According to CalMatters Housing reporting, a health care workers union that successfully championed a millionaire wealth tax is now backing another ballot measure called Proposition 44, which would require community health clinics to spend at least 90 percent of their revenue on direct patient services. The measure would cap administrative and other non-service spending at 10 percent of revenues, and would allow the state attorney general to fine clinics that fall short of the threshold. Those fines would go into a special fund for health care worker compensation.
The union backing the measure, SEIU-UHW, argues that too many clinics waste money on executive salaries and lavish spending rather than focusing resources on the patients they serve, particularly low-income and uninsured individuals. The union has raised around 17 million dollars to support the campaign, mostly from its own coffers. Union leadership says federal funding cuts to health care make it crucial for clinics to invest in patient services rather than administrative overhead.
On the other side, clinic operators and their allies counter that the measure threatens their ability to function. They've raised roughly 37.6 million dollars in opposition, arguing that clinic spending is already heavily regulated and that the new spending cap would force many facilities to cut services, reduce staff, or close entirely. The executive director of the California Primary Care Association, which represents the clinics, called it an "existential threat" and noted that in many communities, these health centers are the only source of medical care available.
Community health clinics are nonprofits already required by law to reinvest 100 percent of their revenue back into their organizations. According to the state legislative analyst, most clinics currently spend around 80 percent of their revenues on health services, though some spend less. A California Policy Institute survey found that only about one in three likely voters support the measure.
The dispute has grown contentious beyond the ballot itself. The Primary Care Association filed a federal lawsuit accusing the union of using the ballot measure as leverage to extract concessions unrelated to Proposition 44, including demands for increased union organizing at clinics or withdrawal of the association's opposition to the millionaire tax. The union denies these allegations as "categorically false," and a judge previously dismissed a clinic association attempt to keep the measure off the ballot.
What I am seeing locally here in the Bay Area is that this Proposition 44 debate mirrors larger questions we're grappling with in real estate and community development: how do we balance operational efficiency with mission-driven service to underserved populations? Community health clinics are critical infrastructure in many of our neighborhoods, particularly in East County and parts of Fremont where I work with buyers and sellers. If these facilities faced closures or service cuts, it would directly impact property values and neighborhood stability in those areas. The outcome of this measure will likely shape the health care landscape that affects our communities for years to come.
