Create the 90% spending requirement
Certain private nonprofit health care clinics would have to spend at least 90% of their revenue each year on providing health care services.
Statewide ballot measure · November 3, 2026
Proposition 44
Requires Community Health Clinics Spend 90% of Revenue on Program Services. Initiative Statute.
The question: Should certain private nonprofit community health clinics have to spend at least 90% of annual revenue on program services or face a financial penalty?
Start with the decision
What your vote would do
These descriptions come from the nonpartisan Legislative Analyst’s Office. They explain the legal result of each choice, not an argument for either side.
Keep current clinic spending rules
The new spending requirement and its penalty system would not take effect. Current reporting and oversight rules would continue.
No forecasts here.
Paper Trail Politics does not publish polls, betting markets, win
probabilities, momentum labels, or predicted outcomes on ballot-measure
pages.
Status quo and proposal
What Proposition 44 changes
The official title uses “program services.” The Attorney General would issue more detailed guidance defining which expenses qualify.
Current system
Clinics report revenue and expenses
Private nonprofit safety-net clinics already report financial information to federal and state governments. The LAO says clinics currently report spending an average of about 80% of revenue on health care services, though individual clinic percentages differ.
If approved
A statewide minimum and enforcement process would begin
- Affected private nonprofit safety-net clinics would have to spend at least 90% of total annual revenue on program services.
- The Attorney General could publish guidance defining qualifying expenditures, using existing federal reports as a starting point.
- A clinic falling short would owe a penalty equal to the spending gap.
- The clinic could recover the penalty after complying within five years; otherwise, the state would use the money for clinic workforce programs.
- Temporary waivers could be available in specified exceptional circumstances.
Official fiscal analysis
What it could cost
Fiscal estimates are ranges, not promises. The LAO identifies costs that can be estimated and effects that remain uncertain.
Estimated annual state enforcement cost
Low tens of millionsThe state would review financial reports and investigate affected entities. Fees charged to affected clinics would cover these costs.
What remains uncertain
Clinic and government responses
Other state and local effects would depend on how qualifying expenses are defined and how clinics respond. Clinics might increase direct care spending, incur penalties, seek waivers, reduce other costs, or in some cases close. The LAO does not assign a dollar value to those possible effects.
Claims from each campaign
The case for and against
These are condensed from the official arguments and rebuttals submitted by advocates. Publication in the state voter guide does not make a campaign claim an official finding.
Supporters say
More clinic revenue should reach patient care
- The 90% rule would direct more public funding toward patient care and services that support care.
- Existing oversight has not stopped some clinics from spending too much on executive compensation and administrative costs.
- Clinics that come into compliance could recover penalties, while unrecovered money would stay in the health system through workforce programs.
- The definition could include transportation, interpretation, care coordination, clinical staff, medical equipment, information technology, and preventive care.
Opponents say
The spending formula could reduce access to care
- The measure’s spending categories could exclude or constrain essential staff, equipment, facilities, technology, and community services.
- Clinics unable to meet the threshold could cut services or close, sending more patients to emergency rooms.
- Community clinics are already subject to federal and state rules, audits, public reporting, and nonprofit governance requirements.
- The campaign describes the measure as a labor-backed pressure tactic against clinics rather than a needed accountability reform.
Campaign finance
Who is funding each side
Money is influence context. It is not evidence that a position is correct or likely to win.
The figures below are FPPC top-contributor totals last modified August 7, 2026. They are not comprehensive receipts, expenditures, cash balances, or polling. Full transaction and spending views will come from CAL-ACCESS filings after reconciliation.
Top contributions supporting
$16,929,633.88*
Californians for Responsible Healthcare, sponsored by SEIU–United Healthcare Workers West
Committee ID 1483073
- SEIU United Healthcare Workers West Political Issues Committee $16,929,633.88*
Top contributions opposing
$16,691,268.18
Protect Patients: Stop the Attack on Community Health Centers and Clinics, sponsored by California Primary Care Association Advocates
Committee ID 1484266
- AltaMed Health Services Corporation$5,467,867.69
- California Primary Care Association entities$2,025,980.37
- WellSpace Health$1,500,000
- North East Medical Services$1,500,000
- Family Health Centers of San Diego$1,500,000
- North County Health Project / TrueCare$1,000,000
- San Ysidro Health$1,000,000
- Innercare$1,000,000
- Neighborhood Healthcare$920,550.12
- Community Health Center Network$776,870
* The FPPC marks the support contribution because the contributor supported
or opposed more than one potential measure in the same election. The amount
cannot be allocated specifically to Proposition 44 and may appear on more
than one measure’s list. FPPC lists cover committees meeting reporting
thresholds and are not all-contribution totals.
View the FPPC disclosure page ↗
Endorsements and opposition
Positions we could verify
This is a sourced directory, not a score. Organizations are not weighted, and affiliated groups are not treated as separate evidence of public support.
Supporting
Organizations and official argument signers
- SEIU–United Healthcare Workers WestCampaign sponsor
- SEIU Local 721Named by support campaign
- Shawna BrownInitiative proponent; official signer
- Brisa J. BarreraCommunity clinic worker; official signer
Opposing
Organizations named in the official argument
- American Academy of Pediatrics, CaliforniaOfficial argument
- California School Nurses OrganizationOfficial argument
- California Medical AssociationOfficial argument
- California Primary Care AssociationOfficial argument
- American College of Obstetricians & Gynecologists, District IXOfficial argument
- Planned Parenthood Affiliates of CaliforniaOfficial argument
- National Association of Social Workers, CaliforniaOfficial argument
- American College of Emergency Physicians, CaliforniaOfficial argument
- California Academy of Family PhysiciansOfficial argument
“Official argument” means the organization was named in a submitted voter-guide argument. It does not mean the Secretary of State endorses or independently verified the position. Future additions should include a dated, first-party position statement.
Coverage and perspectives
Read beyond the campaign mail
Source type is shown prominently so readers can distinguish independent analysis from advocacy.
Legislative Analyst’s Office: Proposition 44
Background on safety-net clinics, the proposal, fiscal effects, and the legal meaning of yes and no votes.
Read the LAO analysis ↗Yes on Proposition 44
The support campaign’s own description, frequently asked questions, and advocacy materials. Read as campaign-authored content.
Visit support campaign ↗No on Proposition 44
The opposition campaign’s arguments, coalition list, and advocacy materials. Read as campaign-authored content.
Visit opposition campaign ↗
Editorial-board positions: None are displayed in this example
yet. An editorial or column would be labeled as opinion and would never be
mixed into the independent-analysis section.
Primary documents
Read the official record
Last reviewed August 12, 2026. The voter-guide files below are the Secretary of State’s public-display versions and are marked as subject to court-ordered changes.