San Francisco and California Ballot Backstory · Why is this on my ballot?
Prop 44: summary
Requires Community Health Clinics Spend 90% of Revenue on Program Services
Mark your own choices here. You may bring this sheet into the voting booth.
A YES vote means
Nonprofit federally qualified health centers must spend at least 90% of revenue on "program services" the Attorney General defines, or pay penalties. Temporary waivers possible.
A NO vote means
No new spending minimum or penalty. Clinics now report spending an average of about 80% of revenue on health care, though it varies.
Both ovals are empty on purpose. The choice is yours.
If it fails
Nothing changes if it fails
If Prop 44 fails, current rules stay and the 90 percent minimum is not added. The Legislative Analyst (LAO) says private nonprofit safety net clinics now report spending an average of about 80 percent of revenue on health care services. The share varies.
Why it’s on the ballot now
Safety net clinics mainly serve low-income and uninsured people, often at low or no cost. California has about 2,000 of them. Most are private nonprofits.
Clinics spend most of their revenue on health care for patients. They also have other costs, such as administrative costs.
The measure's "Findings and Declarations," which argue for it, say many clinics pay executives "excessive shares" of revenue, causing "underinvestment" in patient services. They also cite long waits.
The money
The Legislative Analyst (LAO) says state enforcement costs would be in the low tens of millions of dollars per year, covered by fees on affected clinics. It says there could be other uncertain state and local costs. See the money chart for the latest filed totals.
Needs a simple majority (50% + 1) to pass Some measures need 55% or two-thirds of votes to pass. This one needs only a simple majority.Who bears the cost
Private nonprofit safety net clinics
The LAO says a clinic below the 90 percent minimum would pay the state a penalty equal to the spending needed to reach it. It can get the money back by complying within five years; otherwise the state spends it on clinic workforce programs. Temporary waivers possible in some cases.
State government
The LAO says state enforcement costs would be in the low tens of millions of dollars a year. The measure directs the state to cover them by charging fees on affected clinics.
The strongest case for and against
Strongest case for
Prop 44's official argument is signed by "Shawna Brown, Initiative Proponent" and "Brisa J. Barrera, Community Clinic Worker." They say clinics get billions of taxpayer dollars, yet some spend under half their funding on patient care and services. Supporters argue large shares go to CEO salaries and spending they call wasteful. They say patients wait months for appointments. They say the 90% must go to patient care and services that make care possible. These "can include" nurse managers, medical equipment and information technology. Supporters say the measure "does not cut clinic funding or reduce services patients rely on." They say clinics that fall short can recover penalties by complying. They say the campaign against it is "funded by the same highly paid clinic executives who benefit from the current system."
Strongest case against
Opponents include the American Academy of Pediatrics, California, the California School Nurses Organization, the California Medical Association and the California Academy of Family Physicians. They say Prop 44 sets unworkable limits. These keep clinics from giving patients needed care. They say economic and health experts warn it would cut $1.7 billion from clinics in the first year and cause 88% of clinics to operate at a loss. They argue it limits spending on nurse managers, physician leaders, translation, insurance help, community education, mammogram, X-ray and CT machines, information technology and clinic upgrades. Opponents say clinics are strictly regulated, with laws requiring "regular audits and public reporting of clinic spending." They say clinics serve 1 in 4 Medi-Cal patients. They argue one special interest wrote and funded Prop 44.