California voters reject Proposition 44, which would have required nonprofit community clinics to spend 90% of revenue on patient care
In the unofficial count the morning after the Nov. 3 election, 81.8% of votes were against the measure. Private nonprofit safety net clinics will not face a state spending floor or penalties for falling short of it.
Votes on Proposition 44, unofficial statewide count
Sacramento. California voters have rejected Proposition 44, the ballot measure that would have required private nonprofit community clinics to spend at least 90% of their revenue each year on health care or pay the shortfall to the state. The Associated Press projected its defeat on election night, CalMatters and CBS News reported.
In the secretary of state's unofficial count as of 8:08 a.m. on Nov. 4, 6,148,087 votes, or 81.8%, were against the measure and 1,364,440, or 18.2%, were for it. The figures are not final. Ballots continue to be counted after Election Day, county elections officials must complete official results by Dec. 3, and the secretary of state will certify them on Dec. 11, according to the office.
What the vote means for clinics
The measure would have applied to what its ballot label called nonprofit Federally Qualified Health Centers. Most of the roughly 2,000 safety net clinics in California are private nonprofits, according to the Legislative Analyst's Office. Spending on everything other than health care, such as administration, would have been capped at 10% of revenue, with the state attorney general defining which expenses counted. A clinic that fell short would have paid a penalty equal to the gap.
The official voter guide says a no vote means the new spending requirement does not go into effect. The clinics now report spending an average of about 80% of revenue on health care services, the analyst's office says, though the share varies.
The campaign and the case still in court
The health workers union SEIU-United Healthcare Workers West sponsored the measure, arguing that clinics should be held accountable for how they spend public money and spend less on executive pay. CalMatters reported that voters had also rejected the union's three earlier measures on dialysis clinics, in 2018, 2020 and 2022, and that a similar clinic bill failed last year.
The opposition was led by the California Primary Care Association, which represents community clinics, and included medical groups such as the California Medical Association and the American Academy of Pediatrics California. Opponents raised $39 million, more than double the $17 million supporters reported, according to CalMatters. An analysis commissioned by opponents had estimated the measure would cost clinics about $1.7 billion in penalties in its first year.
In September the association sued the union and its president, Dave Regan, accusing them of using the ballot process to press clinics to accept the union's bargaining demands, CalMatters reported. The union has called the allegations categorically false, and the case is pending. An earlier suit by the association to keep the measure off the ballot was dismissed by a federal judge over the summer.
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