Proposition 44 on California's Nov. 3 ballot would require private nonprofit safety-net clinics to spend at least 90% of their yearly revenue on health care services.

Why it matters: California has about 2,000 safety-net clinics serving mostly low-income and uninsured patients, according to the Legislative Analyst's Office (LAO). Private nonprofit clinics now report spending about 80% of revenue on care, on average.

What it would do

  • Limit other spending, such as administration, to 10% of revenue.
  • Have the state attorney general define which costs count as care.
  • Make clinics that fall short pay the difference to the state. They could get it back if they comply within five years.

Costs

The LAO estimates state enforcement costs in the low tens of millions of dollars a year, covered by fees on clinics. It also warns some clinics that can't meet the minimum might close.

The debate

CalMatters reports that supporters say the measure protects patient care. Opponents warn it could force cuts and closures.

Sources: Legislative Analyst's Office; CalMatters.