By Donaldo M. Hernandez
As a physician who has practiced on the Central Coast for over three decades, I’ve spent my career caring for patients who fall through the cracks of our health system. That includes farmworking families, vulnerable seniors on fixed incomes, the uninsured and the underinsured who depend on our community clinics not as a last resort, but as their only medical home. That’s why I’m asking Santa Cruz County voters to reject Proposition 44 this Nov. 3.
You see, Prop. 44 would eviscerate care for millions of patients across California, including right here in Santa Cruz.
A study by healthcare economists shows that Prop. 44 will cut $1.7 billion from community health clinics in the first year alone — not to mention billions in years thereafter. The result is that 88% of clinics across California would be operating at a loss.
That’s untenable, and the result would be clinics having to reduce services, limit hours, lay off staff or even close their doors altogether. Either way, patients lose. For the people in our community that rely on these health centers for their comprehensive care, the reality would be grim.
The timing of Prop. 44 could not be worse. Our clinics are already absorbing the shock of federal Medicaid cuts under H.R. 1, which are pushing thousands of Central Coast residents toward losing coverage entirely and are already straining clinic budgets countywide. Patients have long wait times and pay too much for coverage as it is — yet Prop. 44 piles on additional barriers to getting care.
What concerns me are the legal flaws that would financially penalize clinics for spending resources on what we know are essential patient services, but that Prop. 44 classifies as “administrative expenses.” That includes healthcare enrollment navigators, janitorial and maintenance staff, telemedicine investments, quality care improvement programs, secure systems for patient medical records, medical technologies and the list goes on.
Prop. 44 applies a blunt statewide formula to organizations that are already among the most heavily regulated entities in healthcare, subject to extensive state and federal oversight. Simply put, it’s unnecessary.
Here on the Central Coast, community clinics are often the only place a low-income family, an immigrant without documentation, or a senior on a fixed income can walk in and see a doctor. When those clinics close their doors or cut services, those patients don’t disappear, they end up in emergency rooms, or they go without care until a manageable condition becomes a crisis. I’ve watched that cycle play out in the hospital where I serve, and the result is bad for everyone, including even longer wait times and higher healthcare costs that the state has to burden.
Prop. 44 is a statewide mandate that ignores the operational realities of safety-net medicine and threatens to shrink the healthcare system it claims to strengthen. I urge Santa Cruz County voters to vote No on Prop. 44.
Dr. Donaldo Hernandez is a hospitalist with Sutter Health/Palo Alto Foundation Medical Group in Santa Cruz, a commissioner of the Central California Alliance for Health, and past president of the California Medical Association.