touting the fact that it has raised more for the 2024 race and for the DNC than at this point in the previous election. Trump’s campaign has raised $96 million and spent $63 million, according to data from the FEC compiled by OpenSecrets. Both candidates also have several PACs and independent committees raising and spending millions to support and oppose them.

When individual contributions — which can exceed no more than $6,600 for the primary and general election campaigns combined — are sorted by city, the Bay Area clearly dominates in donations to Biden. San Francisco is the city with the most cash contributed, $2.5 million, more than Los Angeles, which has quadruple the population. If you calculate the total contributions per capita of the 15 cities whose residents contributed the most, Portola Valley tops the list with an average of $75 contributed to Biden’s campaign. Atherton came in second at $32, whereas San Francisco residents contributed enough to equal out to $3 per person. In Los Angeles, it’s 56 cents per resident.

On Friday, checks of up to $250,000 each will be written out to the Biden Victory Fund, a joint fundraising committee. This allows big donors to give one large sum, higher than the individual contribution limits for any candidate or committee, which is then split up between Biden’s campaign committee, the Democratic National Committee and state-level Democratic parties, following the FEC limits for each.

“For general election candidates for the presidency, this is how fundraising is done for them,” said Brendan Glavin of Open Secrets. “It’s been growing over the last number of cycles.”

The overall population gains were relatively small — a net increase of some 67,000 people to raise California’s population to 39.1 million people in 2023, according to the California Department of Finance.

Some Bay Area counties lost population, including Alameda and San Mateo, as layoffs took hold last year and residents continued to seek cheaper housing in the Central Valley.

But the overall population increase is a positive sign for the state that was much maligned for losing its residents to states with more affordable housing.

“The pandemic is in the rearview mirror and we’re sort of coming back to how we were,” said Russell Hancock, CEO of Joint Venture Silicon Valley, a regional think tank. “People are coming back to California because, actually, it turns out there’s a lot of opportunity here. Not a little, a lot. And to capture a lot of that opportunity, you have to be here.”

Opening the backlog of legal immigration, most from China, India and Latin America that was curtailed during the Trump Administration, largely contributed to the state’s growth with a net gain of 114,200 legal foreign immigrants in 2023 compared to 90,300 in 2022. Birth and death rates also returned to normal post pandemic.

But for all the political blowback progressive California endured when droves of Californians moved to conservative states such as Texas and Florida during the height of the pandemic — Florida Gov. Ron DeSantis blamed California’s “woke” culture —  that exodus has slowed.

California’s net migration in 2023, taking into account those who come and those who leave, dropped in two years to roughly a quarter of its 2021 rate, the report shows. That includes a 28% drop in the actual number of Californians who left the state, according to the Department of Finance.

“During the pandemic, high education, high income people were leaving the state in big numbers. And that was something that hadn’t really happened before,” Eric McGee of the Public Policy Institute said Tuesday. “It was about the flexibility of remote work, being able to work somewhere else where it was cheaper to live. But a lot of places are just saying, ‘hey, come back in two days a week, three days a week.’ It’s just enough to keep people tied to California.”

In a statement Tuesday, Gov. Gavin Newsom celebrated the population turnaround.

“People from across the nation and the globe are coming to the Golden State to pursue the California Dream and experience the success of the world’s 5th largest economy,” Newsom said. “From the Inland Empire to the Bay Area, regions throughout California are growing — strengthening local communities and boosting our state’s future.”

That growth, however, only amounted to 0.17%, a “relatively muted” increase compared with the boom period coming out of the 2008 Great Recession, said Jeff Bellisario, executive director of the Bay Area Council Economic Institute, a a nonprofit business advocacy group.

“If you look at the years between 2011 and 2013, the state was growing between 200,000 to 300,000 people each year,” Bellisario said. “So at 67,000, while still growth and still good, it’s still not necessarily a high growth type number.”

The state Department of Finance uses the decennial federal census, combined with records for births, deaths, and people moving to make annual population estimates for California’s counties and cities for planning and the appropriation of funds. The state’s population estimates are for Jan, 1 of each year, while the U.S. Census Bureau’s annual estimates are for July 1 of each year.

In 2021, nearly 700,000 people left the state while only 340,000 moved here, leaving a net loss of 360,000 people. In 2023, however, 505,000 people left the state, while 414,000 came in, for a net loss of 91,000.

Of California’s 58 counties, the population grew in 31 of them in 2023, with Los Angeles County making up nearly half of the state’s gains with a net influx of 32,000 people, thanks to a relatively healthy housing stock and stable job market. Riverside County saw net growth of 13,800 people.

In the Bay Area, the largest increase was in Contra Costa County, which grew by 0.12%, smaller than the statewide gains but an increase of over 1,000 residents. San Francisco also saw a modest gain, of 0.1%, and Santa Clara County had the smallest change, just 0.02%, an increase of 399 residents. San Mateo, Marin and Alameda counties all saw decreases around half a percent.

Estimates for Bay Area cities showed the largest change in population was Emeryville, which had a 5% increase in population in a year. Mountain View, Oakley, Millbrae, El Cerrito and Alameda were the other cities in the region that had a population increase over 1%.

On the flip side, eight cities in the region saw a population drop in the same year. The largest drop was in Newark, which lost 2.4% of residents. San Leandro, Daly City, Foster City, Novato, Colma, Pleasanton and Union City also saw population losses of over 1% last year.

Some of those drops may have been a shift of families not leaving the state, but seeking cheaper and more abundant housing to Napa and American Canyon to the north and Central Valley towns, including Lathrop, to the east.

So what does the future hold?

“The most realistic scenario is that we’re going to be a slow-growing state,” said the Public Policy Institute’s McGee. “Maybe we will get slightly higher rates of growth, maybe not. But nobody’s really thinking we’re going to return to the days of the mid-20th century when we were really booming.”

New York has been in a similar situation of slow growth, he said, and may be a good model for California.

“I think we’re kind of in New York lane right now,” he said, “slow growing, but high income.”

The new lab is an effort to expand and streamline some common genetic testing routinely done by the insurer and health care provider, and a step towards increasing access to one of the next frontiers in tech and medicine, personalized “precision” treatment based on genome testing.

“Genomics is the study of all the genes… in contrast to genetics… the study of a single condition or trait,” said Dr. Jason Rosenbaum, the director of the new lab, and a pathologist with Kaiser.

Rosenbaum led a tour of the facilities Monday, taking a group of reporters and cameras from one sterile, shiny, white room to another, each with several giant printer-like machines, moving around tiny pallets with dozens of samples, as technicians in white lab coats supervised.

The grand opening marked the first time the lab ran a non-invasive pre-natal screening test, one of several pre-natal screenings that can be done. This option is done with a blood test, anytime after the 10th week of pregnancy. Advanced technology allows technicians to measures small pieces of fetal DNA in the mother’s blood, and is used to screen for certain chromosome disorders, including Down Syndrome.

The lab, in its old digs, had doing about 30,000 tests a year, but all the new robotic equipment has allowed the lab to double its output, without hiring any new staff, according to Rosenbaum. They lab is planning to do over 60,000 of those tests this year, and will expand to 160,000 tests a year by 2029.

The facility was custom built for Kaiser’s purposes, with robotics that help a few technicians run dozens of tests at a time with fewer errors.

The Kaiser Permanente Northern California Regional Genomics Laboratory is set to be fully operational by the end of this year.

They are also not the biggest or most complicated-looking devices in the building, the size of a small office printer, but they do “arguably the most sophisticated medical testing humans have ever created,” Rosenbaum said.

That sophisticated testing is used to offer treatments tailored to an individual’s specific genes.

“People may see [this testing] advertised on TV, which is a unique American feature of our health system,” Rosenbaum said. “A lot of the targeted drugs that are advertised in sporting events like the Super Bowl, are for mutations that are specific to a given kind of cancer. Up to this point, all of that testing has been sent out to reference laboratories. Our plan in the next five years is to internalize all of that to offer it in our system to our patients.”

Kaiser topped the so-called “fair share deficit” list of the country’s hospital systems, netting $1.3 billion more in tax breaks over its community spending, the report said, while Stanford Hospital ranked sixth among the country’s hospitals, with a deficit of $181 million in 2021. In Stanford’s case, it was one of two major hospitals atop the deficit list that spent more in 2020 than it saved from tax exemptions.

Overall, the report found, 80% of nonprofit hospitals totaled $26 billion more in tax breaks than they spent on giving back.

Researchers at the health care think tank focused the analysis on spending that hospitals report to the IRS “that we thought are direct and meaningfully beneficial to the community,” said Dr. Vikas Saini, president of the Lown Institute. The spending included free and discounted care for eligible patients, community health improvement services such as health education classes, free clinics and other services, contributions to community groups, and other community building activities.

It then subtracted what hospitals reported spending on those selected benefits from the hospital’s estimated tax savings for the fiscal year ending in 2021.

According to the analysis Stanford spent 2.5% of its total expenses on those programs.

Kaiser, a huge system of 31 hospital facilities in California alone, spent an estimated 1.5% of its expenses on “meaningful community investments,” as delineated by the institute. Sutter Health also has a large deficit, $330 million, between its 21 facilities in the state.

Stanford and Kaiser, along with the American Hospital Association, challenge the basis of the Lown Institute’s analysis.

The researchers purposefully exclude what hospitals report in research, training, and Medicaid shortfall from their calculation, though they are reported as community benefits to the IRS, in part because the researchers deem them “susceptible to double- or triple-dipping.”

“There are things that we didn’t count that are in the IRS Form, we plead guilty to that,” Saini said.

For example the Medicaid shortfall is often cited by hospitals as a reason for charging private insurance higher rates. And Saini says there are also other programs that compensate the hospital for that care, that aren’t included in the shortfall calculations.

In response to this week’s report, Kaiser Permanente released a statement calling the Lown Institute’s analysis “deeply flawed,” saying the analysis “cherry-picks some community investment categories while ignoring others.”

Stanford also responded, saying that Stanford Medicine “donated more than $1 billion to the local community, supporting a range of services from food donations and free training for medical professionals to patient financial assistance,” also citing the cost of “uncompensated costs” for treating Medi-Cal patients, those covered by the state’s Medicaid program that insures 40% of all state residents.

The national average for spending on those categories, according to the report, is 3.9% of expenses, in California the average is 2.5%.

Stanford’s place on the list is a big transition from last year’s report, which showed Stanford had the third largest surplus, $92 million for the fiscal year ending in 2020.

Hospitals in the U.S. are eligible for tax exempt status, in exchange for providing some community benefit, but critics say the regulations are too loose. A 2023 report from the Government Accountability Office found “tax-exempt hospitals have broad latitude to determine the community benefits they provide,” and found that the lack of clarity leading to a lack of transparency that made enforcement by the IRS difficult.

“There’s actually no minimum spend, there’s no real audit, they just have to file, they could file with $0 [of community benefits] and they would have met their obligation,” Saini emphasized.

According to the Lown Institute analysis of 171 nonprofit hospitals in California, 160 have a fair share deficit, 94% of all the hospitals reviewed in the state, higher than the nationwide rate of 80%. In total those deficits add up to an estimated $3.5 billion.

Data for Bay Area hospitals shows only three hospitals in the nine-county Bay Area had a fair share surplus in 2021; Marin General Hospital, Sutter’s Mission Bernal Campus in San Francisco and Adventist Health St. Helena in Napa.

But the newest population estimates for July 1, 2023, released this week by the U.S. Census Bureau, show the losses were the smallest the region has seen since the pandemic marked the beginning of a dramatic exodus that is now slowing and showing signs of reversing.

Of the core Bay Area counties, San Francisco was the only one that saw an increase in population in 2023 after having the most dramatic drop early in the pandemic.

Russell Hancock, president of Joint Venture Silicon Valley, has some theories about why the recent trend is reversing, especially in San Francisco.

“We seem to be turning a corner on the work-from-home phenomenon,” Hancock said. And like others, he sees the explosion in buzz around AI technologies such as ChatGPT as a big magnet for San Francisco and Silicon Valley. “If you’re a person who is into big data, machine learning, massive computational processing, futuristic stuff, this is where you would want to be.”

In the rest of the Bay Area, counties are still losing residents year over year. That puts them in the minority of counties in the country. According to the bureau’s analysis of all counties, about 60% (1,876) of U.S. counties gained population from 2022 to 2023, an increase from the 52% of counties (1,649) that experienced population growth between 2021 and 2022.

California’s population, like the Bay Area’s, has continued to decline. According to statewide population estimates, released in December 2023, the Golden State was among eight states that saw a population drop from 2022 to 2023, losing 75,000 residents that year.

“Domestic migration patterns are changing, and the impact on counties is especially evident,” said Lauren Bowers, chief of the Census Bureau’s Population Estimates Branch.

The average county-level population increase was 0.29% in 2023, nearly twice the average increase of 0.17% in 2022. While Bay Area counties might be behind the curve, they’re headed in the same direction. Every Bay Area county lost fewer residents in 2023 than the previous year.

The 5-county area saw a 2.6% decrease in population from July 1, 2020, through July 1, 2021, a 0.7% decrease the next year, and the most recent year it only dropped by 0.16%. Each of the 10 years before that, the region recorded increases in population, though the growth was slower in the years before the pandemic than earlier that decade.

Over the last year, the five-county Bay Area — Alameda, Contra Costa, San Francisco, San Mateo and Santa Clara counties — lost just over 10,000 residents in total since 2022.

Census demographers take into account “natural change,” which is births minus deaths, and then how many people move.

The counties had an estimated 60,000 births in that year, and 40,000 deaths, for a net increase of 20,000 residents. But more people left the region than moved here during that period.

The Bay Area lost over 80,000 residents to other parts of the state and the country from 2022 to 2023. Meanwhile, the region gained 50,000 new residents from international immigration.

International immigration was once a much bigger boon to the region’s population, but it dropped dramatically starting after 2016, during the Trump administration, and then again during pandemic travel restrictions.

“The Silicon Valley story is the story of really capable, talented people coming from overseas,” Hancock said. So he is happy to see signs that international immigration is returning to pre-2016 levels.

“Former Congressman Jerry McNerney said campaign money is poisoning the system,” the ad read. “But Jerry McNerney took $5.3 million in PAC money. Guess he didn’t mean it.”

At the end of the ad, in small text, it identified the buyer: Valero, Phillips 66, and Marathon Petroleum.

So why are fossil fuel companies investing half a million dollars in a race that seems to be little more than a choice between two Democrats–McNerney and State Assemblymember Carlos Villapudua–for a seat being vacated by another Democart, Susan Talamantes-Eggman. The seat covers much of Eastern Alameda County and Parts of San Joaquin County.

According to Elizabeth Bergman, an associate professor of political science at Cal State East Bay, the outside money is evidence of the toss-up nature of the race, and the way politics has been played since the Supreme Court’s 2010 Citizens United v. Federal Election Commission (FEC) decision, which knocked down limits on corporate campaign spending. Such independent expenditures are often made without the knowledge or consent of a particular candidate.

“They don’t just throw their money around willy-nilly – they make good, astute investments,” Bergman said. “This one makes particular sense to me because it’s effectively an open seat.”

Although there are no refineries in the district, Bergman said lobbying groups target any seat that they think they might be able to influence in a 40-seat state senate. McNerney, who describes himself as a proponent of climate action, may not be viewed as a friendly partner. Villapudua, meanwhile, is considered one of the more moderate California Assembly members.

“They have to do what I call, ‘finding your Republican’,” Bergman said. “In this case, it’s Villapudua.”

A large portion of the $2.6 million in outside spending in the District 5 election–a surprising amount for a down-ballot primary race–has come from an oil and gas industry PAC,the Coalition to Restore California’s Middle Class, whose funders include Chevron, Phillips 66, Marathon Petroleum and Valero.

The companies had not responded to requests for comment by press time.

According to available records, the group has spent $522,000 in opposition to McNerney’s candidacy. Another PAC, “Fighting for our Future” has spent an additional $347,000 opposing him. Meanwhile, a group representing nurses and educators, the largest spender in the race, has spent about $367,000 in support of McNerney and $630,000 opposing Villapudua.

In an interview with this news organization, McNerney painted Villapudua as a friend of fossil fuels, and noted the same group had supported his opponent in Villapudua’s race for the State Assembly in 2018.

“They obviously think he’s going to look out for their interest in the State Senate,” McNerney said. “That’s pretty much how politics works now.”

Villapudua’s campaign had not responded to requests for comment by press time.

McNerney’s campaign has thus far raised $300,000, trailing both the amount spent by the oil and gas group against him and the $423,380 raised by Villapudua through Feb. 17. The largest amount of money in support of McNerney has come from the nursing, education and reproductive rights group. As the attack ad said, it’s true that McNerney too has benefited from independent expenditures.

With less than a week to go before Election Day, it remains to be seen what effect the outsized amount of money involved will have on the race.

“There’s a lot of money in the race,” Bergman said. “We know it’s going to be close.”

First the money came from the American Federation of State, County, and Municipal Employees (AFSCME) Local 3299, representing 30,000 service workers in the University of California system. The union formed an independent committee to support its past president, Kathryn Lybarger, and backed it up with nearly $2 million, along with some cash from other labor groups. That committee has spent at least $1.9 million so far blanketing local stations with TV ads.

Lybarger’s own committee, with a fraction of the cash, is running digital ads.

The television ads were an early boon for a relatively unknown candidate up against several longtime East Bay politicians in the race, including Berkeley Mayor Jesse Arreguín, former Assemblymember Sandré Swanson, Richmond City Councilwoman Jovanka Beckles and Oakland City Councilman Dan Kalb.

But now ads opposing Lybarger, and supporting Arreguín are hitting local airwaves, funded and sponsored to the tune of over $1 million by Uber, the ride-hailing app giant. And another group called “Housing Providers for Responsible Solutions,” has also put their money in the race, opposing Lybarger and supporting Arreguín.

These “independent expenditure committees,” similar to PACs, are allowed to accept unlimited amounts of money and spend it on whichever candidates they like — so long as they do not coordinate with the candidates’ committees, which are limited to contributions of up to $900.

Lybarger, who served as immediate past president of her union, said that she has not been involved in her union’s decisions on campaign spending or endorsements.

“I’m honored that medical assistants, x-ray techs, cooks and janitors have the belief in me to do this work in the state Senate, enough to put their hard-earned dues to help me get elected,” she said in an interview.

This isn’t the first time that AFSCME has spent big in support of a state Senate race. In 2022, the union spent more than $1 million to help Hayward City Councilmember Aisha Wahab win the District 10 Senate seat over Fremont Mayor Lily Mei. The spending in that race — $7.7 million — made it the most expensive state Senate race in the area’s history.

In January, the California Dental Association spent $160,000 on mailers for Arreguín’s campaign. In a statement, the CDA told this news organization they support candidates committed to “solving the challenges experienced by the dental profession and their patients.”

Arreguìn, who said he didn’t know about the mailers until he received one at his home last weekend, said the California Dental Association has supported him because of his work on public health issues, like Berkeley’s 2014 soda tax.

But the association was also a major donor to the senator currently holding the seat, Nancy Skinner, who introduced and helped pass legislation sponsored by the dental association to increase transparency around dental insurance plans.

No other candidates in the race have received any independent expenditures. The top two candidates will continue to the November general election.

Arreguín’s campaign has so far brought in the most contributions, including thousands from different building and trades unions around the East Bay, for a total of $637,387 through Jan. 20. The candidates with second largest war chest is Lybarger, with $484,303 in donations, followed by Oakland City Councilman Dan Kalb, with $321,356.

In total, over $5.8 million has been poured into the race, into candidate committees and independent expenditures. That would work out to almost $13 per vote, for each of the roughly 450,000 votes counted in the last election when Nancy Skinner won re-election in 2020. And with three weeks left before the election, that figure is sure to grow.

Fed up with high housing costs and other quality-of-life issues, and untethered from the office by remote work, California residents left in droves during the pandemic. Increased deaths and a steep drop in international migration due to COVID-19 restrictions also contributed to a population decline.

The state population shrank by more than 75,000 residents to just under 39 million people in 2023, a 0.2% dip from the year before, according to recently released census data. The decline was less than the 0.3% annual slide in 2022 and the 0.9% drop in 2021. Over the three years, the state’s population fell by 1.4%, or more than 538,000 residents.

While officials and experts believe a return to growth is on the horizon, there’s still plenty to unpack in the recent migration shifts and their potentially lasting consequences. Here are five charts that help explain who left, where they went and how much money they took with them.

California lost $29 billion in taxable income to other states

In 2021, fleeing California residents took billions of dollars in personal income to other states, according to a Bay Area News Group analysis of the latest available IRS data.

On a net basis, the Golden State lost $5.6 billion in residents’ taxable income to Texas alone. California also lost $4.4 billion to Nevada, $3.5 billion to Florida and $2.6 billion to Arizona. In total, the state lost $29 billion to other parts of the country.

A decline in taxable income undoubtedly played a part in California’s current budget shortfall of at least $37.9 billion, though stock market fluctuations that hammered wealthy residents’ investment returns were likely a bigger factor, said Jeff Bellisario, executive director of the Bay Area Council Economic Institute, a pro-business think tank. On Wednesday, Gov. Gavin Newsom announced his annual spending plan to close the budget gap.

Bellisario said it was unsurprising that Sunbelt states such as Texas and Florida, which became prime destinations for fleeing Californians during the pandemic, saw the largest gains. In addition to offering less expensive housing and a lower cost of living, many also boast growing tech sectors that have attracted high-income workers.

The five-county Bay Area region lost $1.2 billion in taxable income to Travis County, Texas, home to Austin, a burgeoning tech hub. The Bay Area also lost $747 million to Clark County, Nevada, which includes Las Vegas, another upstart Silicon Valley rival.

“The big concern you have is that some of the population moving out are the future entrepreneurs and the people who are going to be starting businesses,” Bellisario said. “Everybody wants a piece of what San Francisco or Silicon Valley has.”

More than 800,000 fled the Golden State annually during the pandemic

In 2021 and 2022, more than 800,000 residents packed up and left California in each of those years for other parts of the country, according to the latest available census data.

Compare that to 2018 and 2019, the two years before the pandemic hit, when 650,000 to 700,000 people left the state each year. Data for 2020 was unavailable.

Which states siphoned the most residents away from California? The usual suspects: Texas, Arizona, Florida, Washington and Nevada.

Those states also saw among the largest increases in California migration compared to pre-pandemic years, though none experienced nearly as big a spike as Idaho. The Gem State, a new hotspot for Silicon Valley billionaires, saw the number of incoming Californians surge by 191% from 2013.

But the data also shows fewer California residents left in 2022 than the year before, a trend experts expect should continue. And with international migration returning, the state’s population woes could soon subside.

“As we turn the page to 2024, the data is pointing less to an exodus and more to population stabilization across California and the Bay Area,” Bellisario said.

A California brain drain?

During the pandemic, more people with graduate or professional degrees left California than arrived from other parts of the county, a remarkable reversal for a state with a powerhouse economy and world-class universities.

According to the latest available data from the Brookings Institution, a nonprofit public policy organization in Washington D.C., roughly 30,200 more people with advanced degrees left California than arrived in 2021. In 2018 and 2019, the numbers were about equal. The data does not account for international migration.

For most of the past two decades, California has had more U.S. residents leaving than coming to the state, largely driven by the departures of less-educated and lower-income residents. But with the freedom of remote work and more high-paying jobs available in different parts of the country, highly educated workers have increasingly looked elsewhere.

Some of the state’s largest companies have also moved out. California-born companies, including Tesla, Oracle and Hewlett Packard Enterprise, all opened new headquarters in Texas over the past few years.

Yet in 2022, more highly educated workers came to California and fewer left than in 2021, according to the data. William Frey, a demographer with Brookings, said that’s evidence the trend, like other recent migration shifts, could be reverting to a pre-COVID norm.

“It’s too soon to tell what’s permanent and what’s a pandemic effect,” he said.

Research shows that many times patients don’t need that level of care. And whether the ambulance ride was necessary or not, you are likely to get stuck with a big bill.

Now, Alameda County wants to change that wasteful practice so ambulance providers are more accountable for providing an appropriate level of care.

The county’s emergency services agency on Friday unveiled its vision as it begins the search for its next ambulance provider for all areas of Alameda County – outside of the cities of Berkeley, Piedmont, Alameda and Albany. The new contract would start in 2026, when the county’s current contract with Falck US expires.

“This is kind of cutting edge,” said Lauri McFadden, director of Emergency Medical Services at Alameda County Health Care Services Agency. The effort comes as public officials have been grappling with national conversations about mental health, policing, and our health care system.

Offering an exclusive coverage contract allows the county to ask for more from its ambulance service provider, said McFadden, whose office has been working on the new framework with EMS providers and other stakeholders for several years.

“What we found is this one model of taking everyone to the hospital just wasn’t sustainable,” she said.

The county will require its next provider to develop an “appropriate tiered system” for their responses, offering things like at-home telehealth appointments when appropriate, instead of just transporting people to the hospital. The contract comes at no cost to the county, because ambulance services are funded by the revenue generated from billing patients and their insurance.

“We are looking to be more innovative in helping people get the right care at the right place, and that involves potentially a dispatch clinician, a nurse practitioner, or perhaps a doctor… rather than going to the hospital and waiting hours and hours and hours,” McFadden said.

In Alameda County, like the country as a whole, there is a patchwork of emergency services, public and private. In some places, Berkeley, Piedmont, Alameda and Albany, the fire departments handle ambulance transports. Other places, like the rest of Alameda County, offer an exclusive coverage contract, in exchange for more input and choice over how those services are provided, and guaranteed service.

Some municipalities allow private ambulance companies to compete for emergency calls, a system that can lead to poor service for historically underserved communities that are overlooked in favor of calls for help from places with more income and better insurance coverage.

Colleen Chawla, director of the Alameda County Health Care Services Agency, said public education will be a big part of the challenge.

“It’s really going to be a culture change,” she said, “to have people think about emergency response, not just as an ambulance arriving as fast as possible, but as the right response for what you need in the moment.”