As California voters mail back their primary ballots ahead of the June 2 deadline, it’s not too early to start investigating the crowded November ballot, which may have a dozen statewide measures. Some, like the Billionaire Wealth Tax sponsored by SEIU-UHW have already drawn significant attention. But two other measures initiated by the same union have largely flown under the radar.
One, the Clinic Funding Accountability and Transparency Act, would require nonprofit Federally Qualified Health Centers (FQHCs), community clinics that provide primary care to low-income and underserved populations, to spend at least 90% of their total annual revenue on mission-related services. A second, the Health Care Executive Compensation Act of 2026, would cap total annual compensation for executives, managers, and administrators at hospitals, hospital groups, and physician groups at $450,000.
Both measures seem attractive from a fiscal conservative standpoint. Community health clinic executives do sometimes take home large paychecks. For example, the CEO of Altamed, a large Southern California FQHC, was paid nearly $1.95 million in 2024. Hospital system executives across California are compensated at levels that dwarf the pay of the frontline workers they oversee.
But the union’s decision to address these issues is worth considering, because SEIU-UHW has tried this before. In 2018, 2020, and 2022, the union placed three successive ballot measures targeting California’s kidney dialysis industry — Propositions 8, 23, and 29 — each framed as a patient protection measure. Voters rejected all three. Dialysis companies spent lavishly to defeat them: DaVita and Fresenius spent over $216 million fighting the three initiatives. As some observers concluded, the campaigns were not primarily about patient safety. Since there are no unionized employees at California’s dialysis clinics, the effort was widely interpreted as a strategy to exhaust the companies’ resources through repeated costly ballot fights until they agreed to recognize the union. The Santa Rosa Press Democrat called it “an abuse of the initiative process.”
SEIU’s attack on FQHCs may have the same goal. The union originally tried to implement its 90% health spending requirement via legislation. The legislative vehicle, AB 1113 exempted any FQHC participating in a bona fide Labor-Management Cooperation Committee (LMCC) from the 90% requirement, thereby giving SEIU-UHW a foot in the door.
But when the Assembly failed to pass the bill, SEIU turned to the ballot. Although the ballot initiative lacks the Labor-Management Cooperation Committee exemption, it adds an enforcement mechanism that gives the union leverage. Under Section 5 of the initiative, any patient of a noncompliant clinic can bring a breach of charitable trust claim directly against the clinic, with good faith and the business judgment rule explicitly barred as defenses. It would be easy for SEIU to find patients to lodge claims on its behalf.
The executive compensation initiative goes further still. Under Section 8(g), injunctive relief and civil penalties can be sought by “any person or organization acting in its own interest or the interest of its members.” That language gives SEIU-UHW legal standing to sue any covered hospital or physician group that pays executives above the cap, making the union a private enforcement arm against the very employers it seeks to organize.
SEIU-UHW’s own spending record provides a useful counterpoint to its demands on others. According to the union’s 2024 Department of Labor filing, SEIU-UHW spent just over one-third of its revenue on “representational activities”, the core mission of a labor union.
None of this means the underlying policy concerns are imaginary. Excessive executive pay at nonprofit healthcare providers is a legitimate issue, and the argument that taxpayer-subsidized institutions should spend a high proportion of revenue on direct services is reasonable on its face. But voters should understand that these measures, if passed, would hand SEIU-UHW a statutory litigation weapon against healthcare employers it is trying to organize — a private right of action that the union could wield or withhold as a practical matter depending on whether a healthcare provider reaches an accommodation. The dialysis campaigns cost union members millions while failing each time. The clinic and executive compensation measures appear to be the next chapter of the same strategy to expand the union’s power without clearly benefiting its current members.
Marc Joffe is a Visiting Fellow at California Policy Center.