Dr. Clifford Wong: President's Message Q3 Bulletin September 9, 2026 From the President CMA Position on November Ballot Initiatives By Clifford Wong, MD, ACCMA President Every election season brings a long list of ballot measures, some of which can have significant implications for our patients and California’s healthcare system. The California Medical Association (CMA) carefully reviews each statewide initiative and, when appropriate, takes positions to help physicians understand the potential implications. This November, CMA is opposing two healthcare-related ballot measures while supporting a third that offers a more sustainable, long-term approach to healthcare funding. CMA is opposing Proposition 44, the Clinic Funding Accountability and Transparency Act. The measure would require Federally Qualified Health Centers and other qualifying community health clinics to spend at least 90 percent of their annual expenditures on defined program services, with financial penalties for clinics that fail to meet the requirement. Transparency and accountability are important principles, and CMA supports ensuring that healthcare dollars are used effectively to serve patients. However, while intended to direct more resources toward patient care, the measure reduces the flexibility clinics have to tailor services to the unique needs of the communities they serve. In addition to providing direct medical care, many clinics also provide services that improve access to care, such as transportation for patients who have no reliable way to travel to medical appointments, particularly in California's rural communities. Clinics may also provide care coordination, patient navigation, language assistance, outreach, and other supportive services that help patients receive timely and appropriate care, but may not qualify as "program services" under the measure. By imposing a rigid 90 percent spending requirement backed by financial penalties, Proposition 44 could limit clinics' ability to provide these essential services and adapt to the changing needs of their patient population. CMA believes policy should strengthen the healthcare safety net by giving clinics the flexibility to deliver comprehensive, patient-centered care rather than imposing mandates that could inadvertently reduce access to care for the communities they serve. CMA is also opposing Proposition 40, the Billionaires Tax Act. Proposition 40 would impose a one-time tax of up to 5 percent on the net worth of certain billionaires to fund healthcare and other public programs. While the goal of increasing funding for healthcare is an important one, the measure raises significant implementation, administrative, legal, and constitutional questions. The Franchise Tax Board is not currently equipped to administer and enforce a tax requiring valuations of complex assets, and developing the systems, regulations, and expertise needed to implement the measure would likely take years. In addition, revenue estimates are highly uncertain, with the Legislative Analyst's Office projecting substantially different revenues than those projected by the measure's proponents. It is also likely to face constitutional challenges, creating additional uncertainty regarding implementation and the timing and amount of any revenues collected. Because California's healthcare system depends on stable and predictable funding, CMA is concerned that Proposition 40 will not provide a reliable long-term funding source for critical healthcare programs. CMA has consistently supported responsible revenue measures, including Propositions 30, 55, and Proposition 3, because they provide a more stable and sustainable funding mechanism for California's healthcare system. Instead, CMA supports Proposition 3, which would permanently extend California's existing tax rates on the state's highest-income earners. Because these revenues are already part of the state's fiscal structure, Proposition 3 would provide a more predictable, long-term funding stream for healthcare, education, and other essential public services without relying on a one-time infusion of revenue. CMA believes this approach offers greater fiscal stability and better protects the programs our patients depend on. Reasonable people may reach different conclusions on these measures. CMA's positions are guided by a consistent principle: supporting policies that strengthen California's healthcare system, preserve access to care and provide stable, long-term investments in the health of our communities. I encourage you to learn more about these initiatives before casting your ballot this November.