California faces a real health care challenge. Federal cuts are putting new pressure on Medi-Cal, the public program millions of Californians depend on to get the health care they need.
We all agree: California needs to protect health care.
But Proposition 40 is not the answer, and will actually make our challenges much worse.
The measure imposes a one-time 5% tax on the assets of the wealthiest Californians. But patients don’t need health care once. They need it every year. Doctors, hospitals and community clinics also need predictable, stable funding every year.
Instead of offering a sustainable solution, Prop. 40 creates a funding cliff when the one-time money is gone. A study from Stanford University estimates when lost income tax revenue is accounted for, Prop. 40 would actually leave the state worse off by at least $25 billion.
This is not simply the argument of taxpayer or business groups. It is the conclusion of the doctors, hospitals, community clinics, reproductive health care providers and so many others who run California’s health care system and keep its safety net secure.
It should give everyone pause that the very groups proponents claim will benefit most – the California Medical Association, California Primary Care Association, California Hospital Association, Planned Parenthood Affiliates of California, California Children’s Hospital Association and other health care organizations — are all so strongly opposed.
Another major concern: The measure lacks the kind of guardrails Californians should expect when tens of billions of taxpayer dollars are pouring into Sacramento coffers.
In fact, Prop. 40 includes no guarantee that its funding will reduce costs for patients or improve the care they receive. That means health insurers and pharmaceutical companies could reap the biggest benefits, while our patients are left behind.
There is also a larger fiscal problem.
California already relies heavily on volatile revenues, particularly income tied to capital gains and high earners. A one-time wealth tax on a small number of taxpayers adds yet another layer of instability to that system. The state’s nonpartisan Legislative Analyst’s Office notes that the measure could reduce tax revenues by “hundreds of millions of dollars or more per year.”
This isn’t just speculation. Before the residency requirements under Prop. 40 kicked in at the start of 2026, half a dozen top innovators, investors and entrepreneurs departed the state, removing $536 billion — or nearly 30% of aggregate billionaire wealth — from California’s tax base. Economists project many more will follow.
This erosion of the state’s broader revenue base — and the investment, jobs and businesses that come with it — will rip a massive hole through our safety net. And the consequences won’t stop there. All of California’s priorities will be impacted, from public safety and infrastructure to schools and housing.
Our opposition to Prop. 40 is not an objection to asking wealthy Californians to pay their fair share. California can have a serious conversation about taxes and about protecting health care without pretending that a one-time windfall solves an ongoing problem.
The stakes are too high for that.
Patients, clinics, hospitals, care providers and doctors need reliable, predictable solutions that survive the next budget cycle, the next economic downturn and the next change in federal policy.
California should protect Medi-Cal. But protecting Medi-Cal means building a durable funding strategy with accountability, stability and a clear connection between public dollars and patient care.
Prop. 40 is built on promises it can’t deliver. We urge you to vote “no.”
Dr. René Bravo is president of the California Medical Association.