What is Prop. 44? The California ballot measure that would tell community clinics how to spend their money

PALM SPRINGS, Calif. (KESQ) Proposition 44 asks California voters to set a spending floor for the nonprofit community clinics that care for low-income and uninsured patients.

If it passes Nov. 3, those clinics would have to spend at least 90% of their total revenue each year on providing health care services, according to the Legislative Analyst’s Office. Everything else, including administrative costs, would be capped at 10%. The California attorney general would decide which expenses count.

A clinic falling short would pay the state an amount equal to the gap. It could get the money back by meeting the requirement within five years. If not, the state would keep it for clinic workforce programs. Clinics could ask for a temporary waiver in some cases.

The measure applies to private nonprofit safety-net clinics, known as federally qualified health centers. California has about 2,000 safety-net clinics, and the analyst’s office says they report spending an average of about 80% of revenue on care.

Opponents include the California Primary Care Association, the California Medical Association, the California Hospital Association, Planned Parenthood Affiliates of California and both the state Democratic and Republican parties. A study commissioned by the primary care association estimates clinics would owe $1.7 billion in penalties in the first year and says many could close.

Supporters had reported raising about $16.9 million and opponents about $34.9 million as of Aug. 2, according to the secretary of state. A September Public Policy Institute of California poll found 34% of likely voters support it, the lowest of any measure on the ballot.

The analyst’s office estimates state enforcement would cost in the low tens of millions of dollars a year, paid for by fees on the clinics.