This November, California voters will weigh in on Proposition 44, a ballot measure that would require community health clinics to spend 90% of their revenue directly on patient care and would give the state Attorney General new authority to resolve disputes over how that money is spent. Supporters argue it will hold clinics more accountable. But as a physician who has spent my career working alongside community health centers, I believe this measure is far more likely to hurt patients than help them — and I’m urging voters to reject it.
Family physicians like myself work inside California’s community health clinics every day, delivering care to patients who often have nowhere else to turn. Prop. 44 puts that work — and the clinics themselves — in serious jeopardy.
The problem lies in how the measure is written. Its spending rules are so rigid that, by some estimates, roughly 91 percent of the state’s health centers would fail to meet them. An independent analysis commissioned by the California Primary Care Association found that clinics could collectively face as much as $1.7 billion in penalties in just the first year, with continuing costs in the years after. That’s money that currently keeps clinic doors open and supports the kind of comprehensive, community-based care that has made these centers a trusted resource for millions of Californians.
The financial fallout could be severe. Recent data suggests that the vast majority of clinics statewide are already operating on thin margins. A sudden wave of penalties tied to Prop. 44 could push most of them into the red, forcing painful decisions about which services to cut just to stay afloat.
If that happens, some clinics may be forced to shut down entirely — eliminating safety-net care for the very communities that depend on it most. Each year, California’s community clinics serve more than 7 million patients, including children, working families, uninsured residents, seniors, veterans, and roughly one in three Medi-Cal enrollees. Prop. 44 threatens the funding base that keeps this system functioning.
Beyond the financial risk, the measure is poorly constructed and legally murky. Clinics could be penalized simply for spending money on the things that keep them running — new medical equipment, technology upgrades, disaster preparedness, or reserve funds set aside for emergencies. Under the initiative’s language, even responsible financial planning could trigger steep penalties.
Anyone who has spent time inside a community clinic understands that health care extends well beyond the exam room. Programs that provide patients with transportation to appointments, telehealth options for those who can’t make it in person, and enrollment assistance to help people access insurance they qualify for are not extras — they are essential parts of keeping people healthy and connected to care. Prop. 44 puts all of that at risk.
Perhaps the most troubling piece of this measure is what it does to the relationship between doctors and patients. Prop. 44 would give the state Attorney General — an elected official without medical training — significant influence over which services clinics are able to offer. If recent years have taught us anything, it’s that political figures should not be inserting themselves into decisions about a patient’s care.
Our health care system is already stretched thin. Costs continue to climb, wait times for primary care and specialist appointments keep growing, and emergency rooms are routinely overwhelmed. If Prop. 44 leads to clinic closures or reduced services, patients won’t simply stop needing care — they’ll delay treatment until conditions worsen, often ending up in emergency rooms for issues that should have been handled through routine, preventive visits. That shift would only add more strain to hospitals, lengthen wait times, and drive health care costs even higher.
Opposition to Prop. 44 spans a wide and politically diverse coalition — not just physicians, but many others who understand what’s at stake for the patients who rely on these clinics every day. Millions of Californians are counting on voters to get this one right.
Original source: CalMatters
