44

Why Thrive LA opposes 44

Proposition 44 would force nonprofit community health clinics (Federally Qualified Health Centers) to spend at least 90% of their total revenue on "program services" or face financial penalties equal to the shortfall. These clinics serve roughly 8.6 million low-income Californians, many of them uninsured or on Medi-Cal, in medically underserved areas across the state. The measure is sponsored and funded almost entirely by one union: SEIU-UHW West. This is a price control on organizational structure, and like all price controls, it will create shortages. The 90% mandate sounds reasonable until you learn that the average community clinic currently spends about 80% of revenue on direct services. That gap is not waste. It covers IT systems, billing staff, compliance officers, facility maintenance, and the administrative infrastructure that keeps clinics open and functional. Forcing clinics to slash that spending by statute, regardless of local conditions, clinic size, or patient complexity, is the kind of rigid, one-size-fits-all mandate that drives organizations into insolvency. Opponents estimate $1.7 billion would be cut from clinic budgets in the first year alone, and analysts warn that 88% of affected clinics could operate at a loss under this threshold. The downstream consequences are predictable and severe. Clinic closures would eliminate jobs, particularly in rural and underserved communities. Displaced patients would flood emergency rooms, driving up Medi-Cal costs to the state. Homeless populations, who rely on these clinics as a primary healthcare access point, would lose care. And the measure creates a new state enforcement bureaucracy costing tens of millions of dollars annually, funded by fees charged to the very clinics it burdens. Those fees ultimately come from public funds, since FQHCs are largely supported by Medicaid and federal grants. There is no offsetting reduction in government spending. The opposition coalition tells you everything you need to know. The California Medical Association, the California Hospital Association, the California Chamber of Commerce, Planned Parenthood, the California Academy of Family Physicians, the California Primary Care Association, and dozens of other healthcare organizations all oppose this measure. So does the Democratic Party of California. So does Reform California. When every major healthcare stakeholder in the state, across the entire political spectrum, agrees that a ballot measure will harm patients, voters should listen. Vote No on Proposition 44. It will close clinics, eliminate jobs, and reduce healthcare access for the Californians who need it most.