Service Employees International Union — United Healthcare Workers West (SEIU-UHW) filed signatures for two citizen initiatives that would enact laws limiting executive pay and requiring clinics to spend 90% of their revenue on patient care.
Initiative #25-0008, also referred to as the Clinic Funding Accountability and Transparency Act, would require nonprofit federally qualified health centers to spend at least 90% of their annual total revenue on expenses that advance the FQHC’s mission. The initiative defines this as the mission-spend ratio, which would be calculated annually by the California Attorney General. The mission spend ratio would apply to each clinic's first full fiscal year that begins at least six months after the initiative's approval.
The initiative would authorize the state Department of Public Health to levy penalties for failing to meet the 90% mission-spend ratio. The penalty would be equal to the difference between the 90% requirement and the amount the clinic spent on mission-related expenses in that year.
Initiative #25-0009, referred to as the Health Care Executive Compensation Act of 2026 by proponents, would create a fair compensation limit for CEOs, executives, administrators, and managers of healthcare corporations. The fair compensation limit would be $450,000 and would increase annually by 3.5% or by the yearly cost-of-living increase. Under the initiative, compensation would include salaries, bonuses, and some benefits.
In a press release announcing the signature submission, the SEIU-UHW said, “Healthcare workers say this accountability is more urgent than ever. Many clinics have diverted funds away from their core mission, spending excessive amounts on executive compensation and other non-essentials. Some clinics spend as little as 57% of their funding on patient care. At a time when California could lose up to $30 billion annually in federal healthcare funding under proposed cuts, workers say every dollar must be spent responsibly and go towards direct patient care.”
Carmela Coyle, president and CEO of the California Hospital Association (CHA), which opposes the initiatives, said, "These measures couldn’t have come at a more precarious time for health care in California. Following the largest cut to health care in our nation’s history, this is a moment when the state should be doing all it can to recruit and retain thoughtful, mission-driven leaders who can develop innovative ways to preserve access to vital health services for patients. Instead, this proposal will only make it difficult — if not impossible — to do so."
The California Hospital Association is sponsoring an initiative that would require health care labor unions to inform members annually how member dues are being spent on political activities, specifically spending on state and local ballot measures, and require a majority of members to approve such expenditures. The campaign reported collecting at least 25% of signatures on Jan. 15.
The SEIU-UHW and CHA initiatives are initiated state statutes. To qualify an initiated state statute in California, petitioners need to collect 546,651 valid signatures, equal to 5% of the votes cast in the prior gubernatorial election. The deadline to qualify for the 2026 ballot is June 25.
The SEIU-UHW proposed similar hospital executive compensation limit initiatives in 2014 and 2016 in California, in 2014 in Oregon, and in 2016 in Arizona. None of the initiatives qualified for the ballot.
The SEIU-UHW is also sponsoring an initiative that would impose a one-time 5% tax on the accumulated wealth, including shares of capital stock, bonds, or other evidences of indebtedness, and any legal or equitable interest, of billionaires in the state to fund state-funded health care programs, such as Medi-Cal, state food assistance, and public education. The campaign reported collecting at least 25% of the required number of signatures on Feb. 26.
Campaigns behind three other initiatives have also submitted signatures for verification. The initiatives would:
- Establish a homeownership loan program for households with incomes that do not exceed 200% of the area median income for a family of the same size in the county that requires at least a 3% of the purchase price of the qualified home for the down payment
- Require a two-thirds vote by the electorate to enact special local taxes enacted by local governments and successful citizen initiative campaigns
- Require voters to present government-issued identification when casting ballots and require election officials to use government data to confirm voter citizenship and report verification rates
Including the billionaires tax and CHA initiative, eight circulating initiatives have reached the 25% of signatures collected threshold for the 2026 ballot. Between 2010 and 2024, an average of nine initiatives qualified for statewide ballots in California.
The California State Legislature referred three measures to the November ballot that would:
- Allow the state and local governments to create programs that provide candidates with public funds under spending limits and eligibility rules;
- Eliminate the successor election when a state officer is recalled, thereby leaving the office vacant until it is filled according to state law; and
- Require initiatives that change vote thresholds to supermajority votes, such as the one proposed by Reform California, to pass by the same vote requirement as is proposed.
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