Prop 44 Community Clinic Spending Rule, California 2026: Who's Paying and Why

On the November 3 Ballot

Prop 44: Community Clinic Spending Rule

Union vs. community health centers

Who paid to put it on the ballot SEIU-UHW, a healthcare workers' union, through a petition drive. After a similar bill failed in the Legislature.

History A similar bill backed by the same union failed in the Legislature. The union then took it to the ballot. Its three dialysis-clinic measures (2018, 2020, 2022) all failed.^7,8

A YES vote means: Certain nonprofit community health clinics would have to spend at least 90% of their revenue each year on health care services, or pay penalties.⁹
A NO vote means: No new spending rule for clinics.⁹

Yes side $16.9M No side $17.5M Who gains, who pays

Who it helps if it passes

Supporters say patients benefit, because money moves from overhead and executive pay into patient care

Who pays or loses if it passes

Community clinics serving low-income patients. The state's budget analyst says most don't meet the 90% rule today. Opponents say some would cut services or close.

What the funders get SEIU-United Healthcare Workers West is the only funder. The clinics have sued the union in federal court, alleging it offered to drop the measure if they helped it unionize 25,000 clinic workers. The allegations have not been proven. The same union sponsored three dialysis-clinic measures in 2018, 2020 and 2022. Voters rejected all three.^1,6

Cost to taxpayers State costs in the low tens of millions of dollars a year, covered by fees.⁹

Requires nonprofit community clinics that serve low-income patients to spend at least 90% of their revenue on patient care, with financial penalties for those that don't.⁹

The Legislative Analyst's Office says most clinics do not currently meet the 90% threshold. The fight is between a healthcare workers' union and the clinics themselves.⁹

YES side special interest: Low

✓ One funder dominates: SEIU-United Healthcare Workers West paid 100% of the YES money¹
✗ Funders profit: No documented financial gain. Clinics allege a union-organizing motive (unproven). (our judgment)
✗ Narrow benefit: Affects clinics and their patients statewide (our judgment)
✗ Outside money: All top YES donors are in California¹

NO side special interest: Low

✗ One funder dominates: No single funder paid more than 35% of the NO money¹
✓ Funders profit: The clinics funding it would face penalties if it passes (our judgment)
✗ Narrow benefit: Clinics and their patients statewide (our judgment)
✗ Outside money: All top NO donors are in California¹

Endorsed by

SEIU-United Healthcare Workers West

Opposed by

California Primary Care Association
California Medical Association
California Hospital Association
Planned Parenthood Affiliates of California
California Democratic Party

Funding the YES campaign

$16.9M¹

Name on its ads: "Californians for Responsible Healthcare, Sponsored by Service Employees International Union - United Healthcare Workers West." All of this side's money is from SEIU-United Healthcare Workers West.¹

SEIU-United Healthcare Workers West

$16.9M

Funding the NO campaign

$17.5M¹

AltaMed Health Services

$6.1M

Community clinic network
California Primary Care Association

$2.1M

Clinic trade group
Family Health Centers of San Diego

$1.5M
WellSpace Health and North East Medical Services

$3M

$1.5M each
Five other community clinics

$4.8M

San Ysidro Health, TrueCare, Innercare, Neighborhood Healthcare, Community Health Center Network

Sources for this measure: ^1,6,7,8,9