Prop. 44: Californians to vote on 90% spending rule for community health clinics

Proposition 44 requires certain private nonprofit healthcare clinics to spend at least 90% of their annual total revenue on patient services. Below is a transcript of the video above. Read our voter guide story on Prop. 44 here, along with the editorial board’s take on the issue.

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There’s a measure on your California ballot that could change spending rules for community health clinics. Let’s talk Prop. 44.

Proposition 44 targets federally qualified health centers. Those are the nonprofit clinics that serve underserved communities across California. There’s about 2,000 of them.

The ballot measure proposes a new rule: These clinics would have to spend 90% of their revenue on patient care and services tied to their mission. Right now, they average about 80%.

Miss that target, and the clinic pays a penalty. They can earn it back if they hit 90% within five years. If not, the state keeps the money.

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Supporters, led by the healthcare union SEIU-UHW, say it stops wasteful spending on executive pay and forces accountability.

Opponents — including both major state parties, Planned Parenthood and the California Medical Association — say clinics can’t realistically hit 90%. One analysis found 89% of California clinic organizations would fail in year one, facing $1.6 billion in fines.

Read the full breakdown before you vote.

This story was originally published November 2, 2026 at 9:19 AM with the headline “Prop. 44: Californians to vote on 90% spending rule for community health clinics.”

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