By Tim Fraser, Senior Vice President, Government Affairs
Community health centers are a cornerstone of the healthcare safety net, providing high-quality, affordable care to millions nationwide regardless of their ability to pay.
But this November, a California ballot measure threatens healthcare access for millions of people and even creates strain for Californians who don't rely on community health centers for their care.
It's called Proposition 44 (Prop 44), and it would create new requirements about how community health centers – sometimes called community health clinics or Federally Qualified Health Centers – spend their money.
On the surface, Prop 44 seems patient-friendly. In reality, Prop 44 would cut funding for essential patient services, threaten the viability of community health centers, and create strain on the entire California healthcare system.
Here's why you should join us in saying No on Prop 44.
What Prop 44 Would Do
Prop 44 establishes one-size-fits-all spending requirements for nonprofit community health centers and clinics, with financial penalties for health centers that don't spend 90% of their budgets on patient care.
Leaving aside the very real risk that any financial penalties could cripple health centers, which already do more with less, Prop 44 oversimplifies how healthcare organizations operate and fails to recognize the financial realities of providing high-quality care.
The Reality of Running a Health Center
High-quality care involves much more than what happens in an exam room.
Community health centers support their patients with investments in IT and cybersecurity (protecting confidential patient records and empowering telemedicine), staff training and quality improvement initiatives (ensuring care is efficient and effective), language access services (ensuring patients and providers understand one another), critical equipment (enabling modern care with things like x-ray and mammography machines), and facilities (meeting patient demand).
But none of those essential examples align with Prop 44’s patient care spending requirements.
Meanwhile, according to state analyses, nonprofit safety-net clinics already dedicate the majority of their resources to healthcare services, while also balancing the administrative, technological, and workforce investments necessary to keep their doors open.
Thus, Prop 44 doesn't solve any problems. It just creates new ones.
Who Would Be Most Affected?
At a time when health centers are already facing workforce shortages, rising operating costs, and growing demand, new financial restrictions could force difficult decisions.
Services could be cut. Sites could close. Health centers fortunate enough to avoid those drastic steps would find it harder to invest in patient-centric improvements to their facilities or operations, not just immediately but long term.
Of course, the gravest consequences are for the millions of people who rely on community health centers for their care, which include traditionally underserved communities.
But the ripple effects would be felt across the California healthcare system, when barriers to access at community health centers lead to greater demand at emergency rooms across the state.
A Solution in Search of a Problem
If it wasn't bad enough that Prop 44 fundamentally misunderstands what's involved in modern patient care, Prop 44 also would add more red tape to part of the health system that is already highly regulated.
Community health centers already operate under extensive federal and state oversight, complying with rigorous reporting requirements, financial audits, quality standards, and governance regulations. It's due to those requirements that community health centers have patient-majority boards, ensuring that community voices remain heavily involved in decision-making so that health center resources are aligned with local needs.
Prop 44 improves none of that. It just makes it harder for those patient-majority boards to meet patient demand in their communities.
Supporting Care, Not Restricting It
If policymakers want to improve access to care, the focus should be on strengthening the healthcare workforce, supporting recruitment and retention efforts, expanding services, and investing in the infrastructure that modern healthcare delivery requires.
Community health centers have a long track record of adapting to local needs and delivering high-quality care in underserved communities.
They need flexibility to make strategic investments that improve patient outcomes, not restrictive formulas that limit their ability to operate effectively.
The Bottom Line
Community health centers exist to put patients first.
Prop 44 threatens that mission by imposing a rigid spending mandate that could weaken the financial stability of clinics across California and reduce access to care for millions of residents.
At a time when communities need stronger healthcare systems, not weaker ones, voters should join our health center members and a growing coalition saying No on Prop 44.