Every day, community health centers ensure people can see a doctor, manage chronic illness, receive behavioral health support and get preventive care. In Santa Cruz County, that care is not an abstraction. It is a lifeline for nearly 14,000 patients served by Santa Cruz Community Health each year. That lifeline is now at risk.
Proposition 44 would cut an estimated $1.7 billion from clinics statewide in its first year and impose a rigid spending mandate on community health centers. The result wouldn’t be more care or greater accountability. It would be fewer services, fewer care options, lost jobs, delayed investments and possible clinic closures.
Supporters say Proposition 44 would ensure clinic dollars are spent on patients. But its narrow definition of “mission-related” expenses ignores how care is actually delivered.
Care does not begin and end in the exam room. It depends on trained staff who can answer calls, technology to protect medical information, interpreters who help patients understand treatment, and coordinators who connect people with specialists and hospitals. These are essential parts of safe, effective care.
A health center must have secure health information technology, electronic health records, interpretation services, insurance enrollment, care coordination, workforce development, safe facilities, and clinical leadership to function safely and effectively. Proposition 44 would slash funding for these essential tools.
Proposition 44 would be especially damaging right now. Community health centers are confronting federal funding reductions, workforce shortages, rising costs and growing demand. Upcoming Medi-Cal eligibility restrictions, work-reporting requirements, and more frequent eligibility reviews could cause many Californians to lose coverage and turn to community clinics for help.
Proposition 44 would take resources from clinics when more people may need them, weakening the safety net and worsening outcomes for patients who already face barriers to care.
When clinics lose resources, patients do not stop needing care. They delay treatment, conditions worsen, and routine health needs become emergencies. More people are pushed into hospital emergency rooms, increasing overcrowding, extending wait times, and raising costs for the entire healthcare system.
Santa Cruz Community Health provides primary care, behavioral health, reproductive health, pediatric care and chronic disease management. Our patients include children, older adults, working families, people experiencing homelessness and neighbors who might otherwise have nowhere to turn. They should not suffer because of a policy that misunderstands what it takes to keep a community clinic open.
Proposition 44 adds bureaucracy without adding care. Community health centers already operate under extensive federal and state oversight, undergo audits, meet mandatory reporting requirements, and are governed by patient-majority boards. Accountability matters, but new restrictions should not undermine the very systems patients depend on.
Opposition to Proposition 44 is broad and growing. Patients, doctors, nurses, more than 1,000 community health clinics, and nearly 100 healthcare and community organizations have joined the statewide coalition. Locally, the Santa Cruz County Board of Supervisors, the Health Improvement Partnership of Santa Cruz County, Encompass Community Services, Dientes Community Dental, and the Santa Cruz County Chamber of Commerce oppose the measure.
The stakes could not be higher. If we weaken community health centers, we weaken the entire local healthcare system. We lose capacity for preventive care, make it harder for patients to manage illness, and place even more pressure on already overburdened hospitals and emergency departments.
Santa Cruz County cannot afford to lose its healthcare safety net. Our community deserves policies that strengthen access to care, not mandates that force trusted providers to cut the people, tools, and services that make care possible.
I urge voters to protect community clinics and preserve access to care — vote no on Proposition 44.
Anita Aguirre is Chief Executive Officer at Santa Cruz Community Health.
