Overview: California voters will decide on four health-related ballot measures in November, including Proposition 4, which would borrow $10 million on bonds to reduce climate risks and impacts, and Proposition 5, which would lower the percentage of voter approval for bonds for local affordable housing. Proposition 34 would restrict spending of prescription drug revenues by some health providers, and Proposition 35 would provide ongoing funding for Medi-Cal through a permanent tax. The measures address issues related to criminal justice, housing, and healthcare, and voters will have the opportunity to make decisions on these matters.
Breanna Reeves
In less than two months, Californians will hit the polls to vote on 10 measures addressing issues related to criminal justice, housing and health care. Among the 10 propositions, four of them give voters the opportunity to make decisions regarding health care.
Take a look at the health-related ballot measures that will appear on the Nov. 5 ballot:
Proposition 4: Borrows $10 billion on bonds to reduce climate risks and impacts
Prop. 4 would also authorize $3.8 billion for safe drinking water, $1.95 billion for wildfire prevention and extreme heat mitigation and $1.9 billion for protection of natural lands.
Addressing extreme heat continues to be a source of concern for climate activists and workers rights advocates across the Inland Empire. Temperatures this summer have hit record-breaking numbers in the Inland Empire. In July, Coachella Valley residents experienced temperatures of 124 degrees. Indoor and outdoor workers across the region have demanded heat protection rights, and recently gained some protections from the California Division of Occupational Safety and Health (Cal/OSHA).
According to an analysis by the Legislative Analyst’s Office (LAO), a large sum of the bond money would be used for “loans and grants to local governments, Native American tribes, not-for-profit organizations, and businesses.” Additionally, some of the bond funds would also be available for state agencies to spend on state-run activities.
Proposition 5: Lowers the percentage of voter approval for bonds for local affordable housing
Prop. 5 sets out to amend the California Constitution guidelines for approving certain local bonds. Currently, bonds for affordable housing, public infrastructure and fire protections require a two-thirds approval by voters. This proposition would amend that approval to 55%.
Under this measure, local governments would be allowed to assess property taxes above 1% to repay affordable housing and infrastructure bonds if approved by 55% of voters instead. The LAO estimated that the impact of this measure would increase local borrowing to fund affordable and supportive housing, but the amount of increased borrowing would depend on local governments and voters.
For decades, affordable housing has been an important topic for discussion among housing advocates. According to the LAO’s California Housing Affordability Tracker, the annual household income needed to qualify for a mortgage on “a mid-tier California home” in June 2024 was roughly $239,000 — more than two times the median California household income in 2022 ($95,500). With more than 180,000 homeless individuals in California, the need for affordable and supportive housing is one important factor that could alleviate the growing houseless population across the state.
Proposition 34: Restricts spending of prescription drug revenues by some health providers
Under a federal program, pharmaceutical companies provide discounts on their medications to hospitals and other health care providers. To qualify for these discounts, providers must be public or private nonprofits that focus on serving low-income individuals. An analysis of the LAO noted that providers often earn revenue from the federal drug discount program by charging private health plans or government programs more than the cost to provide the drugs.
The goal of the federal discount drug program is “to allow eligible providers to increase services and serve more low-income patients,” which providers could do with their revenue. In the end, providers are not restricted by law on how they spend the revenue from the discount program.
Prop. 34 would establish new rules on how certain health care providers spend their revenue from the federal program. According to the measure, these providers would have to spend at least 98% of their net revenue earned in California on health care services provided directly to patients. These rules apply to health providers who: participate in the federal drug discount program, has/had a license to operate in California or has certain contracts with Medi-Cal, has spent more than $100 million on purposes other than patient care in a ten-year period, and those who own and operate multifamily housing units.
Proposition 35: Provides ongoing funding for Medi-Cal through permanent tax
For more than a decade California has charged a tax on specific health plans under the Managed Care Organization Provider Tax (“health plan tax”). The state currently charges plans based on the number of people they provide health coverage to, including those enrolled in Medi-Cal.
This tax has not been permanently approved, rather it’s approved for a few years at a time. The federal government also must approve the tax. Prop. 35 would make the existing health plan tax permanent starting in 2027.