By Impulso Newspaper
Ask a nonprofit clinic in Los Angeles how much healthcare really costs, and the answer is never just doctors and offices. It’s the interpreter who explains a diagnosis in Zapotec or Mixtec to a patient who barely speaks Spanish, let alone English. It’s the community outreach worker who tracks someone down when they miss an appointment. Proposition 44 doesn’t consider any of that as healthcare.
The rule itself sounds simple: nonprofit community clinics must allocate at least 90 percent of their revenue to what the state calls “program services,” or pay a penalty. The complication lies in how narrowly the state defines that phrase and what it recognizes as valid. It recognizes the doctor’s office. But it doesn’t recognize what makes it possible for a patient to get there: an interpreter, a Medi-Cal enrollment counselor, transportation to an appointment that no bus route covers, the contractor building the foundation of a new clinic. With such a narrow line, a clinic can spend every dollar necessary to keep this city healthy and still fall on the wrong side of an arbitrary figure.
This shouldn’t be that complicated.
When California’s own nonpartisan Legislative Analyst did the math, he didn’t describe a minor inconvenience. He described clinics closing their doors and patients ending up in emergency rooms, which would add more than $1 billion a year to the state’s health care bill. A separate analysis by the Berkeley Research Group puts a number on the damage even before that happens: $1.7 billion that would be siphoned from community clinics statewide during the first year, with nearly two-thirds of them losing money.
It’s worth asking who actually decides whether a clinic meets the requirements. That authority doesn’t rest with a doctor or the community the clinic serves—that is, the patients themselves, who by federal law must already hold a majority of the seats on the board of directors. Instead, it’s the Attorney General’s office that makes the decision. If the clinic doesn’t meet the standard, it must pay a fine from the very same fund designated for healthcare.
Federal health care cuts are already impacting clinic budgets for the next few years. A state measure that adds its own financial pressure just as that federal funding dries up doesn’t seem like accountability, but rather an ill-timed measure disguised as reform. More than 1.6 million children in California receive care through these clinics, some only through a health center located in their own school, and none of them benefit from a state penalty coming right in the middle of federal cuts that are already affecting them.
The California Primary Care Association, the California Medical Association, the California Hospital Association, and the California Academy of Family Physicians. These aren’t outside critics of the healthcare system. They are the very associations whose members would have to make this formula work in real-world clinics, and they are telling Sacramento that it can’t be achieved without harming the patients it claims to protect. That alone is reason enough for this publication to urge a NO vote on Proposition 44 this November.