California voters will decide Prop. 44, which would regulate community health clinic spending on program services

California voters are deciding on Proposition 44, which would regulate how much community health clinics spend on program services.

If passed, the measure would require community health clinics to spend at least 90% of their annual revenue on program services.

The initiative would also impose penalties on nonprofit Federally Qualified Health Centers that spend less than 90% of their revenue on program services.

The state would be responsible for reviewing financial reports and investigating clinics that are not meeting the requirement. According to an analysis in the California Secretary of State's Voter Guide, enforcement could cost tens of millions of dollars per year. The initiative would direct the state to cover costs by charging the affected clinics fees.

If Prop. 44 is passed, it would limit additional clinic expenses such as administrative costs to no more than 10% of a clinic's revenue.

"The California Attorney General would define in more detail which kinds of expenses are related to providing health care services, and which are other expenses, using existing reports to the federal government as a starting point," according to the California Secretary of State's Voter Guide.

Supporters of Prop. 44 say the initiative would help keep clinics and executives accountable for how revenue is spent on patient care and services. They add that it would also increase transparency and reduce wasteful spending.

Brisa J. Barrera, a community clinic worker listed as a supporter in the Secretary of State's Voter Guide, clarifies that the measure does not cut clinic funding or reduce services. She says the measure will ensure that every dollar stays in the healthcare system and is spent directly on patients. 

The American Academy of Pediatrics - California, an opponent of Prop. 44, argues that it would shut down hundreds of community health clinics, which would harm millions of patients.

"By shutting down clinics, Prop. 44 will force millions of patients into already overcrowded emergency rooms—increasing wait times for everyone," said Dr. Susanne J. Spano, President of the American College of Emergency Physicians - California.

Other opponents, including the California School Nurses Organization and California Medical Association, say the measure is poorly written and it will restrict clinics from spending resources on essential services and staff.