Vote No on Proposition 44: A No-Brainer NO

Martin Booe, APHCV Board Member

I have spent much of my professional life working in healthcare and medical journalism. I also serve on the board of Asian Pacific Health Care Venture, Inc., which gives me a perspective on the challenges facing community health clinics and the people who depend on them. I might not have looked beneath the surface of Proposition 44 if these two parts of my life hadn’t come together. But once I did, the conclusion was unmistakable: Prop. 44 is a no-brainer NO.

On its face, the proposition sounds like common sense. Who wouldn’t want community health clinics to spend 90 percent of their revenue on patient care rather than administration, executive salaries and overhead? Excessive executive compensation and questionable spending in the nonprofit healthcare world indeed deserves scrutiny, but Prop. 44 is not a reasonable solution to those problems. It is a badly conceived, arbitrary restriction that could do real damage to the very clinics and patients it claims to protect.

California’s community health clinics already spend, on average, about 80 percent of their revenue on healthcare services. That’s according to the nonpartisan Legislative Analyst’s Office. Nonprofit organizations are already tightly controlled by the state and federal government. Their  revenues are reinvested in their operations and their communities, not distributed to shareholders.

So why impose an arbitrary 90 percent requirement? Running a healthcare clinic takes more than doctors and examination rooms. It takes trained administrative staff, information technology, billing and compliance departments, translators, patient navigators, equipment, maintenance and the infrastructure necessary to keep the doors open. These aren’t luxuries. They are the bone structure of any operation, whether it’s healthcare or manufacturing.

Prop. 44 also financially penalizes clinics who don’t conform to the letter of rules that haven’t be written yet. All in all, this measure not only puts undue extra burden on clinics when they are most needed and most vulnerable; and it creates so many oversight headaches that government officials at all levels reach for the aspirin bottle at its mention.

Who came up with this? Proposition 44 was sponsored by the Service Employees International Union–United Healthcare Workers West (SEIU-UHW), which originally pursued similar legislation in Sacramento before turning to the ballot initiative process. This is not a proposal developed by community clinics, medical professionals or the organizations that represent the patients they serve.

And that last point is telling. The California Medical Association, the California Academy of Family Physicians, the American Academy of Pediatrics–California, the California Primary Care Association, Planned Parenthood Affiliates of California and the California Hospital Association are among the organizations opposing Prop. 44. The California Democratic Party is opposed as well. That breadth of opposition speaks volumes.

Indeed, we should demand accountability from healthcare organizations. But accountability is not the same thing as imposing a one-size-fits-all spending formula on organizations doing complicated, essential work.

Proposition 44 takes a legitimate concern and applies a simplistic solution that could undermine California’s healthcare safety net. The people most likely to pay the price are not the executives the proposition targets. They are the patients who have nowhere else to go.

That’s why I voted NO on Proposition 44.