By El Latino Services
In 1970, a group of Barrio Logan residents entered an abandoned building and refused to leave until the neighborhood had its own clinic. That building became Family Health Centers of San Diego, now one of the ten largest community health centers in the nation, serving more than 227,000 patients annually at over 90 locations throughout the county. This is exactly the kind of institution Proposition 44 claims to protect. A closer look at the measure proves otherwise, and this publication recommends voting NO this November.
Proposition 44 would require nonprofit community clinics to allocate at least 90 percent of their revenue to what the measure calls “program services.” Presented that way, it’s easy to think the measure simply asks clinics to focus on patients. The fine print tells a different story.
Nursing supervisors and medical directors are not counted as program services. Neither are interpreters who make consultations possible for patients with limited English proficiency, staff who guide families through the Medi-Cal enrollment process, or drivers who take someone to an appointment they otherwise couldn’t attend. Building or expanding a clinic is also excluded. By removing these functions from the accounting, a clinic can be doing everything right and still fall short of an arbitrary figure.
Berkeley Research Group, a health research firm, estimates the measure would divert $1.7 billion from community clinics statewide and push nearly two-thirds of them into the red. The nonpartisan California Legislative Analyst reaches a similar, albeit more direct, conclusion: some clinics could be forced to close. Patients who lose access to a clinic and instead end up in an emergency room would raise statewide health care costs by more than $1 billion annually. The state attorney general, not a doctor or a clinic board member, will decide which expenses qualify, and clinics that fall short of the target will be fined from the same budget allocated for patient care.
Community clinics are already absorbing federal funding cuts that will be phased in over the next few years. Those cuts hit hardest clinics serving low-income and immigrant families who can’t afford to seek care elsewhere. Adding a new state penalty makes it even harder for neighborhood clinics to stay open long enough to serve them. More than 1.6 million children in California, including students who receive care at school health centers, rely on a system that Proposition 44 would put under even more financial strain.
Federal law already requires these clinics to have a majority of patients on their boards of directors, and they are already subject to rigorous state and federal audits every year. Proposition 44 does not add any further oversight. It is a mandate that penalizes clinics for spending money on the staff and services that patients need to even walk through the door.
That’s likely why the measure is being rejected by those who run these clinics on a daily basis: the California Primary Care Association, the California Medical Association, the California Hospital Association, and the California Academy of Family Physicians, along with clinic systems like Family Health Centers of San Diego. They know what a 90 percent formula leaves out, because they’re the ones who would have to explain it to a patient.
This publication recommends voting NO on Proposition 44.