On its surface, everything about Proposition 44 on California’s November ballot looks appealing. 

Its title is straightforward: “Requires community health clinics spend 90% of revenue on program services.” 

And the text of the measure boldly declares its intent to “ensure clinic patient service delivery and workforce stability is prioritized over management and overhead spending.” 

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Great. After all, these clinics, which are largely funded by taxpayers, provide low-cost or free care to uninsured and low-income residents in disadvantaged neighborhoods. Given the huge looming federal cuts to healthcare, why wouldn’t Californians vote to ensure limited dollars are spent on services for vulnerable patients, rather than administrative bloat or padding executives’ salaries?

Well, because Prop 44 will almost certainly make things worse for patient care.

The details are wonky, but you don’t have to dig deep to spot the farce.

Prop 44 would establish strict spending requirements for a subset of community health clinics known as “federally qualified health centers” run by private nonprofits that are already subject to extensive federal regulations. The measure would mandate these clinics spend at least 90% of their revenue on things related to their nonprofit “mission” — i.e., patient care — and a maximum of 10% on management and administrative expenses, including fundraising. 

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“We are just trying to ensure that when these federal health cuts really hit, that these clinics are ready and that they can stay open and operational for the people who need them,” rather than “spending money on extravagant fundraisers, on excessive executive pay,” Renée Saldaña, press secretary of Service Employees International Union-United Healthcare Workers West, the union........

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