**Proposition 44**, which would require nonprofit federally qualified health centers to spend at least 90 percent of annual revenue on program services advancing their charitable mission or face penalties, faces significant headwinds ahead of the November 3, 2026 ballot. Clinic associations and physician groups have mounted strong opposition, arguing the measure would trigger roughly $1.7 billion in first-year penalties, push most clinics into operating losses, and risk service reductions or closures for safety-net providers. A Public Policy Institute of California poll released in mid-September ranked it among the least popular of the 14 statewide measures. The SEIU-UHW union qualified the initiative through petition signatures after an earlier legislative effort stalled and a legal challenge from clinics was unsuccessful, yet the combination of provider resistance, transparency and spending concerns, and broader voter skepticism has produced trader consensus favoring rejection at 59.5 percent. Upcoming voter guide distribution and any late campaign spending could still shift sentiment before election day.