Alongside the billionaire tax, California voters will decide on Nov. 3 whether to set a spending floor for the nonprofit clinics that serve many low-income and uninsured patients. Proposition 44 is backed by the same union behind the wealth tax, and it has drawn a well-funded opposition.
What it would do
Under Prop. 44, private nonprofit safety-net clinics would have to spend at least 90% of their total revenue each year on health care services, leaving no more than 10% for everything else, according to the nonpartisan Legislative Analyst's Office. Those clinics now report spending about 80% of revenue on care, on average.
The state attorney general would decide which costs count as health care and which count as administration, starting from the reports clinics already file with the federal government. A clinic that falls short would owe a penalty equal to the gap. It would have five years to come into compliance and get the money back; otherwise the state would keep it for clinic workforce programs.
The analyst's office puts enforcement costs in the low tens of millions of dollars a year, paid by fees on clinics, and calls the measure's other fiscal effects uncertain.
The case for it
Service Employees International Union-United Healthcare Workers West, which represents about 120,000 health care workers, is the main sponsor and has raised about $17 million, CalMatters reported. The union argues that federal cuts to programs for low-income patients make it more important that clinic dollars reach patient care.
Spokesperson Renee Saldana pointed to clinics with "extravagant fundraisers" and executives paid millions while patients wait for appointments, and said the measure is meant to protect spending on patients and workers, not take money from clinics.
