Another Voice: Vote No on Prop. 44

To the Editor: Proposition 44: Read the Fine Print In November, voters will decide Proposition 44. It sounds reasonable in a sound bite, but it isn't. If it passes, we could lose community health centers throughout the county—something none of us can afford. The measure requires federally qualified health centers like Mendocino Community Health Centers to spend at least 90 percent of revenue on 'program services.' That sounds fine until you realize it's an accounting term, not a healthcare standard. The legislative text ties 'program services' directly to IRS Form 990, the federal form all nonprofits use for tax reporting. It's built for tax-reporting comparability across every kind of nonprofit, not for evaluating what's required to run a health center. Form 990's Statement of Functional Expenses splits spending into three categories: program services, management and general, and fundraising. Under Prop 44, 90 percent of a health center's budget would have to fall into 'program services,' activities like clinical staff salaries, medical supplies, provider time, and care delivered in the exam room. Everything else—human resources, compliance, accounting, IT infrastructure—would have to be funded from the remaining 10 percent. Even that dividing line isn't fully settled. The exact scope of 'program services' is still being worked out, so we don't yet know precisely where it will fall, only that it starts from a tax accounting standard that was never intended to be used to optimize clinical operations. Why Prop 44 is dangerous As a clinician and healthcare administrator, I can tell you this measure is misguided. It allocates resources without regard for how care actually gets delivered, and the penalties for noncompliance are steep enough to shut health centers down rather than bring them into line. Closing centers across Mendocino County (and across California) wouldn't just be devastating for healthcare access. It would also cost the local economy thousands of jobs. Prop 44 is offered under the guise of accountability, which is almost laughable given the depth and breadth of regulations we comply with to assure safety, quality, and adherence to strict federal healthcare standards. We do not lack oversight; we are not misspending money. This measure solves a problem that doesn't exist, while putting access to healthcare at risk in communities like ours. What it actually takes to deliver care Healthcare has a lot of moving parts. Before a patient is seen by a provider and after the visit concludes, our non-clinical staff and services ensure patients receive timely, high-quality care and appropriate follow-up. These activities may not be classified as program services or direct patient care under Prop 44, but without them, patient care would suffer. Let's start with facilities. Maintenance staff keep building systems in good working order, making care delivery possible: heating and cooling to keep exam rooms at safe temperatures, plumbing for sanitation and sterilization, and electrical systems that keep vaccines and medications properly refrigerated. Environmental services staff clean and disinfect waiting areas and clinical spaces to standards well above routine janitorial work. Human Resources staff handle recruitment, credentialing, and licensing verification for our providers, along with benefits and the personnel support our workforce needs to do demanding, stressful work. IT staff maintain the network systems, hardware, and telehealth platforms our clinical operations depend on. When those systems go down, so do appointments, including virtual visits. Electronic health record (EHR) staff maintain the systems used to document care, track medical history, and share information between providers. Every time reporting requirements change, our EHR staff update the system and train other employees to ensure that everyone who needs access to information has it. Compliance staff ensure we meet Medi-Cal, HRSA, and state and federal regulations. This isn't optional: it's a condition of the funding that enables us treat all patients, regardless of insurance status or ability to pay. Care coordinators contact patients to schedule and remind them of appointments, help manage referrals to specialists, and track whether recommended care is completed. Van drivers pick up and drop off patients who could not otherwise travel to their appointment. This work keeps people healthier, which reduces overcrowding in hospital emergency departments. Interpreter and translation staff make it possible for patients with limited English proficiency to participate in their own care and understand their treatment. None of this is optional. Health centers cannot deliver safe, high-quality care on 10% of their budgets. Vote No on Proposition 44 Proposition 44 sounds like accountability. In practice, it's a misguided mandate written without input from the people who run community health centers, built on a definition borrowed from a tax code that was never meant to govern healthcare. If it passes, centers like MCHC will be forced to cut the very staff and services that make quality, affordable care possible in our communities. Please join me in voting no on Proposition 44 this November. -Ben Anderson, Interim MCHC CEO