ESCONDIDO — The City Council unanimously agreed to oppose Proposition 44, a statewide ballot measure that local health care leaders say could force community health centers serving underserved populations to close.
The council voted Aug. 26 to oppose the measure after hearing from Dr. Rakesh Patel, chief executive officer of Neighborhood Healthcare, a community health center serving populations in three Southern California counties with a significant presence in Escondido.
Neighborhood Healthcare, Vista Community Clinic, TrueCare and San Ysidro Health are federally qualified health centers, or community clinics that receive federal funding to provide care in medically underserved areas.
Proposition 44 would directly affect these health centers by requiring them to spend at least 90% of their revenue on program services. Those that fail to meet the threshold would be required to pay a penalty to the state.
According to Patel, given the number of health centers statewide, the penalties could result in a gain of up to $1.7 billion for the state.
While the requirement may sound good in theory, Patel said, defining which expenses count toward the 90% threshold is complicated. He said the measure could force health centers to cut billions of dollars from their budgets, drastically reduce patient numbers and potentially close within a few years.
“Proposition 44 has major flaws that financially penalize clinics if they spend resources on important staff and patient services,” he said.
Patel believes that if the proposition takes effect, most of the state’s community health centers will close within a few years.
“The numbers don’t make sense,” he added.
In Escondido alone, Neighborhood Healthcare recorded 221,918 visits from about 47,902 patients across its nine locations last year. So far in 2026, its Escondido clinics have averaged 763 visits per day. The organization also has approximately 814 employees in the Escondido area.
Neighborhood Healthcare provides primary care, behavioral health, dental care, women’s health services, podiatry, pediatrics, chiropractic care, acupuncture, enrollment services, mobile dental services and mobile health services.
The health care system also plans to open a health center at the YMCA this year.
Even Patel said he was surprised by Neighborhood Healthcare’s footprint in Escondido.
“We’re increasing that number even by the day as we look at adding specialty care and other things,” he said.
Deputy Mayor Joe Garcia said it was alarming to hear that clinics could close under the proposed ballot measure.
“I know many people that use your services, so this is very concerning,” he said.
Neighborhood Healthcare has numerous locations across San Diego and Riverside counties and expanded into San Bernardino County with a new location in Rialto a few weeks ago.
Under Proposition 44, Neighborhood Healthcare would be unable to fund nursing managers, chief medical officers, human resources, janitorial services, recruitment, care management, health care enrollment navigators, telemedicine, appointment support, mammograms, X-rays and other medical technology. The measure would also restrict funding for new clinics, building rent or leases and transportation services.
Patel said federally qualified health centers already must follow strict regulations and undergo audits. They are also required to provide some of the services that could be affected, including transportation and care management.
Proposition 44 faces widespread opposition and has little, if any, support.
According to SEIU United Healthcare Workers West, the labor union sponsoring the measure, its purpose is to stop health centers from “wasting money on executive pay and non-essentials.”
Additionally, the SEIU website states that the proposed penalties would be collected in an escrow account and could be earned back if health centers meet the 90% threshold in future years.
“This encourages clinics to do the right thing and makes sure funds that can be used for patient care are not lost,” the website states.
Although SEIU sponsors Proposition 44, Patel believes the labor union is devoting more attention to another measure it sponsors, Proposition 40, known as the California Billionaire Tax Act.
Opponents include numerous health care groups, businesses, health care workers, patients and political organizations, including the California Democratic and Republican parties.
“It is that devastating to our healthcare system,” Patel said.
A full list of opponents is available at noprop44.com.
Voters will decide in November whether to approve Proposition 44.
