Leaders at community health clinics in the central San Joaquin Valley are taking aim at a union-backed ballot initiative they say could force clinics to cut services, sparking concern over California’s rural clinics, some of which are the only health care providers for miles in every direction.
The ballot measure, filed earlier this month with the backing of the Service Employees International Union – United Healthcare Workers West (SEIU-UHW), would require some community clinics to spend at least 90% of their total revenue on direct patient care and “mission-related services.” The goal is to curb spending on “bloated executive pay or other non-essentials,” said union spokesperson Renée Saldaña.
But in a news conference at United Health Centers’ administration building in northwest Fresno on Tuesday, leaders of multiple Valley clinics said the “dangerous” healthcare initiative would take down a number of essential services in its path.
“We pick up our patients to and from their house to the clinic at no cost. This would not be considered part of the mission service. We hire Zumba instructors to try and target obesity. We work with farmworkers and dairy workers — lechería — by providing health and blood screenings and education,” said CEO Graciela Soto of Tulare’s Altura Community Clinic, “all of which would be decimated by the initiative.”
The healthcare initiative comes at a time when many clinics face uncertain futures due to federal Medicaid cuts.
While the clinic leaders argue the measure is kicking them when they’re already down under the looming federal budget, the union said that’s all the more reason for budgetary scrutiny for clinics that receive federal dollars.
What the ballot measure targets
SEIU-UHW’s ballot measure targets what are known as “federally qualified health centers.”
That refers to a specific type of primary care clinic that receives federal funds to provide health care services in underserved communities, according to California’s Department of Health Care Services.
These clinics’ share of federal dollars is what put them in SEIU-UHW’s crosshairs, Saldaña said.
“More than any other healthcare facilities, community clinics are funded by our tax dollars,” she said, “which means they have an added responsibility to ensure that those funds are used responsibly and for the core mission of the clinics.”
Given that the clinics operate in underserved communities, they tend to take on various support services for patients that face added barriers to accessing health care “far beyond the exam room,” Soto of Altura Community Clinic said.
Miguel Rodriguez, chief administrative officer of United Health Centers of the San Joaquin Valley, said the healthcare initiative would put those added services like transportation, enrollment and case management at risk for the roughly 180,000 patients they serve.
But Saldaña disputed whether those services would be on the chopping block under the ballot measure.
“The measure is designed to direct more funding into patient services and programs that are key to (a federally qualified health center’s) mission. That is not merely patient care,” she said, “but encompasses all the ancillary services they provide in addition to direct patient care. There is no limitation that it be only direct patient care spending in the initiative.”
Healthcare initiative puts executive pay back in the spotlight
In addition to the ballot measure regarding community health clinics, SEIU-UHW is backing a second ballot initiative filed earlier this month that would put a $450,000 cap on hospital executives’ pay.
The union is critical of community health clinic executives’ pay as well, including the central San Joaquin Valley.
In an email, SEIU-UHW was critical of former UHC CEO Colleen Curtis’ salary of just under $1.2 million in 2023. The 20-year CEO stepped down in April of that year, according to UHC’s Form 990.
The union also criticized the share of UHC’s revenue that went toward “management and general expenses” in 2023 — which amounted to just under $33 million, according to tax filings. It also criticized UHC’s roughly $25 million “surplus” or net income in that year.
That was compared with over $180 million in total expenses, roughly $148 million of which went toward “program service expenses,” according to tax filings.
The union claims the ballot measure would have required UHC to spend an additional $37.5 million on program services and activities rather than management and surplus accumulation.
Fresnoland reached out to UHC for comment on these 2023 financial records.
Other local health care executives’ pay has come under fire in Fresno in recent years.
In a May 2024 investigation, experts told Fresnoland that Valley Children’s Hospital’s direct community investments were lower than expected, especially when compared to its soaring profits and executive compensation that reached record-highs during the pandemic.
Other SEIU-UHW ballot measures
This isn’t the first time SEIU-UHW has put efforts into ballot measures aimed at creating new regulations for health clinics.
Some of those most recent initiatives targeted dialysis clinics. SEIU-backed initiatives to increase oversight for dialysis clinics appeared on Californians’ ballots in 2018, 2020 and 2022 — and were rejected all three times, Politico reported.
Rodriguez of UHC questioned the authenticity of SEIU-UHW’s intentions with the current ballot measure, calling it a tactic to “gain political clout” and “increase their members, at the end of the day.”
Saldaña countered that the measure is about “transparency and accountability.”
Both of the ballot initiatives SEIU-UHW is backing are currently under review from the state Attorney General’s Office. The initiatives will have to receive a certain number of signatures in order to qualify for the November 2026 ballot.