Letter to the Editor: Vote No on Proposition 44

Dear Editor:

I am the Medical Director at Long Valley Health Center in Laytonville, a nonprofit Federally Qualified Health Center that has served North-Central Mendocino County since 1978. Every day I see what it means when patients fall through the cracks — and what becomes possible when they don’t. Proposition 44 would make it much harder to catch them.

Let me tell you about one of our patients — I’ll call her Renee.

Renee is 36 years old. She has had Type 1 diabetes since she was three. By the time she came to us, that disease had ravaged her kidneys — she was driving to Ukiah three days a week for dialysis, battling addiction, with no income, no stable housing, and dangerously uncontrolled glucose levels. She was scared, overwhelmed, and feeling almost entirely alone.

Our Enhanced Care Management team surrounded her. Her caseworker read and re-read every eligibility requirement to help navigate her onto the kidney-pancreas transplant list. Another team member helped her enroll in SSI benefits, giving her income for the first time. Our nurses and her provider answered every question about labs, medications, and following steps. They had hard, honest conversations with Renee about sobriety, about vaping, about what was at stake if she couldn’t stop. Our whole clinic was all hands on deck.

And Renee showed up too. That is what whole-person care looks like. Not one hero — a whole team refusing to let someone fall.

Proposition 44 would defund exactly that kind of care.

Prop 44 would impose strict new spending requirements on nonprofit community health centers, with penalties for noncompliance. Supporters call it accountability. Independent economists at the Berkeley Research Group found that it would cut $1.7 billion from community health centers and clinics in its first year alone. 88% of clinics statewide would face negative operating margins. Clinics caring for more than 11 million patients are at significant risk of having to cut services or shut down entirely.

This poorly written measure excludes critical services from its spending requirements — making them the first targets for cuts: care coordinators, enrollment navigators, translation services, transportation, telemedicine, quality improvement programs, and the billing and IT staff who keep operations running. At community clinics like ours, none of these are administrative luxuries. They are how we keep Renee — and 3,023 patients like her — connected to care.

For rural communities, community health centers are often the only source of care for hundreds of miles. When clinics cut services or close, patients don’t simply find another doctor. They go to emergency rooms — or they go without. That costs everyone more, and it falls hardest on those who can least afford it. Prop 44 would also eliminate funding for hundreds of school-based health clinics statewide, cutting primary care for tens of thousands of California children.

It is also worth knowing why this measure exists at all. According to the California Primary Care Association, Prop 44 is not a good-faith accountability effort — it is a power play by special interests using the ballot initiative process to gain political leverage over community health centers in contract negotiations. Patients are being used as pawns. This is not accountability; this is coercion.

What Prop 44 ignores is that community health centers are already among the most heavily regulated healthcare entities in the state, subject to strict federal and state audits. We are nonprofits by law — our resources go to patient care, not shareholders. A majority of our board of directors must be our own patients.

Opposition to Prop 44 is broad and has nonpartisan support: the California Medical Association, California Academy of Family Physicians, Planned Parenthood, California Teachers Association, California Hospital Association, California Behavioral Health Association, California Black Health Network, and the American College of Emergency Physicians, among many others. When doctors, nurses, teachers, and patient advocates all agree, it is worth listening.

Renee’s story is not unique. It is happening in exam rooms, on phone calls, and in parking lots across Mendocino County right now. Proposition 44 would make stories like hers less likely to have a good ending.

I urge Mendocino County voters to learn more at NoProp44.com and to vote No on Proposition 44. Our neighbors, family, and friends deserve better.