Proposition 44 wrongly squeezes politics between California patients and their healthcare

California voters will decide this fall if community clinics should be required to spend 90% of their revenue on patient care and whether to empower the state Attorney General to settle disputes. Below, a physician argues that Proposition 44’s poor design will end up hurting the vast majority of clinics. The opposing view: A social worker says the measure will ensure funding actually reaches patients.

Primary care doctors train for patients at every stage of life, from children to older adults, to provide the lifelong, comprehensive medical care that millions of Californians rely on. Improving the health of all residents is our mission.

Many of us are worried about Proposition 44 this November and are urging voters to reject it.

Family physicians work at community health clinics throughout the state, providing essential care for millions of patients. Prop. 44 would put that care at risk.

How?

The measure sets strict spending requirements for nonprofit health clinics that could put billions of dollars in revenue at risk, creating arbitrary standards that an estimated 91% of health centers don’t meet. A study commissioned by the California Primary Care Association found that clinics could pay as much as $1.7 billion in penalties the first year alone, with more to follow every year. That’s essential funding that keeps facilities open and helps community health clinics offer the whole-person, whole-community care they are known for.

Upending health center budgets like this could have devastating consequences. It would push the vast majority of clinics across California into the red, forcing facilities to make impossible choices about which services to eliminate.

Unless Prop. 44 is defeated, many clinics that offer safety-net care could even close.

California’s community health clinics serve more than 7 million patients each year, including children, working families, the uninsured, seniors, veterans and 1 in 3 Medi-Cal patients. Prop. 44 threatens the resources these clinics rely on.

The measure is terribly drafted and rife with legal flaws that are going to wind up saddling clinics with enormous financial penalties — just for spending resources on the important staff and patient services that keep clinics running and Californians connected to care. Under Prop. 44, clinics would be financially penalized for investments like capital projects, new equipment and technology upgrades, disaster prep or even if they put revenue in its budget reserves.

Anyone who has worked in or relied on a community health clinic knows that healthcare does not end in an exam room. Ensuring that patients have access to transportation, telemedicine when they cannot make it to the clinic, and healthcare enrollment navigators to help them sign up for the health insurance they qualify for are all essential components of keeping people healthy.

Prop. 44 puts far too much on the line.

While all of these provisions are worrisome, perhaps most concerning is that Prop. 44 squeezes a politician between a patient and their clinic. The measure essentially puts the state’s Attorney General — an elected official with no healthcare experience — in charge of decisions about which services health clinics can and cannot provide.

If we’ve learned anything over the last several years, it’s that politicians should stay out of the relationship between providers and patients.

Our healthcare system is already under enormous strain. Costs are already too high, patients are already waiting too long to see a doctor or a specialist, and emergency rooms are already overcrowded.

If the effects of Prop. 44 force clinics to close and patients to lose access to care, their health needs do not disappear. Patients will delay treatment and end up in hospital emergency rooms for routine care, resulting in more emergency room overcrowding, longer wait times and higher healthcare costs.

It’s not just primary care doctors — the opposition to this measure is vast and bipartisan. Millions of patients across the state are counting on our votes.