By La Opinión Editorial Board
Among the ballot measures that Californians will vote on in the elections culminating on November 3 is Proposition 44. La Opinión opposes it and calls on its readers to vote against it.
From its very first paragraph, its initial premise is flawed.
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The measure, as defined, “requires community health clinics to allocate 90% of their income to program services,” leaving the remaining 10% for administrative costs “and other expenses.” It assigns the state Attorney General the task of determining which expenditures qualify for this remaining amount and fining clinics that violate the requirement.
There are approximately 2,000 non-profit clinics operating throughout the state, serving seven million patients each year, one in three of whom have MediCal .
The clinics that would be in the network established by the proposal are those that receive federal funds to provide prevention and primary care services in underserved areas and whose directory is composed of at least 51% patients.
Proposition 44 seeks to penalize clinics for expenses on staff and patient support services that are essential to their existence and operation, but which could fall outside the state definition determined by official entities that ignore the needs of the community.
If this proposition is approved, these private, non-profit institutions, which for decades have carved out a place of honor in providing medical assistance to poor, immigrant, and elderly communities, and especially among Latinos, will be penalized for investing their funds in staff and customer support services that are outside the state’s arbitrary definition of “program services.”
The state legislature would be authorized to allocate the funds thus collected to the training, hiring, and retention of clinical staff. The fines would be applied to staffing, fundraising, programming, payroll, and even “investments such as capital projects, new equipment and technology upgrades, disaster preparedness, or even to allocate revenue to their budget reserves,” according to the president-elect of the California Academy of Family Physicians .
The proposition presupposes that community clinics in California deceive and profit from people’s suffering, when the reality is quite the opposite.
Equally fallacious is the selection of the Attorney General as the one responsible for determining acceptable expenses, instead of physicians, clinical administrators, or public health regulators. The text authorizes criminal charges against those who submit false expense reports. The idea is precisely that: to label as corrupt—and potentially criminal—those who are not. The proposal ignores the fact that community clinics are already subject to oversight and regulation under state and federal laws. It would therefore create a second unnecessary and counterproductive bureaucratic mechanism that will cost, according to the California Legislative Analyst’s Office (LAO), “at the low end of” tens of millions of dollars.
Once again, the proposal gives the impression of entities that profit from and benefit from the suffering of others and the budgets they obtain. However, it is important to note that currently, according to LAO , the approximately 2,000 community clinics allocate nearly 80% of their income to direct healthcare services, a percentage that obviously varies depending on the clinic but is very close to the absolute 90% target set by the proposal.
If passed, in its first year alone, according to an analysis by the Berkeley Research Group (BRG), it would take $1.68 billion from the budgets of hundreds of community clinics, inevitably leading to a drastic reduction in their services or their closure. Proposition 44 leaves them no other option.
It is unfortunate that the SEIU-United Healthcare Workers West (SEIU-UHW) union is promoting this measure. This is especially true given that the premise on which the proponents base the entire proposal is presented without evidence and in a generalized manner, claiming that “it is necessary because too many community clinics allocate funds to executive benefits and general administrative expenses.”
Those who support the measure may think it will threaten the salaries of clinic directors. In reality, it threatens the very existence of the clinics.
We understand that in the past, and according to the California Hospital Association , this union used similar initiatives at the state or local level as part of its wage negotiation strategy, as tools of political pressure against hospital employers.
He did so in 2014 with the Charitable Hospital Executive Compensation Act and the Fair Healthcare Pricing Act , both withdrawn from the ballot through an agreement with the California Hospital Association; in 2016, an arbitrator declared that his “ Charitable Hospital Executive Compensation Act of 2016 ” violated a prior collaborative agreement; in 2019, he introduced the Public Health and Fair Pay for Hospital Executives ordinance in the city of Los Angeles, and the same ordinance, but under the name Limit Healthcare Executive Compensation in Los Angeles, in 2023. Both were withdrawn from the ballot. Finally, in June of this year, he withdrew the Health Care Executive Compensation Act of 2026 , after it had surpassed one million signatures, following mediation by the California Federation of Labor, after the hospital organization advanced a proposal that would have financially crippled the political campaigns of healthcare unions. None of these initiatives have succeeded or gone into effect.
Perhaps in the past that tactic yielded positive results for the union. But proposing a destructive law like Proposition 44 goes beyond a negotiation tactic, because it exposes not only the clinic executives but the entire institution as predatory and corrupt.
The Trump administration has been pushing through cuts to state public health budgets via the misnamed “One Big Beautiful Bill Act” (OBBBA) , which cuts over $900 billion from Medicaid (MediCal in California). These cuts, and those the administration continues to push through, only underscore the absurdity and injustice of Proposition 44.
Vote NO on Proposition 44.