This ballot is so long, I’ve been publishing my endorsements a few measures at a time. Here are my thoughts on Propositions 43, 44 and 45 on the November 2026 California ballot, which wraps up all 14 measures. Next up: I’ll post the entire voter guide, including my (minimal) thoughts on the candidates and a one-pager you can use if you’re voting in person.
You can find my endorsements on Props 1 through 5 here, Props 37, 38 and 39 here, and Props 40, 41 and 42 here.
The short version, for those of you who are even busier than I am:
- Prop 43 (Two-Thirds Vote for Citizen-Initiated Local Taxes): NO
- Prop 44 (Community Clinic Spending Mandate): HARD NO
- Prop 45 (Fast-Track Environmental Review for “Essential” Projects): NO
Disclaimers
Before we begin, I should clarify that the opinions I express in my voter guides are my own and should not be attributed to my clients, my little girl, or my subversive artist collective. Please send all hate mail to me at info (at) votealix.com.
In the interest of full disclosure, I’m a single mom, a liberal Democrat, and an attorney whose passions include making government work better, helping professionals lead healthier lives, and protecting our environment for future generations. I’ve worked on/volunteered for more political campaigns than I can count, and I also like long walks on the beach.
Prop 43: Lets One-Third of Voters Block Local Taxes. Vote NO.
Every ballot needs a plot twist, and this year’s comes courtesy of Assemblymember Buffy Wicks. She wrote Prop 43, and now she’s campaigning against it. Imagine baking a cake and then standing next to it all night shouting “don’t eat the cake.” There is a method to the madness: she wrote it as part of a deal to get a much nastier anti-tax initiative off the ballot. More on that below.
What it does: A little history first. Under Prop 13 (yes, that one, the gift from 1978 that keeps on taking), and later Prop 218, any special tax a city puts on the ballot needs two-thirds of the vote to pass. Special taxes are the earmarked ones: money set aside for transit, parks, libraries, fire, or kids. General taxes that go into the city’s general fund only need a simple majority, but voters rarely trust their city with a blank check. (Having worked in city hall, I understand.) So the services people care about most face the highest bar.
Two-thirds is a brutal threshold. It means 33.4% of voters can kill anything. Picture a group project where a third of the team can veto everything, and the group project is your kid’s preschool. In a state where a big chunk of voters will vote no on any tax, no matter what it pays for, that turns a lot of popular measures into losers.
Then in 2017, the California Supreme Court’s Upland decision opened a door. It said the two-thirds rule applies to taxes that governments put on the ballot, not to ones citizens put there by gathering signatures. Citizen initiatives only need a simple majority.
Oakland shows how this plays out. In 2018, a citizen-led campaign put Measure AA on the ballot: a $198 parcel tax for 30 years to pay for early childhood education and college readiness. It got 62% of the vote. Everyone, including the ballot materials, assumed it needed two-thirds, so it looked dead. It failed. Then it didn’t. Supporters pointed to Upland, and the City Council voted 5-1 to certify it. The Jobs and Housing Coalition and a group of property owners sued. A trial court struck the measure down, but the Court of Appeal reversed, ruling that because AA was a citizens’ initiative, a simple majority was enough. Today, Oakland’s preschool expansion runs on that money.
Prop 43 shuts that door. Going forward, citizen-initiated special taxes would need two-thirds, just like government ones. (AA itself is safe, since the measure isn’t retroactive.) But the next Measure AA, with 62% of voters behind it, loses. Democracy!
How we got here: The Howard Jarvis Taxpayers Association, which has never met a tax it didn’t want to put in a headlock, has been fuming about Upland since 2017. It qualified an initiative for this ballot that would have retroactively wiped out past citizen-passed taxes that fell short of two-thirds. The LAO said that could cost local governments up to $2 billion a year, mostly from real estate transfer taxes in 26 charter cities, 18 of them in the Bay Area. To get it pulled, legislative leaders cut a deal: the Legislature would put a milder, forward-only version on the ballot, and HJTA would withdraw theirs. Wicks wrote it, the Legislature passed it on June 25, and HJTA backed off. Which is the political equivalent of “relax, we’re only taking one kidney.”
The Yes side: Supporters say it closes a legal loophole and puts citizen and government tax measures on equal footing. They argue special interests exploit the majority threshold in low-turnout elections to sneak taxes through. Measure AA passed in a November general election, by the way. Very sneaky, putting it on the ballot where everyone could vote on it. HJTA’s Jon Coupal is thrilled that the Legislature itself voted to make taxes harder to raise, and honestly, who can blame him? He got a Democratic supermajority to carry his water, and they even brought their own buckets.
Supporters: Howard Jarvis Taxpayers Association, Reform California, the Southern California News Group editorial board, and assorted business groups.
The No side: Opponents point out it doesn’t cut anyone’s taxes. It just hands a veto to a minority of voters over services like fire, 911, schools, roads, hospitals, and affordable housing. And the author herself said on X that she wrote the measure “not because I wanted it to become law. But because it was the only path left to get the more dangerous initiative off the ballot before time ran out.” That sounds more like a prisoner exchange than an endorsement.
Opponents: Assemblymember Buffy Wicks, the California Democratic Party, Evolve California, SEIU Local 1000, and the Sacramento Bee editorial board.
Why I’m voting NO: Majority rule is a pretty good system. It’s even the system we use to pass Prop 43, which needs only 50% plus one to take away your ability to pass things with 50% plus one. If that sentence made your head hurt, good, that means you’re paying attention. When the author of a constitutional amendment is begging you to reject it, take the hint. Vote NO on 43, and let Buffy have her cake back.
Prop 44: Community Clinic Spending Mandate. Hard NO.
Let’s talk about SEIU-United Healthcare Workers West, the union that wrote Prop 44. SEIU-UHW treats California’s initiative process the way a mob boss treats a small business: nice clinic you’ve got here, shame if something happened to it.
I’m a Democrat. I support organized labor. And I resent the hell out of SEIU-UHW, which has turned our ballot into its personal bargaining table. The playbook goes like this: pick a health care industry, draft an expensive regulation aimed squarely at it, gather a million signatures, and wait for the phone to ring. Sometimes the industry cuts a deal and the measure disappears. Sometimes it doesn’t, and the rest of us get stuck figuring out how to vote on dialysis clinic management. Again.
This year SEIU-UHW qualified THREE statewide measures. One, a $450,000 cap on hospital executive pay, vanished in June after SEIU and the hospital industry reached a deal. Funny how that works. Apparently the measure was worth more as a hostage than as a law. The other two are still with us. Here’s their recent statewide record:
- 2018, Prop 8: Capped dialysis clinic revenues. Failed, 59.9% No.
- 2020, Prop 23: Required a doctor on site at dialysis clinics. Failed, 63.4% No.
- 2022, Prop 29: Required a doctor on site at dialysis clinics. (No, that’s not a typo.) Failed, 67.3% No.
- 2024: Nothing! Why? Because the 2023 deal that produced the $25 health care minimum wage included an agreement restricting SEIU-UHW from running certain health care ballot measures. So the one year SEIU-UHW stayed off the ballot, it was contractually required to. That’s not restraint. That’s a non-compete.
- 2026, Prop 40: Billionaire wealth tax.
- 2026, Prop 44: This one.
- 2026, executive pay cap: Qualified with over a million signatures, then withdrawn in a deal.
Voters rejected the dialysis measures three times, each time by a bigger margin. SEIU-UHW heard “no” in 2018 and took it as “try again in 2020.” It heard “NO” in 2020 and took it as “third time’s the charm.” It was not the charm. At some point you have to take the hint.
Statewide measures are just the visible part. According to CalMatters, since 2012 SEIU-UHW has sponsored 48 state and local initiatives and spent roughly $120 million on them, and most were withdrawn or defeated. That works out to about $2.5 million per initiative, mostly for nothing. And these are the people lecturing clinics about wasting money.
The LA Times noted at the time that the dialysis campaigns ran alongside SEIU’s unsuccessful effort to organize dialysis workers. And remember that mob boss joke? Turns out the clinics weren’t laughing either. On September 18, the California Primary Care Association and several clinics sued SEIU-UHW and Dave Regan in federal court under RICO, the racketeering law Congress wrote to go after the mafia. The complaint alleges the union spent $216 million on a scheme to use ballot initiatives as bargaining chips. It also alleges SEIU-UHW offered to drop Prop 44 if the clinics agreed to union election procedures that would bring in 25,000 new members, or if they dropped their opposition to the billionaire tax and put their campaign money behind it. In the complaint’s words, SEIU-UHW “filed initiatives designed not to pass, but to subjugate and terrify.” These are allegations, not findings, and civil RICO cases are notoriously hard to win. But when your political strategy gets you sued under the same law as the Gambino family, it might be time for new leadership.
What it does
Prop 44 requires nonprofit community health centers (the clinics that provide primary, dental, prenatal and mental health care to low-income and uninsured Californians) to spend at least 90% of their revenue on patient care. Administration, overhead and everything else get 10%. A clinic that falls short pays the state a penalty equal to the shortfall, which it can earn back if it complies within five years. Falsifying the numbers can bring criminal charges. And the clinics pay for the state’s enforcement costs, estimated at the low tens of millions a year. So the measure meant to cut clinic overhead starts by adding a new line of clinic overhead. Bold choice.
For context, California clinics currently average about 80%. So this isn’t about trimming a few bad actors. It’s a sector-wide overhaul written by people who don’t run clinics.
The case for Prop 44
Supporters say these are nonprofits living on taxpayer money to serve vulnerable people, so the public has every right to demand that the money go to patients rather than executive pay, consultants and fundraising. The Yes campaign says some clinics spend less than half their revenue on care while patients wait for appointments in understaffed clinics with outdated equipment. With federal Medi-Cal cuts coming, they argue, every dollar matters more than ever. And the 90% isn’t just doctors and nurses: interpreters, transportation, care coordination, medical equipment and patient-care IT all count.
Supporters: SEIU-UHW. That’s the list. The Yes coalition could hold its strategy meetings in a phone booth. SEIU has put up about $16.9 million, which is essentially all the money on the Yes side. The official voter guide lists supporters as “None submitted,” which is technically a paperwork quirk but also feels spiritually accurate.
The case against Prop 44
The 90% figure appears to have come from nowhere relevant. An SEIU analyst told the Chronicle it was partly modeled on New Mexico’s rule for insurance companies, which are a completely different kind of business. That’s like writing restaurant health codes based on the rules for gas stations. There’s no clinic industry standard anywhere that uses 90%.
“Overhead” is not a synonym for “waste.” Clinics need billing, HR, compliance, cybersecurity, medical records, lawyers and insurance. Squeezing all of that into 10% invites exactly the kind of underinvestment that causes data breaches and billing disasters.
The penalties are backwards. A struggling clinic that misses the target has to hand over more money, which it then can’t spend on patients. Opponents estimate $1.7 billion in penalties in the first year. That’s their number, not a neutral one, but even the Legislative Analyst acknowledges some clinics could close. And the measure may not even catch the abuses SEIU keeps pointing to: AltaMed’s roughly $266,000 in European art purchases was booked as a “program service,” which could still count toward the 90%.
To be fair about the money: the No side is funded mostly by the clinics themselves, led by AltaMed at about $6 million. Yes, the art people. Nobody here is a saint.
Opponents: The teachers union, the California Democratic Party, and literally everyone in healthcare. California Primary Care Association, California Medical Association, California Hospital Association, Planned Parenthood Affiliates of California, American Academy of Pediatrics–California, California Academy of Family Physicians, American College of Emergency Physicians–California, ACOG District IX, California School Nurses Organization, NASW–California.
The San Francisco Chronicle editorial board summed it up in its headline: Prop 44 “uses California’s most vulnerable patients as cannon fodder.”
Why I’m voting no
I don’t object to the goal. Clinics that take public money should be accountable for how they spend it. I object to the mechanism. This is detailed health care accounting regulation: a specific ratio, a penalty formula, waivers, enforcement machinery and criminal liability. That’s the Legislature’s job. Lawmakers can hold hearings, look at the actual financial data, decide whether the right number is 80, 85 or 90, and fix it when it inevitably needs fixing. Once voters pass an initiative statute, the Legislature can’t just tweak it. Nobody in a voting booth can tell you whether 2,000 safety-net clinics can survive on 10% overhead, and nobody should be asked to guess.
SEIU already tried this in the Legislature in 2025, and it failed. So now they’re asking us, the way a kid asks the other parent. Given their track record, I’m not convinced they even want it to pass so much as they want what it can buy them at the negotiating table.
Vote NO on 44. And SEIU-UHW, knock it off. Get a hobby. Or better yet, get a new President.
Prop 45: Fast-Track Environmental Review for “Essential” Projects. NO.
In 2021, a developer proposed 495 apartments on a Nordstrom parking lot at 469 Stevenson Street in San Francisco, a few blocks from BART. The Planning Commission approved it. Then the Board of Supervisors voted 8-3 to send it back for more environmental review, which meant studying the environmental impact of replacing a parking lot with homes. (Whatever you do, don’t tell Joni Mitchell.) That cost the project 18 months. By the time it was re-approved in 2023, construction costs and interest rates had soared, and it’s still a parking lot today. Nordstrom, meanwhile, closed. The parking lot outlived the store it was built for.
The law that made this possible is the California Environmental Quality Act, or CEQA, signed by Governor Reagan in 1970, back when Republicans signed environmental laws. CEQA requires the government to study the environmental impact of projects it approves, from apartment buildings to highways to power lines. CEQA has led to more thoughtful development throughout California, and it has also been used as a weapon by NIMBYs and project opponents. CEQA lawsuits can tie a project up for years. Stories like 469 Stevenson are why the Legislature passed major CEQA reform in 2025, and why the California Chamber of Commerce is now spending $42 million on Prop 45 to go much further.
As a former Deputy City Attorney in the real estate division, where I spent several years as counsel to the redevelopment agency, I had a front row seat to the weaponization of CEQA, so I fully expected to endorse Prop 45. I won’t. The Legislature already fixed the part that mattered most, and Prop 45 goes a lot further than the problem.
What it does. For a long list of “essential projects” (housing, transportation, water, clean energy, hospitals, schools, broadband, wildfire prevention, and, by my count, nearly everything), developers can opt into a fast-track version of CEQA. Agencies get 365 business days to finish environmental review, and courts get about nine months to resolve lawsuits. Deadlines are fine. I love a deadline. But Prop 45 also changes the substance. The developer picks the one alternative the agency has to consider, which is a bit like letting the defendant pick the jury, and the jury is one person. Environmental standards are frozen on the day the application is filed. And if a court finds the review broke the law, it can only halt the part of the project that broke it. To amend any of this, the Legislature needs a two-thirds vote, which in Sacramento is roughly as easy as redeveloping a Nordstrom parking lot.
The backstory. Thanks to the 2025 reforms, most urban infill housing is now exempt from CEQA altogether, and more than 10,000 units used that exemption in the first year. CalChamber filed Prop 45 four months after Governor Newsom signed those reforms. You know the children’s book If You Give a Mouse a Cookie? This is If You Give a Chamber of Commerce a CEQA Exemption. The business community saw what the Legislature passed and decided to ask for a lot more.
The case for Prop 45. Supporters say California doesn’t just have a housing problem. It has a building problem. Housing, transmission lines, water systems, hospitals and wildfire projects all spend years in environmental review and then more years in court, and every year of delay adds financing, labor and legal costs that renters, ratepayers and taxpayers end up paying. They also argue that CEQA lawsuits are too often filed for reasons that have nothing to do with the environment: neighbors who don’t want the project, unions looking for leverage, and competitors trying to slow each other down. (All true.) Prop 45 doesn’t repeal CEQA. Projects still get reviewed, other environmental laws still apply, people can still comment and sue, and developers choose whether to use the fast track at all. Supporters say it just makes the process end at a predictable time instead of dragging on until a project dies.
Supporters. The people you would expect: CalChamber, the California Building Industry Association, the California Association of Realtors, the California Hospital Association, the California Housing Consortium, and GrowSF. Edison International has put in $2 million, and homebuilders like Lennar and KB Home have chipped in hundreds of thousands more, which tells you who expects to be doing the building. The San Diego Union-Tribune calls it a “rare victory for common sense.”
The case against Prop 45. Opponents say Prop 45 isn’t just a speed-up. It changes what environmental review looks at and what courts can do about it. Today the agency comes up with a range of alternatives for a developer to consider. Under Prop 45, the developer supplies one alternative. Public comment periods get capped. And when a court finds the review broke the law, it can no longer stop the project while the problem gets fixed. Opponents also say the “essential project” label covers far more than housing and hospitals, and that communities already dealing with pollution would have less say over what gets built next to them. Finally, nothing in the measure requires developers or utilities to pass any savings on to the people paying the bills. And speed isn’t free: the LAO estimates that meeting the new deadlines will cost state and local governments tens of millions of dollars a year, partly covered by fees, with long-term savings uncertain.
Opponents. Sierra Club California, California Environmental Voters, the California Environmental Justice Alliance, Western Center on Law & Poverty, the State Building & Construction Trades Council, and the California Democratic Party. Yes, the Sierra Club and the Building Trades are on the same side. Write down where you were when it happened. From the official ballot argument: “Proposition 45 limits both the environmental review of major new development projects and the public’s right to be heard.”
My take. The most telling thing about Prop 45 is who’s sitting it out. SPUR and California YIMBY, two of the loudest voices for CEQA reform and big backers of the 2025 package, both declined to endorse it. When the YIMBYs won’t say yes to a building measure, pay attention. SPUR says Prop 45 “would make broader changes that conflict with SPUR’s vision for urban growth.” It could speed up good projects like housing near transit and zero-emission energy. It could just as easily speed up sprawl, highway expansions, and gas infrastructure, especially since land at the urban edge is cheaper.
That’s my problem with it too. The infill housing we actually need already got its exemption in 2025. What’s left for Prop 45 to fast-track is ugly subdivisions on the fringe and the roads to serve them. Freeways qualify as “essential,” by the way. High-speed rail is specifically excluded, which I guess makes sense, since nothing about high-speed rail in California has ever been fast.
There’s a real case for faster permitting on transmission lines and solar farms, and I’d like to see it made. That’s a job for targeted legislation, which Sacramento is already doing. It shouldn’t be done through an initiative that takes a two-thirds vote to fix when something goes wrong.
Vote no. And will somebody please build something on that parking lot.
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