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Proposition 4 – Bond Funding for Children’s Hospitals

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General Election, November 06, 2018


There are currently eight private nonprofit hospitals in California, as well as the children’s program at the five University of California medical centers that are designated as “children’s hospitals.”  In addition, other hospitals in California that are not specifically identified as “children’s hospitals” have wings or centers that specialize in treating children.

A majority of funding for children’s hospitals comes from the federal-state Medicaid program, commercial health insurance coverage, other governmental health care programs, and private donations.  The California Children’s Services (CCS) Program is a state-local health care coverage program that pays for specialized treatment and other services for children with complex chronic health conditions, including many children treated at children’s hospitals.

Proposition 4 is sponsored by the California Children’s Hospital Association and would authorize the state to sell $1.5 billion in general obligation bonds for capital improvement projects at the 13 state children’s hospitals and other public or private nonprofit hospitals that treat children under the CCS program.  Of this total, $1.1 billion would be provided to the eight private nonprofit children’s hospitals.  Another $270 million would be provided to the five UC children’s hospitals.  The remaining $150 million would be made available to other public or private nonprofit hospitals that provide services to children through the CCS program.

Bond proceeds would be used for projects including the “construction, expansion, remodeling, renovation, furnishing, equipping, financing or refinancing of eligible hospitals in the state.”

On two previous occasions, California voters have authorized the state to issue general obligation bonds to pay for capital projects at children’s hospitals.  In 2004, Proposition 61 provided $750 million in bond funding.  In 2008, Proposition 3 provided $980 million in bond funding. Only the 13 hospitals specifically identified as children’s hospitals in state law are eligible to receive funds under these previous measures.  As of May 2018, most of the funding from the previous two measures had been committed to projects, with the remaining funds expected to be fully committed by the end of summer 2018.

A YES vote on Proposition 4 means the state could sell $1.5 billion in general obligation bonds for the construction, expansion, renovation, and equipping of certain hospitals that treat children.

A NO vote on Proposition 4 means the state could not sell such bonds.

Fiscal Impact:

According to the Legislative Analyst Office (LAO), Proposition 1 would result in increased state bond repayment costs averaging about $80 million annually over the next 35 years. 

CCC Position:

No position.

Reflections on Church Teaching:

We have to care in a special way for children and for grandparents. Children and young people are the future; they are our strength; they are what keep us moving forward. They are the ones in whom we put our hope. Grandparents are a family’s memory. (9/26/15, Prayer Vigil)

“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.”  Catechism of the Catholic Church, no. 2288

“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.

“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.”  Saint Pope John XXIII, Encyclical Letter Pacem in terris, 1963 (11).