REQUIRES COMMUNITY HEALTH CLINICS SPEND 90% OF REVENUE ON PROGRAM SERVICES. INITIATIVE STATUTE.

Key points

• 1Applies to private nonprofit Federally Qualified Health Centers (safety net clinics); the Legislative Analyst notes about 2,000 safety net clinics in California, most of them private nonprofits.
• 2Sets a minimum of 90 percent of total annual revenue on program services, limiting other expenses such as administrative costs to no more than 10 percent; clinics currently report an average of about 80 percent.
• 3Penalty equals the amount of spending needed to reach the 90 percent minimum; refunded if the clinic complies within five years, otherwise kept by the state for clinic workforce programs.
• 4The Attorney General would publish guidance defining qualifying expenditures; the Department of Public Health may waive requirements in exceptional circumstances.
• 5State enforcement costs estimated in the low tens of millions of dollars per year, covered by fees charged to affected clinics; other state and local costs are uncertain.

Cost to taxpayers

Increased state costs in the low tens of millions of dollars per year, covered by fees.

What each side says

Supporters

VOTE YES ON PROP. 44 TO PUT PATIENTS FIRST AND HOLD CLINICS ACCOUNTABLE. California’s community health clinics receive billions of taxpayer dollars to provide care for people who need it most. Yet some clinics spend less than half of their funding on patient care and services, while large portions of their revenue go to bloated CEO salaries and other wasteful spending. As a result, patients wait months for appointments and healthcare workers struggle with staffing shortages, outdated equipment, and limited resources. WHY PROP. 44 IS NEEDED Community health clinics receive taxpayer funding for one purpose: to provide primary care, mental health services, dental care, prenatal care, vaccinations, and other essential services to millions of children, seniors, working families, and Californians with disabilities. Without access to these clinics, many patients would not get the care they urgently need. But some clinic CEOs are misusing taxpayer dollars by diverting millions to inflated executive salaries and other non-essentials. With massive federal healthcare cuts expected to eliminate billions in funding for California’s healthcare system, community clinics will be among the hardest hit. Clinics may be forced to reduce services, lay off staff, or even close their doors. That means every healthcare dollar matters more than ever. California taxpayers can’t afford to waste resources that should be helping patients receive timely, high-quality care. PROP. 44 DIRECTS HEALTHCARE DOLLARS TO PATIENT CARE Proposition 44 is simple. It requires community health clinics to spend at least 90% of their revenue on their non-profit mission—patient care and the services that make care possible. That could include medical visits, mental health care, dental care, medications, medical equipment, transportation, language interpretation, care coordination, outreach, and other services that serve the clinics’ charitable healthcare mission. What doesn’t count towards the 90%: excessive CEO pay, lavish events, bloated overhead, and other spending that takes resources away from the clinic’s core mission of caring for patients. PROP. 44 HOLDS CLINICS ACCOUNTABLE Proposition 44 will increase transparency by requiring clinics to publicly report how healthcare dollars are spent, so patients and taxpayers can hold them accountable. Currently, there are hundreds of millions of dollars in the clinic system that are not being spent on the core mission of patient care. Prop. 44 will make sure those healthcare dollars go where they can do the most good. This measure does not cut clinic funding or reduce services patients rely on. Clinics that meet the standard keep every dollar, and even clinics that fall short can recover any penalties by coming into compliance. Unrecovered penalties, if any, are redirected to recruiting, training, and retaining the healthcare workers our clinics desperately need. Every dollar stays in the healthcare system—prioritized for patient care instead of excessive overhead. Join healthcare workers, patients, and Californians who believe accountability strengthens our healthcare system. VOTE YES ON PROP. 44 TO PUT PATIENTS FIRST. Shawna Brown , Initiative Proponent Brisa J. Barrera , Community Clinic Worker

Opponents

VOTE NO ON PROP. 44: STOP THE ATTACK ON PATIENTS & COMMUNITY HEALTH CLINICS Prop. 44 is a dangerous, poorly drafted measure that would threaten care for millions of California patients. Prop. 44 imposes deeply flawed and unworkable restrictions that prevent community clinics from providing the care patients need. Economic and health experts warn Prop. 44 will: • Cut $1.7 billion from health clinics in the first year alone. • Cause 88% of all clinics in the state to operate at a loss. • Force thousands of clinics throughout the state to cut back patient services or shut down entirely. • Eliminate care for millions of Californians. • Send more patients to hospital emergency rooms—increasing wait times for all families. PROP. 44 ARBITRARILY RESTRICTS SPENDING ON VITAL PATIENT SERVICES Prop. 44 is so poorly written that it restricts clinics from spending resources on essential staff and services, including nurse managers, physician leaders, translation services, insurance assistance and community education. It even restricts clinics from funding mammogram, X-ray and CT machines, information technology and expanding or upgrading clinics. PROP. 44 DECIMATES THE HEALTH CARE SYSTEM AND HURTS ALL PATIENTS Community health clinics provide primary care, prenatal care, urgent care, mental and behavioral health services, telehealth, and dental services. They operate school-based health clinics that care for hundreds of thousands of children. Community clinics serve 1 in 4 Medi-Cal patients, the uninsured, working families, seniors, veterans, and children. In many rural and medically underserved communities, community health clinics are the only source of care within hundreds of miles. Prop. 44 will make our bad healthcare problems even worse— increasing patient wait times and eliminating the only source of care for many patients. PROP. 44 IS UNNECESSARY. COMMUNITY CLINICS ARE STRICTLY REGULATED. Community clinics are already heavily regulated by the federal and state governments, with strict funding rules on patient care and essential services, and regular mandatory public audits. All clinics are overseen by patient board members, to ensure care is focused on community needs. And clinics are non-profits legally required to focus resources on patient services and community benefits. PROP. 44 OPPOSED BY PATIENTS, NURSES, DOCTORS AND COMMUNITY LEADERS “Prop. 44 will eliminate the only source of care in many communities. Please vote NO.” —Kim Yu, MD, FAAFP, President, California Academy of Family Physicians “Community clinics are a lifeline for my family and millions across California. Please, protect patients like me. Reject Prop. 44.” —Carmen Huertero, Clinic Patient, San Marcos, CA “Prop. 44 threatens women’s access to healthcare at a time when it’s already under attack. Vote No.” —Jodi Hicks, President & CEO, Planned Parenthood Affiliates of California "By shutting down clinics, Prop. 44 will force millions of patients into already overcrowded emergency rooms—increasing wait times for everyone.” —Susanne J Spano, MD, FACEP, President, American College of Emergency Physicians, California “Prop. 44 threatens to shut down hundreds of school-based clinics that provide primary care, vaccinations, health screenings and mental health services for tens of thousands of children. Vote NO.” —Katie Nilsson, RN, President, California School Nurses Organization Prop. 44 Opposed By: • American Academy of Pediatrics, California • California School Nurses Organization • California Medical Association • California Primary Care Association, representing thousands of community health centers and clinics • American College of Obstetricians & Gynecologists District IX • Planned Parenthood Affiliates of California • National Association of Social Workers, California Chapter • American College of Emergency Physicians, California • California Academy of Family Physicians www.NoProp44.com Eric Ball , MD, FAAP, President American Academy of Pediatrics, California Katie Nilsson , RN, President California School Nurses Organization René Bravo , M.D., President California Medical Association