State Measure 44 “Requires Community Health Clinics Spend 90% of Revenue on Program Services” is a dangerous proposition that could cause small non-profit health care centers to go out of business leaving our most vulnerable communities in dire straits.
The primary sponsor of California’s Proposition 44 for the November 2026 election is the labor union Service Employees International Union-United Healthcare Workers West (SEIU-UHW West).
The powerful SEIU United Healthcare Workers West (SEIU-UHW) operates with an annual fiscal budget of approximately $144 million to $146 million, based on its latest filed financial reports.
In opposition to the measure are vulnerable private non profits such as American Academy of Pediatrics, CA School Nurses Org., CA Academy of Family Physicians and CA Medical Association whose budgets combined does not come close to members SEIU-UHW is backing.
These non profit health care centers and others that would meet the criteria will be forced to spend 90% of its revenue on health services or be subjugated to a penalty if Prop. 44 is voted into law.
For any business to be forced to spend 90% of its revenue in any one particular aspect is essentially committing malpractice on itself. How will these non profits retain or hire administrative talent or individuals to administer the services their donors or grants mandate them to do?
Non profits are community assets not corporate giants, and each one should be held accountable to their board and the communities they serve and not punished because they don’t join a union.
While some organizations benefit from their membership with unions such as SEIU-UHW, there are others that will go out of business if they were under such authority. Unions are not one size fit all.
Clinics spend most of their revenue on providing health care to patients. They also have other expenses, such as administrative costs. Each year, private nonprofit safety net clinics in California report their revenues and expenses to the federal government and the state. These clinics currently report spending an average of about 80 percent of their revenue on providing health care services, though the percent varies across clinics.
Proposition 44 requires private nonprofit safety net clinics to spend at least 90 percent of their total revenue each year on providing health care services.
Under Proposition 44, the state would enforce the new requirements on private nonprofit safety net clinics. This includes reviewing financial reports and investigating affected entities. State enforcement costs would be in the low tens of millions of dollars per year. The proposition directs the state to cover the costs by charging fees on affected clinics.
Prop 44 is a dangerous ballot measure without any underlying benefits. It attempts to establish one set of rules for private nonprofits to operate and another set for the members under the powerful union and its lobbyist.
Vote NO on Prop 44 and close the door on this misguided approach to community health care during the most delicate times of our lives.
