Proposition 44
Require more clinic spending on patient care
Proposition 44 would require community clinics that serve low-income patients to spend 90% of their annual revenue on patient care. The measure directs the attorney general to publish guidance on what spending qualifies and allows the state to fine clinics that don’t spend the full 90%. The labor union SEIU-UHW pushed a similar bill last year, but it failed. Clinics failed to keep the measure off the ballot with a lawsuit earlier this year.
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Summary
Support
Supporters, led by the health workers union SEIU-UHW, argue that clinics should spend more on direct patient care and less on executive pay and overhead. With federal cuts under H.R. 1 — which is expected to leave many more uninsured — looming, supporters say it is especially critical for clinics to prioritize patient care now.
Oppose
Opponents say the measure is unnecessary because community clinics are already heavily regulated by the state and federal governments. They say it would cost clinics more than $1.7 billion in noncompliance fees in the first year, ultimately forcing clinics to significantly reduce services or close.
People and organizations
Support
- SEIU-UHW
Oppose
- California Primary Care Association
- California Medical Association
- Planned Parenthood Affiliates of California
- California Hospital Association
- California Democratic Party
Commentary
Campaign finance
Proposition committees raise money to support or oppose propositions. Outside groups can also raise and spend money independently to influence outcomes.
- Proposition committees
- Outside spending
- Difference to other side
Support
Oppose
Proposition committees
These committees are primarily formed to campaign for or against a proposition. They must identify donors who give $100 or more. There are no limits on how much donors can give. Below, we exclude donors whose contributions total less than $100.
Support
Oppose
Outside spending
Separate from proposition committees, outside groups can pay for ads, mailers and other efforts to influence voters. They can’t coordinate that spending with proposition committees. There is no limit on how much they can spend.
Support
Oppose
Ballot text
REQUIRES COMMUNITY HEALTH CLINICS SPEND 90% OF REVENUE ON PROGRAM SERVICES. INITIATIVE STATUTE. 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.
Source: California Secretary of State
