California voters reject clinic spending limit
Proposition 44, which would have mandated a 90% spending floor for community health centers, was defeated by a wide margin.
By Julia Novak ·
California voters defeated Proposition 44 on Tuesday, rejecting a mandate that would have required community health clinics to direct at least 90% of their annual revenue toward program services. The measure received 81.7% of the vote against it, a result that aligns with October polling from the Public Policy Institute of California. That survey showed only 25% of likely voters in favor of the proposal.
The loss marks the fourth consecutive ballot failure for SEIU-United Healthcare Workers West. The union previously lost efforts to regulate dialysis clinics in 2018, 2020, and 2022. Opponents, led by the California Primary Care Association, raised $39 million to defeat the measure. Supporters reported raising $17 million, meaning the opposition outspent the union by a two-to-one margin.
Francisco Silva, president of the California Primary Care Association, called the result a resounding defeat for the union. In a statement, Silva said health centers would not be bullied and that protecting whole-patient care remained a priority. The association represents approximately 2,000 community clinics across the state.
The union argued the measure added accountability to how clinics use taxpayer dollars. Renée Saldaña, a union spokesperson, stated that money should not go to excessive executive compensation or non-essentials. Some executive salaries recently became the subject of a complaint filed with the Internal Revenue Service. Clinics currently serve an estimated 7 million low-income Californians and rely heavily on public insurance reimbursements and federal grants.
A nonpartisan analysis by the Legislative Analyst’s Office indicates that clinics currently spend about 80% of revenue on services on average. Opponents argued the new 90% floor would be difficult to meet. An analysis commissioned by the opposition estimated that noncompliance penalties could cost clinics $1.7 billion in the first year. Some clinics might close or reduce services to avoid these fines.
Dr. Jerry Abraham of Kedren Health in South Los Angeles warned that the measure puts patients in danger. He noted that if clinics reduce access, patients will likely turn to emergency departments for care. Clinic leaders also pointed out that their centers are already heavily regulated by state and federal authorities. A key uncertainty was that the state attorney general would determine which costs qualified as appropriate healthcare spending.
The California Primary Care Association has sued the union twice. A federal judge dismissed a summer case that sought to keep the measure off the ballot. A separate lawsuit filed in September accuses the union and its president, Dave Regan, of using the ballot process to coerce clinics. The union called these allegations categorically false. The second lawsuit remains pending in court.
