The Rev Dr. Rick SchlosserCalifornia Church IMPACT recommends a NO vote
This proposition is sponsored by Service Employees International Union-United Healthcare Workers-West (SEIU-UHW-West), an organization California Church IMPACT has had a long and productive alliance with. That said, this measure raises questions worth addressing.
The measure would require all Federally Qualified Health Centers (FQHCs) to spend 90% of their revenue on direct care services. An FQHC is defined by:
- Being located in or serving a high-need community
- Being governed by a community board made up of at least 51% health center patients
- Providing comprehensive healthcare on a sliding fee scale based on ability to pay
- Holding status as a Health Center Program award recipient or “look-alike” (look-alikes receive Medi-Cal and Medicare reimbursement but no other federal funding)
All FQHCs in California are nonprofits. Conventional nonprofit operating costs run 20-35%, covering office and support staff; the remainder funds direct patient care, including wages for staff with direct patient contact. Operating costs vary by organization but can include the executive director, bookkeeping, medical coding, community outreach, fundraising, and equipment and supply management — in short, this funds the support infrastructure behind direct care.
As discussed in our analysis of Proposition 40, federal Medi-Cal and clinic funding has been drastically cut or eliminated, leaving the state to cover as much of the gap as it can. Support staff are already being laid off in some locations, and support services reduced. How to protect what remains — especially if Proposition 40 fails or underperforms — is a pressing concern across providers serving low-income communities.
We think it’s unrealistic to impose an arbitrary cap on funding for the support services behind direct care. There may well be room to review executive compensation, particularly amid a funding crisis, but clinics will protect patient services by mission first, and are already cutting support staff before anything else.
Even if federal funding resumes, or Prop. 40 revenue materializes, Proposition 44’s 90% mandate could still prove risky to clinics’ well-regulated functioning. If a clinic can’t adequately fund medical coding, supply management, or fundraising within the remaining 10%, care quality suffers too — support staff aren’t a frill.
Good management tends to favor lean staffing during hard times, but robust staffing is the healthier long-term goal. We believe standard nonprofit practices should guide operations in good times, not just lean ones — and that this measure is too rigid to serve clinics well over the long term.
Recommend a NO vote