Why It Matters
California voters rejected Proposition 44, which would have required community health clinics to direct at least 90% of annual revenue to patient care or face state fines. The clinics serve an estimated 7 million low-income Californians and receive substantial funding through public insurance reimbursements and federal grants.
What Happened
Voters opposed Proposition 44 by 81.7% on Tuesday. The measure was placed on the ballot by SEIU-United Healthcare Workers West.
Under the proposal, clinics could have faced penalties if spending below the required threshold included medical equipment upgrades, support staff, construction projects or budget reserves. Spending guidance would have been left to California’s attorney general.
Community clinics spend about 80% of their revenue on services on average, based on a nonpartisan analysis by the Legislative Analyst’s Office. The California Primary Care Association, which represents about 2,000 community clinics, led the opposition coalition.
Francisco Silva, president of the California Primary Care Association, said, “Today’s resounding defeat shows that health centers will not be bullied and that protecting the whole-patient, whole-community care we are known for will always be a priority.”
Renée Saldaña, a spokesperson for SEIU-United Healthcare Workers West, said supporters opposed directing money toward “excessive executive compensation or other non-essentials” in the clinic system.
By the Numbers
44 — proposition number.
90% — minimum annual revenue required for patient care or program services.
81.7% — share of voters opposing Proposition 44 on Tuesday.
80% — average share of clinic revenue spent on services.
7 million — estimated number of low-income Californians served by clinics.
$39 million — amount raised by opponents.
$17 million — amount reported by supporters.
$1.7 billion — estimated first-year noncompliance penalties.
2 to 1 — ratio by which opponents outspent the union.
Zoom Out
Proposition 44 was the healthcare workers’ union’s second attempt to restrict clinic spending. Voters previously rejected the union’s dialysis-clinic measures in 2018, 2020 and 2022.
An October Public Policy Institute of California survey found 25% of likely voters supported Proposition 44. The California Primary Care Association’s opposition coalition ultimately raised more than twice the amount reported by supporters.
A federal judge dismissed the association’s lawsuit seeking to keep Proposition 44 off the ballot. A separate lawsuit against SEIU-United Healthcare Workers West and Dave Regan remains pending, and the union said allegations in that case were “categorically false.”
What’s Next
Proposition 44 will not impose the proposed spending requirement or related fines. SEIU-United Healthcare Workers West also backed Proposition 40, which proposed a one-time 5% tax on California residents with $1 billion or more in wealth.