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Could a ballot measure close hundreds of California clinics right when they need every dollar to survive? 🤔
California’s Proposition 44 is on the November ballot. On its face, the pitch sounds reasonable: require nonprofit FQHCs to spend at least 90% of their total annual revenue on program services, or face a financial penalty equal to the shortfall.
But the numbers behind it are brutal.
According to Patch, an analysis commissioned by the California Primary Care Association estimates that clinics could face about $1.7 billion in first-year penalties if their spending patterns do not change. A separate Berkeley Research Group analysis finds that 88% of clinics across the state would operate at a loss under the measure.
This is hitting California’s more than 1,000 FQHCs at the worst possible moment.
These centers already serve roughly 6 million patients each year on a sliding scale based on ability to pay. And state estimates project that a federal budget law signed by President Trump could eventually cost California roughly $30 billion a year in federal funding.
Clinic leaders are now facing two cliffs at once.
🔹 Prop. 44 penalties are calculated as the dollar amount of the shortfall, not a fixed fine
🔹 Clinics have five years to come back into compliance and recover the penalty funds
🔹 If they fail to comply within five years, the money goes to the state for clinic worker training, recruitment, and retention
🔹 Clinic personnel who falsify records could face criminal charges
Supporters of the measure, led by the SEIU-UHW union, point to real problems. AltaMed Health Services reportedly paid its president and CEO nearly $1.93 million in 2024. The union argues the measure is about accountability, not defunding.
The opposition is not small. The California Democratic Party, the California Medical Association, and the California Hospital Association are all opposing Prop. 44.
💡 Accountability matters. But clinics running on thin margins in underserved communities do not have room for $1.7 billion in aggregate penalties on top of the federal cuts already coming their way.
The patients who depend on these centers are not going to find another option if their clinic closes.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn.
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
