The state Legislature has routinely raised and maintained this fee, paid by private hospitals within the state, to be in compliance with federal regulations that qualify CA for Medi-Cal funding. This fee provides a net benefit to the hospital industry, public and private, by gaining more from Medi-Cal federal support ($3.5 billion 2015-16) than the fee costs. This measure will require a 2/3 vote of the Legislature to create a fee cancellation or reduction. Medi-Cal expansion under the Affordable Care Act has generated enormous benefits to the homeless and families and children in poverty. Preserving the fee is a positive step in preserving the health of our population.