California voters have become accustomed to voting down state ballot measures seeking to impose onerous rules on dialysis clinics that would put many out of business.
Those measures – in 2018, 2020 and 2022 – were placed by a particularly cynical health workers union abusing the initiative process to punish dialysis clinics that opposed unionization efforts. The point was never to pass the initiatives but to force dialysis clinics to spend hundreds of millions of dollars to defeat the measures nonetheless.
That union, the Service Employees International Union-United Healthcare Workers West (SEIU-UHW) is back at it, this time with a new and broader target – community health clinics, or Federally Qualified Health Centers – whose employees it wants to unionize.
Community health clinics serve a vital role in California’s healthcare system.
As explained by the nonpartisan Legislative Analyst’s Office, “Many clinics are considered ‘safety net,’ as they mainly serve low-income and uninsured people. The care they provide is often low cost or free to patients.” There are 2,000 such “safety net” clinics across the state, making them a potentially lucrative source of power and revenue for the union.
Enter Proposition 44, titled, “Requires Community Health Clinics Spend 90% of Revenue on Program Services. Initiative Statute.”
As the title suggests, the measure’s ostensible purpose is simple, to require clinics to spend 90% of their revenue on program services, along with penalties and enforcement mechanisms.
Setting aside the actual purpose of Prop. 44, the measure makes little sense on its own terms.
For one, why 90%? The LAO notes that such clinics already “spend most of their revenue on providing health care to patients,” with clinics on average reporting spending 80% of their revenue on patient services.
Is there any reason to believe that mandating a 90% threshold would make things better? No.
In fact, if implemented, clinics warn Prop. 44 could put many out of business simply by defining away legitimate spending as not counting toward the 90% threshold. While the SEIU-UHW insists the measure is needed to rein in runaway administrative spending, the arbitrariness of its threshold threatens the entire system.
As the Berkeley Research Group notes, “The strict 90% ratio would not allow clinics to keep funding in reserves for major capital investments, such as opening new clinics, purchasing new equipment or technologies, investments into value-based care, and preparing for potential public health or other emergencies.”
While the measure provides state authorities the ability to waive requirements in certain cases, such hurdles, coupled with the threat of fines, will only undermine the ability of community health clinics to effectively serve patients. Potentially hundreds of clinics could outright close as a result of Prop. 44, disrupting patient care and displacing patients.
Passage of Prop. 44 would be an outcome that serves no one.
But as with the dialysis measures of past years, passing Prop. 44 isn’t really the goal.
Politico recently told the story. Francisco Silva, president of the California Primary Care Association, which represents hundreds of community health clinics, recounted the hardball tactics of SEIU-UHW’s leader Dave Regan.
Regan, according to Silva, suggested the union might not go ahead with a ballot measure “if the clinics would stand aside to allow his union to sign 25,000 clinic staffers up as new union members.”
Regan, for his part, “acknowledged his union has been in talks with the clinic association over the past few years about facilitating statewide union elections,” but “insisted those discussions were separate from the ballot measure.”
A representative from the California Primary Care Association reiterated the same story to our editorial board, while a spokesperson from the union likewise insisted there was no link between the unionization push and the measure.
Given their history, no one should give Regan or SEIU-UHW the benefit of the doubt.
It’s evident what SEIU-UHW wants – more members, more dues, more power – and that it’s willing to threaten the healthcare of Californians across the state in pursuit of those ends.
That’s why a diverse coalition has come together to reject this measure – including the California Democratic Party, the California Republican Party, the California Medical Association and the California Chamber of Commerce.
Californians must not fall for SEIU-UHW’s thuggish tactics. Vote no on Proposition 44.