Proposition 44: California Spending Requirements for Federally Qualified Health Centers Initiative

SEIU-UHW measure to require more of health clinic revenues to go to services instead of executive pay

Source (https://www.sfgreenparty.org/endorsements/123-november-2026-endorsements)

Prop 44 is SEIU-UHW's fourth try at regulating a healthcare industry by ballot measure, after voters rejected all three of its dialysis initiatives (https://ballotpedia.org/California_Proposition_23,_Dialysis_Clinic_Requirements_Initiative_%282020%29). The target this time is nonprofit community clinics, where operators say the union is organizing (https://fresnoland.org/2025/08/13/healthcare-initiative/), and the tool is a rule that every clinic spend at least 90% of its revenue on "mission-related expenses."

A 90% floor sounds reasonable. But everything else a clinic pays for has to fit into the other 10%, and the Legislative Analyst's Office found that clinics today average about 80% (https://lao.ca.gov/ballot/2026/prop44-110326.pdf), so most community clinics in the state would owe a penalty. That penalty is the entire shortfall (https://growsf.org/voter-guide/san-francisco-voter-guide-november-2026-election/measures/prop-44/legal-text/#prop-44-90-percent-penalty). The measure also never defines its central term: the Attorney General writes the definition after the election (https://growsf.org/voter-guide/san-francisco-voter-guide-november-2026-election/measures/prop-44/legal-text/#prop-44-ag-guidance), so a clinic that pays for patient vans or community outreach could be penalized like a profiteer. An analysis commissioned by the clinics (https://protectpatientsca.com/wp-content/uploads/2025/11/BRG-Report-on-Clinic-Funding-Accountability-Transparency-Act-2025_1117.pdf) puts first-year penalties at $1.7B, and the clinics are suing in federal court (https://calmatters.org/politics/2026/04/healthcare-workers-clinics-ballot-measure/) to stop it.

The people who actually run the safety net, the California Primary Care Association, the California Medical Association, and Planned Parenthood (https://calmatters.org/politics/2026/06/california-ballot-measures-november-election/), all oppose it, at a moment when federal Medicaid cuts are already squeezing clinics that serve 4.2 million Medi-Cal patients (https://kffhealthnews.org/wp-content/uploads/sites/8/2026/05/Community-Clinic-complaint-vs.-SEIU-UHW-initiative.pdf). A labor dispute belongs at the bargaining table. Don't let it be settled by fining the clinics your neighbors depend on. Vote no.

Source (https://growsf.org/voter-guide/san-francisco-voter-guide-november-2026-election#prop-44)

This sounds good at first glance—nonprofit, federally-funded clinics that care for poor people should spend money on patient care, not on overhead or executive salaries. You might be picturing health care giants like Sutter and Kaiser that may very well be spending their money in the wrong places. BUT this also applies to smaller community clinics like La Clinica de la Raza, Lyon-Martin, and neighborhood health centers. Advocates for these vital health care facilities are opposing Prop 44 because they’re concerned that a lot of what they spend their money on to serve their patients and keep their doors open, like translation, janitorial services, and billing, wouldn’t count as “patient care.” If that’s the case, they could end up having to pay large fines at a time when they’re facing MAGA’s drastic federal cuts to Medicaid and health-care funding thanks to the “Big Beautiful Bill”🤮🤮🤮. Even if those activities do get to count toward the 90%, Prop 44 adds additional paperwork and bureaucratic burden to prove it. Oh, and these determinations would be made not by medical or public health experts but by the CA Attorney General. These clinics are barely keeping their doors open and we need them more than ever. 

Do we think clinics should do everything they can to care for patients? Sure. Do we think they should have to spend their time arguing with the state over which operational expenses should count as “patient care? No.

Source (https://www.theleaguesf.org/#Prop44)

No on Prop 44: Imposes Costly Mandates on Community Health Clinics

Increases mandates and costs on community health clinics, threatening their ability to provide patient care. Clinics that miss the arbitrary 90% mandate pay penalties into a government account and hotwired to a narrow special interest group who is one of the politicians’ biggest campaign contributors. Trusted healthcare experts warn that Prop 44 would trigger $1.7 billion in penalties in the first year alone and force clinics across California to close their doors.

Source (https://www.reformcalifornia.org/voter-guides/san-diego)

NO on Prop. 44

This measure requires community clinics that provide primary care to medically underserved areas and populations to spend at least 90% of their revenue on patient services, not management and overhead. It authorizes the Attorney General to publish guidance on qualifying expenditures and lets the Department of Public Health issue waivers. It authorizes monetary penalties and criminal charges. It is sponsored by a powerful labor organization seeking to expand its control over private clinics.

Vote NO on 44.

Source (https://www.hjta.org/2026votingguide#Ballot-Measure-Recommendations)