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Proposition 52 – State Fees on Hospitals

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Official Title:

State Fees on Hospitals. Federal Medi-Cal Matching Funds. Initiative Statutory and Constitutional Amendment (Read How is the California Constitution Amended?)


The federal government established the Medicaid program to help pay for health care services provided to low-income patients, including the elderly, persons with disabilities, and children.  In California this program is called Medi-Cal. In order for any state to receive federal Medicaid funds, the State has to contribute a matching amount of its own money.

In 2009, a new program, authorized by federal law, was created with the full support of hospitals.  It called for California hospitals to begin paying a fee to help the State obtain available federal Medicaid funds, at no cost to California taxpayers.  This program has helped pay for health care for low-income children and resulted in California hospitals receiving approximately $2 billion per year in additional federal money to help hospitals to meet the needs of Medi-Cal and uninsured patients.

If Proposition 52 is approved by the state's voters, it will add language to the California Constitution to require voter approval of changes to the hospital fee program to ensure that California uses these funds for the intended purpose of supporting hospital care to Medi-Cal patients and to help pay for healthcare for low-income children.

The initiative was originally introduced as the "the Medi-Cal Funding and Accountability Act of 2014" in July 2013 by the California Hospital Association.  The measure was approved for circulation on December 3, 2013, as an initiated state statute and initiated constitutional amendment but it did not qualify for the 2014 ballot.

Fiscal Impact:

According to the Legislative Analyst Office (LAO), Proposition 52 would result in state savings from increased revenues that offset state costs for children's health coverage of around $500 million beginning in 2016-17 (half-year savings) to over $1 billion annually by 2019-20, likely growing between five percent to 10 percent annually thereafter.   The proposition would also result in increased revenues to support state and local public hospitals of around $90 million beginning in 2016-17 (half-year) to $250 million annually by 2019-20, likely growing between 5 percent to 10 percent annually thereafter.  The hospital industry received in 2015-16 a net benefit of $3.5 billion as a result of the fee because the hospitals received $8.1 billion in payments and paid $4.6 billion in fees.

CCC Position:

No position


Supporters of Proposition 52 include the California Hospital Association, the Alliance of Catholic Health Care, the California Democratic Party, the California Republican Party, and numerous health care, business, and labor, and community organizations.

Supporters state that the Medi-Cal hospital fee program was initially enacted as a bi-partisan program by the Legislature in 2009.  It has been renewed three times, but each time there has been attempts to divert the money to some other use.  Proposition 52 has been placed on the ballot by California’s over 400 local community hospitals in order to ensure that California continues to receive its fair share of federal matching funds for Medi-Cal – money which helps provide health care services for California’s most vulnerable citizens.  Proposition 52 also prohibits the Legislature from using these funds for any other purpose without a vote of the people. 


Opponents of Proposition 52 include individual health care workers. 

They assert that Proposition 52 takes resources from patients and communities and siphons it into the pockets of rich special interests and hospital CEOs with no oversight, no accountability, and no guarantee that it is spent on health care.  Opponents believe that this proposition will hurt low-income women, children, and seniors. 

Reflections on Church Teaching:

“Participation can be achieved in all the different relationships between the citizen and institutions: to this end, particular attention must be given to the historical and social contexts in which such participation can truly be brought about. The overcoming of cultural, juridical and social obstacles that often constitutes real barriers to the shared participation of citizens in the destiny of their communities' calls for work in the areas of information and education[409]. In this regard, all those attitudes that encourage in citizens an inadequate or incorrect practice of participation or that cause widespread disaffection with everything connected with the sphere of social and political life are a source of concern and deserve careful consideration. For example, one thinks of attempts by certain citizens to “make deals” with institutions in order to obtain more advantageous conditions for themselves, as though these institutions were at the service of their selfish needs; or of the practice of citizens to limit their participation to the electoral process, in many cases reaching the point where they even abstain from voting.”  Compendium of the Social Doctrine of the Church [191]

"We must speak of man's rights. Man has the right to live. He has the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services." Pacem in Terris, St. John Paul II

"Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good.  Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance."  Catechism of the Catholic Church, no. 2288.

The topic chosen by you this year "Caritas in Veritate -- For Equitable and Human Health Care," is of particular interest for the Christian community, in which the care of the human being is central, because of his transcendent dignity and inalienable rights. Health is a precious good for the person and society to promote, conserve and protect, dedicating the means, resources and energies necessary so that more persons can enjoy it. Unfortunately, the problem still remains today of many populations of the world that do not have access to the necessary resources to satisfy fundamental needs, particularly in regard to health. It is necessary to work with greater commitment at all levels so that the right to health is rendered effective, favoring access to primary health care. In our time we witness on one hand a care of health that risks being transformed into pharmacological consumerism, medical and surgical, becoming almost a cult of the body, and on the other, the difficulty of millions of persons to accede to conditions of minimal subsistence and indispensable medicines to be cured. - Pope Benedict sent to the 25th International Conference of the Pontifical Council for Health Care in 2010

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