CMA Position on November Ballot Initiatives By Clifford Wong, MD, ACCMA President Every election season brings a long list of ballot measures, some of which can have significant implications for our patients and California’s healthcare system. The California Medical Association (CMA) carefully reviews each statewide initiative and, when appropriate, takes positions to help physicians understand the potential implications. This November, CMA is opposing two healthcare-related ballot measures while supporting a third that offers a more sustainable, longterm approach to healthcare funding. CMA is opposing Proposition 44, the Clinic Funding Accountability and Transparency Act. The measure would require Federally Qualified Health Centers and other qualifying community health clinics to spend at least 90 percent of their annual expenditures on defined program services, with financial penalties for clinics that fail to meet the requirement. Transparency and accountability are important principles, and CMA supports ensuring that healthcare dollars are used effectively to serve patients. However, while intended to direct more resources toward patient care, the measure reduces the flexibility clinics have to tailor services to the unique needs of the communities they serve. In addition to providing direct medical care, many clinics also provide services that improve access to care, such as transportation for patients who have no reliable way to travel to medical appointments, particularly in California's rural communities. Clinics may also provide care coordination, patient navigation, language assistance, outreach, and other supportive services that help patients receive timely and appropriate care, but may not qualify as "program services" under the measure. By imposing a rigid 90 miec_2023_ACCMA_bulletin_backcover_small.pdf 1 9/18/23 4:24 PM percent spending requirement backed by financial penalties, Proposition 44 could limit clinics' ability to provide these essential services and adapt to the
changing needs of their patient population. CMA believes policy should strengthen the healthcare safety net by giving clinics the flexibility to deliver comprehensive, patient-centered care rather than imposing mandates that could inadvertently reduce access to care for the communities they serve. CMA is also opposing Proposition 40, the Billionaires Tax Act. Proposition 40 would impose a one-time tax of up to 5 percent on the net worth of certain billionaires to fund healthcare and other public programs. While the goal of increasing funding for healthcare is an important one, the measure raises significant implementation, administrative, legal, and constitutional questions. The Franchise Tax Board is not currently equipped to administer and enforce a tax requiring valuations of complex assets, and developing the systems, regulations, and expertise needed to implement the measure would likely take years. In addition, revenue estimates are highly uncertain, with the Legislative Analyst's Office projecting substantially different revenues than those projected
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Join the East Bay medical community on Friday, November 13th as we celebrate the 158th ACCMA Annual Meeting! All proceeds benefit the ACCMA Medical StudentScholarship Program, which provides essential financial support to local medical students. Gather with us at Bloc15 in Oakland at 6:00 PM for a cocktail reception We’re gearing up for the 2027 membership cycle—and want to make sure you’re ready to lock in your early bird discount! Invoices will be emailed in late September and early October. Early bird pricing ends November 30. To avoid delays, please take a moment to confirm your contact info is current. For more information, please use the QR code.
UNDERSTANDING & INFLUENCING HEALTH POLICY: ADVOCACY TRAINING FOR PHYSICIANS ACCMA’s Understanding and Influencing Health Policy: Advocacy Training for Physicians program equips physicians with the knowledge, skills, and confidence to effectively engage in health policy and advocacy. Through a series of sessions led by policy experts, elected officials, and physician leaders, participants gain practical insight into how healthcare policy is shaped— and how their voices can influence meaningful change. The series is designed to be practical, engaging, and immediately applicable to your professional role.
TRUMP EO TARGETING CHILDHOOD VACCINE SCHEDULE IS RECKLESS INTERVENTION INTO PUBLIC HEALTH POLICY
CMA is warning that a new executive order from President Donald Trump targeting the nation's childhood vaccine schedule is a "reckless intervention into established public health policy", says CMA President and pediatrician René Bravo, M.D., that could undermine confidence in vaccines and put children at risk. The order directs federal health agencies to review and potentially revise the vaccine schedule based on recommendations that would significantly reduce the number of vaccines routinely recommended for children. Vaccines affected could include those for hepatitis A, hepatitis B, rotavirus, influenza and certain forms of meningococcal disease.
CMA PUBLISHES 2026 MID-YEAR LEGISLATIVE UPDATE
Throughout the session, CMA successfully defeated or amended numerous measures that would have expanded scope of practice without appropriate safeguards and training, increased unnecessary administrative burdens, or undermined physician clinical judgment. CMA has also sponsored key legislation to implement commonsense prior authorization reforms, promote transparency around the use of AI-generated "deepfakes" in health care advertising, and modernize e-bike safety laws. The Mid-Year Legislative Update highlights these priorities and victories.
ACCMA LAUNCHES PRACTICE MANAGEMENT VIRTUAL SERIES
We are continuing our virtual ACCMA practice management series! Physicians, practice managers, and administrators are invited to join us the last Thursday of each month at 12:30 PM for discussions on the operational, financial, staffing, compliance, and patient service challenges facing today’s independent medical practices.
RESIDENT/FELLOW LEADERSHIP & CAREER DEVELOPMENT PROGRAM
ACCMA is hosting the Resident/Fellow Leadership & Career Development Program, a weekend intensive designed to help residents and fellows build leadership skills and prepare for the transition into practice. The program will take place August 29–30 and will include networking, interactive leadership and professional development sessions, career planning discussions, engagement with physician leaders, and more. Those interested in joining the first cohort should complete the interest form.
RESOURCES AVAILABLE FOR PHYSICIANS FACING IMMIGRATION RELATED CHALLENGES
Resources are available to support physicians and physicians in training facing immigration-related challenges. From direct advocacy with elected officials and assistance navigating DACA delays to connecting physicians with experienced immigration attorneys, CMA is helping physicians overcome immigration-related barriers so they can continue caring for patients. CMA's work is grounded in policy adopted by the House of Delegates last year, which opposes the deportation of
ACCMA & MIEC After Hours Event Summary – August 6th, Walnut Creek, Headlands Brewery
Nearly 50 physicians gathered at Headlands Brewing in Walnut Creek on August 6th for an evening of networking, education, and collaboration. Attendees enjoyed a pleasant summer happy hour while connecting with colleagues across the region.
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A group of coaches gathered at Fieldwork in San Leandro for an afternoon of connection and engaging coaching “shop talk.” The group enjoyed reconnecting with old friends, making new connections, learning about one another’s coaching practices, and exchanging ideas and experiences over great food and beer. Thank you to Dr. Sharon Chang for hosting this fun event!
health care workers and medically vulnerable patients based solely on their documentation status.
CMA WARNS 2026-27 STATE BUDGET WILL INCREASE HEALTH INSURANCE COSTS
California's 2026-27 budget and accompanying health budget trailer bill include a $1.5 billion tax increase that will be passed on to consumers through higher health insurance premiums. The increase could add as much as $400 annually to premiums for a family of four and comes as federal actions are already expected to result in significant coverage losses for Californians. At a time when Californians are already facing significant threats to health care access and affordability, CMA believes increasing health insurance premiums will create yet another barrier to coverage and care.
CMA-SPONSORED BILL TO REDUCE PRIOR AUTHORIZATION DELAYS ADVANCES
A CMA-sponsored bill to reduce unnecessary prior authorization delays and protect patients’ continuity of care cleared its first legislative hurdle. Assembly Bill (AB) 539 would ensure that once a health plan approves a prior authorization, it remains valid for the duration of a prescribed course of treatment, up to one year. AB 539 now heads to the Senate Appropriations Committee for consideration.
BILL PROTECTING PATIENTS FROM DEEPFAKE DOCTOR SCAMS ADVANCES IN LEGISLATURE
A CMA-sponsored bill to combat the alarming rise of “deepfake” doctor scams continues to gain momentum in the state legislature. Senate Bill 1146, authored by Sen. Lena Gonzalez, targets the dangerous use of artificial intelligence to alter or digitally replicate the likenesses of physicians and licensed medical professionals in advertisements. SB 1146 establishes essential guardrails to protect vulnerable populations from predatory marketing and pervasive health misinformation.
FEDERAL IDR RULE AIMS TO STREAMLINE NO SURPRISES ACT DISPUTE PROCESS
Federal regulators have finalized sweeping changes to the No Surprises Act's Federal Independent Dispute Resolution (IDR) process. Key changes include a dramatic reduction in administrative fees, expanded batching
For more information or to view full articles of any of these topics, scan the QR code or visit accma.org/bulletin.
flexibility, and new requirements intended to help physicians determine whether claims are eligible for the federal dispute process. While CMA welcomes many of the changes included in the final rule, additional action will be needed to address ongoing challenges with the implementation and enforcement of the No Surprises Act.
HEALTH CARE EXECUTIVE COMPENSATION MEASURE WITHDRAWN FROM NOVEMBER BALLOT
A CMA-opposed proposal that would have capped compensation for health care executives, including physician leaders, has been withdrawn from California's November ballot following a last-minute agreement, but CMA continues to oppose two other initiatives that qualified. Proposition 40 would impose a one-time wealth tax on certain billionaires. Proposition 44 would impose new spending restrictions on federally qualified health centers that would divert resources away from patient care, increase state health care spending and threaten access to care.
PHYSICIAN ORGANIZATIONS RALLY BEHIND MEDICARE PAYMENT REFORM BILL
The CMA has joined more than 100 physician organizations nationwide backing bipartisan federal legislation intended to stabilize Medicare physician payment and strengthen patient access to care. In a May 19 letter to Congress, the coalition urged lawmakers to support the Provider Reimbursement Stability Act (H.R. 8163). The legislation would make several reforms to the Medicare Physician Fee Schedule aimed at improving payment accuracy and reducing year-to-year volatility.
CMA’S MODEL MEDICAL STAFF BYLAWS UPDATED FOR 2026
CMA has released its 2026 Model Medical Staff Bylaws, a comprehensive, annotated resource to help medical staffs navigate governance, accreditation and legal requirements. The bylaws are available free to any medical staff with an active membership in CMA’s Organized Medical Staff Section (OMSS). The bylaws provide background information on critical provisions, including explanations of relevant state and federal laws, hospital accreditation standards, and other explanatory information.
ACCMA members gathered at Putters Goat Track Mini Golf in Walnut Creek in March to connect and discuss colorectal cancer screening, with a focus on the rise in young-onset cases. In a relaxed setting, attendees enjoyed snacks, drinks, and mini golf while raising awareness during Colorectal Cancer Awareness Month. Special thanks to Dr. Negar Salehomoum for bringing members together around this important topic. accma@accma.org | (510) 654-5383
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(continued from page 1) by the measure's proponents. It is also likely to face constitutional challenges, creating additional uncertainty regarding implementation and the timing and amount of any revenues collected. Because California's healthcare system depends on stable and predictable funding, CMA is concerned that Proposition 40 will not provide a reliable long-term funding source for critical healthcare programs. CMA has consistently supported responsible revenue measures, including Propositions 30, 55, and Proposition 3, because they provide a more stable and sustainable funding mechanism for California's healthcare system. Instead, CMA supports Proposition 3, which would permanently extend California's existing tax rates on the state's highest-income earners. Because these revenues are already part of the state's fiscal structure, Proposition 3 would provide a more predictable, longterm funding stream for healthcare, education, and other essential public services without relying on a one-time infusion of revenue. CMA believes this approach offers greater fiscal stability and better protects the programs our patients depend on. Reasonable people may reach different conclusions on these measures. CMA's positions are guided by a consistent principle: supporting policies that strengthen California's healthcare system, preserve access to care and provide stable, long-term investments in the health of our communities. I encourage you to learn more about these initiatives before casting your ballot this November.
UPCOMING EVENTS ACCMA LOCAL NEEDS ASSESSMENT ON ACCESS TO CARE THURS., AUGUST 27 | 6:30PM PRACTICE MANAGEMENT SERIES (LAST TH. OF THE MONTH) THURS., AUGUST 27 | 12:30 PM ACCMA EQUITY THROUGH DESIGN: A SYSTEMS CHANGE LEADERSHIP PROGRAM SATURDAY, SEPTEMBER 19TH | 9:00 AM UC BERKELEY – MLK BUILDING (VIRTUAL PROGRAM ON WEDNESDAY, SEPT 30. OCT. 14TH & OCT. 28TH) COCKTAILS & CONVERSATIONS THURS., OCTOBER 1ST | 6:00 – 8:00 PM BUFFALO BILL’S BREWERY, HAYWARD CMA HOUSE OF DELEGATES SATURDAY & SUNDAY, OCTOBER 17TH & 18TH SACRAMENTO ACCMA 158TH ANNUAL MEETING FRIDAY, NOVEMBER 13TH | 6:00 PM BLOC15, OAKLAND