Proposition 44 is a blunt union power play whose passage would allow the government union promoting this travesty to bleed clinics dry. Prop 44’s goal is to draw the lifeblood out of California’s safety-net clinics.
Roughly 170 nonprofit Federally Qualified Health Centers operate about 2,400 sites across California. In 2024 they served 5.8 million patients, about 15 percent of the state’s residents. Seventy-two percent of those patients are covered by Medi-Cal.
Proposition 44 would require these clinics to spend at least 90 percent of annual revenue on “program services,” with the Attorney General defining the methodology only after the measure passes. Clinics that fall short would pay a penalty equal to the gap. The money is refundable only if they comply within five years. Enforcement is expected to cost tens of millions a year, funded by fees on the clinics themselves.
The Draw
SEIU-United Healthcare Workers West placed the measure on the ballot and has spent roughly $17 million promoting it. This same union is also backing Prop 40, the separate billionaire wealth-tax proposal. SEIU-UHW represents more than 120,000 healthcare workers, with a large presence of upwards of 50% in major hospital systems including Kaiser Permanente, Dignity Health/Common Spirit, Sutter Health, Sharp Healthcare, Tenet, and Prime Healthcare.
Unlike the large hospital networks, union participation is lower among community clinic workers; one estimate puts existing collective-bargaining coverage at about 30 percent. The union’s public case is that taxpayer-supported clinics should spend more on patients and less on administration and executive pay. Clinics currently average about 80 percent of revenue on care.
Nice Clinic You’ve Got There…
A federal lawsuit filed by the California Primary Care Association and several clinics alleges the union has used ballot measures as leverage for years. According to the complaint, SEIU-UHW offered to withdraw Proposition 44 if clinics agreed to union election procedures designed to produce 25,000 new members. The union disputes the claims.
They doth protest too much.
This threatening pattern fits the same methods used against hospitals and dialysis providers.
Prop 44 is the only proposition on the ballot opposed by both the California Republican and California Democrat Parties. In fact, opposition to Prop 44 brings together the most diverse of political bedfellows: the California Medical Association, the California Hospital Association, the Association of California Healthcare Districts, Planned Parenthood’s California affiliate, the state Chamber of Commerce, Reform California, and groups of physicians and nurses.
These groups argue the spending rule is vague, ignores differences in clinic size and patient mix, and will force service cuts or closures. One clinic-group analysis projected up to $1.7 billion in first-year penalties and estimated that 88 percent of clinics could operate at a loss.
A Public Policy Institute of California poll of likely voters found just 34 percent supporting Proposition 44, with 61 percent opposed. Even a one-in-three showing would be far too much for this damaging measure. Vote NO, NO, NO on Prop 44.
Simple Treatments, Not Radical Surgery
The clinics that Prop 44 targets already operate under federal rules, state licensing, IRS nonprofit requirements, and patient-majority boards. They file extensive financial reports. If administrative spending or executive compensation is an actual problem, targeted disclosure rules, audits, or ordinary legislation can address it without a rigid percentage and new penalties.
Flatline
California’s safety-net clinics treat millions of low-income and uninsured residents. Imposing a one-size-fits-all spending mandate with enforcement costs and the threat of large penalties does not improve care. It does, however, create financial pressure that can be used as leverage in labor negotiations. Voters who want clearer reporting and tighter oversight can demand it through the Legislature. We should not hand one union a ballot measure that treats community clinics as a membership-recruitment tool.
Proposition 44 is not accountability. It is a union shakedown designed to bleed patients and Medi-Cal dry.
Vote NO on Prop 44
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Ballots are out.
If you plan to vote early, start with California Current’s proposition guide—written from the only point of view that actually pays the bill: the overworked, under-appreciated California taxpayer.
We don’t hand you a cheat sheet and walk away. Every recommendation is backed by clear headed research. Click the link, read the case, then mark your ballot with your eyes open.