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Prop. 44: community health clinic spending
This ballot measure would require community health clinics to spend 90% of their revenue on patient care. The prop is being spearheaded by SEIU-UHW and is receiving pushback from organizations like California Primary Care Association and California Medical Association. We lay out the basics.
Proposition 44 would require community clinics that serve low-income people to spend at least 90% of their total annual revenue on providing healthcare services to patients. It would direct the state attorney general to define which clinic expenses would qualify as providing healthcare services.
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Wondering how we got here? Here's the backstory to this race:
What’s at stake?
Community health clinics throughout the state serve low-income and uninsured people with low-cost or free services. According to the Legislative Analyst’s Office, the state’s roughly 2,000 so-called "safety net” clinics currently report spending “an average of about 80 percent of their revenue on providing health care services,” though that number varies across individual clinics. Other expenses include administrative costs and executive pay.
Supporters of the measure, including the health workers union SEIU-UHW, claim that clinics have strayed from their mandate to serve the most vulnerable by spending too many taxpayer dollars on executive salaries and administrative costs.
Opponents of Prop 44, including the California Medical Association, contend that it has major “legal flaws” that could penalize safety net clinics for investing in things like telemedicine and transportation services.
Official title on the ballot: Prop. 44: Requires community health clinics spend 90% of revenue on program services
Language you will see:
Imposes penalties on nonprofit Federally Qualified Health Centers (community clinics providing primary care to medically underserved areas and populations) that spend less than 90% of revenue on “program services” advancing their charitable purpose, including but not limited to patient services. Fiscal Impact: Increased state costs in the low tens of millions of dollars per year, covered by fees.
What your vote means
- A "yes" vote means: Certain private nonprofit health care clinics would have to spend at least 90% of their revenue each year on providing health care services.
- A "no" vote means: The new requirement on health care clinic spending would not go into effect.
Understanding Prop. 44
Supporters of the measure say safety net clinics need to make sure they prioritize patient care, especially since planned federal cuts under H.R.1, aka the One Big Beautiful Bill Act, could leave more Californians uninsured. They also say some executive salaries have become too bloated.
What supporters say
- Led by the health workers union SEIU-UHW, supporters claim that clinics have strayed from their mandate to serve the most vulnerable by spending too many taxpayer dollars on executive salaries and administrative costs.
- Notable supporters: SEIU-UHW, a health workers union
What opponents say
- Opponents contend that safety net community health clinics are already sufficiently regulated by state and federal governments. They say research shows the measure could cut “$1.7 billion from community health clinics in the first year and billions thereafter” by forcing them to pay noncompliance fees.
- Notable opposition: California Primary Care Association, California Medical Association, Planned Parenthood Affiliates of California, California Hospital Association, California Democratic Party
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Election day is just around the corner, get your notepads and pencils ready — it’s time for a one-hour cram session. -
Sharpen your pencils and get out your notebooks — it’s time for a cram session! -
LAist reporter Cato Hernández has been covering judicial elections since 2022 and they will help you navigate these particularly challenging pages on your ballot.
Potential financial impact
According to the Legislative Analyst’s Office, Prop. 44 could create new costs for the state to enforce these requirements, estimated to be in the “low tens of millions of dollars per year.”
The LAO notes other unclear costs too. For example, if some clinics spend more on direct healthcare services for patients on Medi-Cal, that could increase state costs. If some clinics close due to the requirements, that could also indirectly cost the state money.
What it takes to win
A majority is needed to pass.
Watch the ballot cram session analysis
Campaign financing
Further reading
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