California voters reject clinic spending limit in Proposition 44 vote
The measure, supported by a healthcare union, would have required community health centers to direct 90% of revenue to patient care.
By George Parker ·
California voters rejected Proposition 44 on Tuesday night, ending a campaign that sought to mandate specific spending levels for community health clinics. The measure failed with 81.7% of the vote against it. This result aligns with polling data from October, which showed only 25% of likely voters in favor of the proposal.
The ballot initiative required community health clinics to spend at least 90% of their annual revenue on program services. If a clinic failed to meet this threshold, it would have faced fines from the state. The Legislative Analyst’s Office, a nonpartisan body, estimated that clinics currently spend an average of 80% of their revenue on providing services.
Service Employees International Union-United Healthcare Workers West sponsored the measure. Union leaders argued the rule would create accountability for how taxpayer dollars are used. They pointed to high executive salaries as a reason for the change. Some of these salaries became the subject of a complaint filed with the Internal Revenue Service.
Renée Saldaña, a union spokesperson, stated that money should not go toward excessive executive compensation or other non-essentials within the clinic system. The union views community clinics as a safety net for approximately 7 million low-income Californians. These clinics receive funding primarily through public insurance reimbursements and federal grants.
The California Primary Care Association led the opposition to the measure. The association represents about 2,000 community clinics. Opponents raised $39 million to defeat the proposal. Supporters reported spending $17 million. The opposition group argued that the 90% spending requirement was too rigid for the complex financial realities of healthcare delivery.
Francisco Silva, president of the California Primary Care Association, said the defeat shows health centers will not be bullied. He emphasized that protecting whole-patient and whole-community care remains a priority. An analysis commissioned by opponents estimated the measure could cost clinics $1.7 billion in penalties in the first year. Some clinics might have had to close or reduce services to avoid those fines.
Dr. Jerry Abraham of Kedren Health in South Los Angeles warned that the proposal could limit patient access to care. He noted that if patients cannot visit clinics, they may go to emergency departments instead. Clinic leaders also highlighted that health centers already face heavy regulation from state and federal authorities.
A central issue in the debate was how to define appropriate healthcare spending. Proposition 44 left that definition to the state attorney general. The attorney general would have issued guidance on which costs qualified. Opponents argued that clinics could be penalized for spending on medical equipment upgrades, support staff, construction projects, or budget reserves.
This was the second attempt by the union to restrict clinic spending. A similar bill failed to advance the previous year. The California Primary Care Association sued the union twice regarding the ballot process. A federal judge dismissed the first case over the summer. The second lawsuit, filed in September, accuses the union and its president, Dave Regan, of using the ballot process to coerce bargaining demands. The union called these allegations categorically false, and the case remains pending.
The union also supported Proposition 40 during the same election cycle. That measure proposed a one-time 5% tax on California residents with a net worth of $1 billion or more.
Source: LAist
