Prop. 44 explained: 90% spending rule for community health clinics
A health care union backs the rule; clinic and doctor groups oppose it, and both state parties say no.
SAN JOSE - Proposition 44 is a citizen initiative that would set a spending rule for nonprofit community health clinics, which provide primary care in medically underserved areas and get much of their money from public programs such as Medi-Cal.
What it would do
According to the Legislative Analyst's Office (LAO), affected clinics would have to spend at least 90% of their revenue on program services, such as patient care, with the rest allowed for administration and other costs. The state attorney general would define the terms. Clinics could ask for a temporary waiver in some cases.
Clinics that fall short would pay the state the amount needed to reach 90%. They could get the money back if they comply within five years; otherwise the state would spend it on clinic workforce programs.
Who would be affected
Community clinics and their patients, many of them low-income or uninsured, would be most affected.
What it would cost
The LAO estimates state costs in the low tens of millions of dollars a year to run the program, paid by fees on clinics.
Supporters and why
The measure is backed by SEIU-United Healthcare Workers West, whose argument says some clinics spend too little on patient care.
"VOTE YES ON PROP. 44 TO PUT PATIENTS FIRST AND HOLD CLINICS ACCOUNTABLE." - Argument in favor
Opponents and why
Opponents include the American Academy of Pediatrics, California, the California School Nurses Organization, the California Academy of Family Physicians and the California Medical Association. They say the rule is unworkable.
"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." - Argument against
Where the parties stand
Prop. 44 is one of two measures on which both state parties agree: the California Democratic Party and the California Republican Party both recommend no. PPIC found six in ten or more of every partisan group opposed.
The money
SEIU-UHW committees fund the Yes side, with listed checks of $2.4 million, $2.37 million and $2.1 million. On the No side, AltaMed gave $3.72 million, $1 million and $750,000, and the California Primary Care Association and several clinic groups gave $1 million each.
Polling
In a Public Policy Institute of California (PPIC) survey of 1,086 likely voters taken Oct. 16-22 (margin of error plus or minus 3.8 points), 25% said yes and 71% no, down from 34% yes in September.
What your vote means
A yes vote means community clinics would have to spend 90% of revenue on health services or face penalties. A no vote means no new spending rule.
Source: Secretary of State, Voter Information Guide, Prop. 44; Legislative Analyst analysis, Prop. 44; Official arguments and rebuttals, Prop. 44; Secretary of State Quick Guide to Props, Prop. 44; California Democratic Party endorsements; California Republican Party endorsements; PPIC Statewide Survey, October 2026