No on Proposition 44: It Would Put Santa Cruz County’s Health Care Safety Net at Risk
Commentary by Anita Aguirre, CEO at Santa Cruz Community Health
Every day, community health centers make sure people can see a doctor, manage a chronic illness, receive behavioral health support, and get preventive care before a health problem becomes a crisis. 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 would not be more care or greater accountability. It would be fewer services, fewer care options, lost jobs, delayed investments, and possible clinic closures.
Supporters describe Proposition 44 as a way to ensure that 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 a worried parent’s call, technology that keeps medical information protected, interpreters who help patients understand their treatment, and coordinators who connect people with specialists and hospitals. These are not administrative luxuries. They 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 available for these essential tools.
Proposition 44 would be especially damaging right now. Community health centers are already confronting federal funding reductions, workforce shortages, rising costs, and growing demand. At the same time, 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 away from clinics at the very moment more people may need them. That is a recipe for a weaker safety net and worse outcomes for patients who already face the greatest 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 driving up costs for the entire health care 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 also 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 health care 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 health care 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 health care 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, preserve access to care, and vote no on Proposition 44. Please vote today or by Nov. 3.
Anita Aguirre is Chief Executive Officer at Santa Cruz Community Health
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