Initiative

A judge in a Northern California county that has become a poster child for election skepticism has halted a voter-approved measure that would dramatically reshape elections there, including by eliminating most voting by mail and requiring ballots to be hand-counted.

Shasta County Superior Court Judge Benjamin L. Hanna on Friday issued a preliminary injunction that temporarily blocks Measure B, a citizens’ initiative approved by 56% of voters in the June primary.

None of the measure’s sweeping changes will be implemented for the November general election, and all active registered voters in Shasta County will receive ballots by mail, as mandated by state law, the county said in a statement.

California Atty. Gen. Rob Bonta and Secretary of State Shirley Weber, the state’s top elections official, sued Shasta County in mid-June, days after the primary, arguing that Measure B violates multiple state election laws and must be struck down before the November election.

The case initially was filed in California’s 3rd District Court of Appeal, but judges there declined to review it, saying the case first should proceed through the trial court.

In his ruling last week, Hanna wrote that he was halting implementation of Measure B while the case proceeds because allowing it to go into effect now “would likely result in the disenfranchisement of many Shasta County voters who would be clearly eligible to vote under state law, but would not meet the improperly narrow criteria to vote under Measure B.”

The measure, Hanna wrote, “seeks to create a whole new electoral system that would require creation of new voter rolls and re-registration of existing voters.” Doing so “would be “difficult under normal time frames, let alone three months before the November general election.”

Hanna cited the state’s “high likelihood” of success in the lawsuit.

Weber said in a statement that the judge’s decision “made clear what we already know — creating unnecessary barriers does not strengthen our democracy, it weakens it.”

The new public observation room at the Shasta County elections office.

(Jason Armond / Los Angeles Times)

The Shasta Election Task Force, the citizens’ group that wrote the initiative and collected thousands of signatures to get it on the ballot, said in a statement that Measure B “was enacted by the voters” and that they do not believe the state has established a lawful basis for blocking it “merely because Sacramento objects to the election reforms they adopted.”

The fight over election integrity in mostly-rural, deeply conservative Shasta County comes as President Trump — who remains fixated on his 2020 election loss — is calling for the federal government to “nationalize” state-run elections and fighting to restrict voting by mail.

Measure B gained popularity amid Trump’s baseless claims of cheating. California’s anticipated but painfully slow vote count after the June primary — largely the result of the labor-intensive process for tallying millions of mailed ballots — only fueled such claims. But it also prompted Gov. Gavin Newsom and Democratic state lawmakers this summer to allocate $40 million to help counties speed up the process.

The citizens’ initiative approved in Shasta County would limit voting by mail, the method used by an overwhelming majority of Californians, to only “the infirm, military, and U.S. citizens living overseas.”

Measure B would require elections to be held in person on a single day and create a separate county voter registration system disconnected from the state’s uniform system. It also would require residents to present government-issued photo identification to cast a ballot (as would a statewide ballot measure that voters will decide upon in November).

The measure drew steep opposition from numerous civil and voting rights organizations — including the ACLU, the League of Women Voters, Disability Rights California, the Asian Law Caucus, and Asian Americans Advancing Justice Southern California — who said it would disenfranchise voters.

One prominent supporter of Measure B told The Times in May that he expected the county to be sued if voters approved it.

“We don’t like the state laws,” said Richard Gallardo, a leader of Save Shasta Elections. “We want to enact our own local election reform. … There’s a lot in there, so, yes, we do expect the state to sue us.”

Gallardo, an election integrity activist who once tried, unsuccessfully, to place all of the county supervisors under citizen’s arrest during the COVID-19 pandemic, is among the “real parties in interest” named in the state’s lawsuit. He said he believed the onus was on the county to “fully and fervently” defend Measure B in court because it’s “the will of the voters.”

Richard Gallardo, a leader of the citizens’ group that wrote Shasta County’s Measure B, is blocked by a guard in November 2022 after attempting to go into a restricted area to observe ballots at the elections office in Redding. At right is then-assistant county registrar Joanna Francescut.

(Mel Melcon / Los Angeles Times)

In recent years, the election skepticism movement bolstered by Trump has found a strong foothold in Shasta County.

In 2023, the Shasta County Board of Supervisors, swept up in unfounded election fraud allegations promoted by the president, ditched Dominion voting machines and opted to hand-count ballots for the county’s more than 110,000 registered voters — quickly prompting a new state law that banned them from doing so.

Last year, the supervisors appointed Clint Curtis — a Florida-based attorney whose claims about rigged voting machines stretch back to the early 2000s — to be the Shasta County registrar of voters, a position vacated by two previous registrars who resigned for health reasons, saying they were exacerbated by the stress of the job.

Curtis promptly eliminated nine of the vast county’s 13 ballot drop boxes. He accused his predecessors in the registrar’s office, without evidence, of stuffing ballots to sabotage conservative Republicans. And he called for federal authorities to raid his office and seize ballots.

Curtis — a vocal proponent of hand-counting ballots who has worked with MyPillow Chief Executive and pro-Trump conspiracy theorist Mike Lindell — advocated for Measure B and is named as a defendant in the state’s lawsuit.

He was voted out of office in June and will be replaced in January by Joanna Francescut, the former longtime assistant registrar, whom he fired.

SACRAMENTO — As the architect of a one-time tax on California billionaires, Dave Regan says he’s pushing the measure to raise $100 billion to protect low-income patients, workers and hospitals from President Trump’s cuts to healthcare.

The behind-the-scenes negotiations with Gov. Gavin Newsom’s office in June to pull the measure off the ballot, however, revealed another possible goal, according to two sources familiar with the talks who requested anonymity to share details of the discussions with The Times.

Regan, the president of SEIU-United Healthcare Workers West, asked for union contracts with two hospitals in San Diego and Fresno and a clinic in Imperial County, among a list of sweeping demands to grow his union, in exchange for rescinding the measure, the sources said.

The union leader denied that he asked for concessions for his union in exchange for removing the billionaire tax from the ballot, calling the allegations “categorically false.”

“We are trying to solve a problem,” Regan said. “The problem is to prevent a catastrophe in California’s healthcare system. We put forward a proposal. Nobody else has offered a solution, and none of what you are referencing happened.”

The talks failed to result in a deal and the measure will appear as Proposition 40 on the November ballot, leaving California voters to decide pivotal tax policy that has roiled the Democratic Party and opponents worry could ultimately reduce revenue for the state budget.

The terms Regan allegedly laid out raise the question of whether he intended for the billionaire tax to go on the ballot, or if it was designed as a leverage play to expand his union, which represents more than 120,000 workers and is among the largest healthcare unions in the nation.

Regan, who has been elected to five consecutive terms as union president since 2011, has a record of launching ballot initiatives at the state and local level to use as leverage for union expansion and to thwart his political opponents.

His foes say that this year he went too far.

“It’s no secret in Sacramento that the ballot initiative has been used this way by UHW as a weapon,” said Francisco Silva, president of the California Primary Care Assn., which represents community clinics. “They’ve been very vocal about it and we think it’s a bigger risk to the safety net than any benefit that it brings.”

Known as a stubborn negotiator and a brash personality, Regan has filed multiple ballot initiatives against the healthcare industry.

His opponents say his strategy centers on launching initiatives that would hurt employers, which forces them to come to the table to negotiate. Regan’s union then requests union contracts or other concessions that could pave the way for a collective bargaining agreement. If employers resist, the initiative advances to the ballot. Voters consistently reject his measures, but companies still spend millions of dollars campaigning against them.

Over the years, Regan has proposed multiple measures that would have limited charges and executive salaries at hospitals and dropped the initiatives after landing temporary deals with the California Hospital Assn. that could help his union’s organizing efforts.

This year, UHW agreed to call off an initiative to again cap compensation for hospital leaders, and the hospital association rescinded its dueling proposal to require the union to seek approval from its members to spend more than $1 million on a statewide ballot measure campaign.

Regan led and lost measures against the dialysis industry in 2018, 2020 and 2022 as he struggled to force dialysis companies to recognize his union and negotiate a contract.

Silva accused Regan of using the same playbook in negotiations around another measure on the November ballot, Proposition 44, which would restrict spending at nonprofit community health clinics.

Regan drafted Proposition 44 to require that community clinics spend 90% of revenue on patient services, which he said ensures that money is aligned with the mission of the health centers. But Silva said the measure dramatically reduces funding for other essential services in the community care model, such as community outreach, education, overhead costs, technology and medical equipment investments, and programs that bring people living on the streets into the healthcare system.

About 70% of the patients community clinics serve are insured through Medi-Cal, and the rest are either on Medicare or uninsured, with a small portion on private insurance, Silva said. The measure would result in layoffs and clinics being forced to close, and ultimately reduce access to care for low-income Californians, he said.

“One of the things that stands out that really highlights the abuse of the ballot initiative process in this instance is that the substance of what’s on the ballot has nothing to do with what he wants to negotiate with us,” Silva said. “The request was to guarantee 25,000 workers, or else.”

Regan also denied that he asked the clinics to support his unionization efforts in exchange for dropping Proposition 44.

“We wanted to construct a relationship with the clinic association that prioritized appropriate funding of the community clinics in California, including restoring the healthcare cuts that were introduced by the ‘One Big [Beautiful] Bill,’” Regan said. “It was a strategic relationship where we’re working in a mutually cooperative way to properly fund the healthcare system to respect workers, and they were not interested in that.”

Regan’s opponents say his strategy runs afoul of the purpose of direct democracy and pushes the bounds of legality.

During negotiations on the billionaire tax, essentially put the onus on Newsom to force unrelated private hospitals and clinics to unionize their employees, the sources said.

Despite a desire to call off the tax measure, Newsom’s office couldn’t provide guarantees to satisfy Regan’s demands, according to those sources.

California legislators changed state law in 2014 to provide more flexibility around initiative negotiations and to allow proponents to pull measures off the ballot after they gather enough signatures and qualify for the election, said Mary-Beth Moylan, an associate professor of law at McGeorge School of Law.

State law also prohibits a proponent of an initiative from bargaining for money or a thing of value in exchange for abandoning their measure, which hasn’t been tested in court, she said.

“I think the intention behind the law allowing the ballot measures to be negotiated off was that the negotiation would be for the Legislature to do the thing that you’re bringing about in the measure,” Moylan said. “It is not to use it as leverage for obtaining something else.”

Regan’s wealth measure retroactively applies a one-time 5% tax on the net worth of billionaires who were residing in California as of Jan. 1, 2026.

He and advocates of his proposal cast it as a solution to the healthcare cuts from the Trump administration. It comes as the progressive message on wealth inequality has gained support in California and beyond.

“What’s remarkable about the situation is that everyone — the governor, the Legislature, the healthcare industry — everyone agrees that the ‘One Big Beautiful’ bill is going to result in 3.5 million people losing healthcare coverage, 150,000 frontline healthcare workers losing their jobs, community clinics and hospitals closing, and all of us who buy or receive our healthcare through job-based insurance are spending more on premiums, deductibles, and copays because the legislation defunded healthcare and in return gave yet another round of huge tax cuts to the wealthiest Americans,” Regan said. “That’s why we have put Proposition 40 forward.”

Newsom contends that Regan’s solution won’t work.

Instead of paying more California taxes, billionaires would simply pick up and move to another state with a lower tax rate before the start of the year, the governor warned. The state budget is dependent on income taxes the rich pay on stock market and similar profits.

A report from the Hoover Institution at Stanford University estimated that the tax would generate only $40 billion, not the $100 billion proponents claim, largely because of an expected exodus of billionaires. Overall, the tax would result in an estimated loss for the state of $24.7 billion, with the permanent decline in future income tax revenue due to billionaire migration eclipsing any gains from the one-time levy, according to the report.

Regan rejected the findings of the report and cast doubt on the amount of taxes that billionaires actually pay in California.

Newsom sought to negotiate with Regan to remove the billionaire tax from the ballot before the beginning of the year. At the time, Regan said he wanted an extra $20 billion for healthcare in 2027-28, which is beyond Newsom’s time in office and not something the outgoing governor could promise, according to two sources familiar with the negotiations.

Regan said he never asked for $20 billion in funding for healthcare to remove the billionaire tax from the ballot. He said he was open to hearing alternative solutions that never came.

“But did we ever make a proposal, or did we ever receive a proposal for something different?” Regan said. “The answer is no.”

In the spring, Newsom began working to form a coalition against the initiative that includes Planned Parenthood, doctors and firefighters while billionaires launched a series of counterproposals.

In an unusual split within labor, major unions such as the California Teachers Assn. and the State Building and Construction Trades Council oppose the measure. Teamsters California and AFSCME California joined Regan. The SEIU California State Council and California Federation of Labor Unions have yet to take positions.

Under California law, proponents had until June 25 to rescind measures that earned enough signatures to qualify for the ballot. Negotiations picked up again to remove the measure from the ballot shortly before the deadline. Two sources said Regan’s demands changed and allegedly had nothing to do with raising money to offset federal healthcare cuts.

Sources said Regan said he wanted union contracts with two private hospitals and a health clinic, an organizing neutrality agreement with healthcare clinics statewide, recognition of his union from dialysis clinics and for billionaires to remove measures they launched in response to his tax.

Newsom’s office said they couldn’t force private companies to do anything. The governor’s aides offered an alternative plan to dedicate around $7 billion over several years to healthcare funding in California, which didn’t move Regan.

“There were no negotiations,” Regan said about the billionaire tax.

Days before the deadline to pull the wealth tax measure from the ballot, UHW announced an offer to reduce the billionaire tax from 5% to 2% of net worth that the union said Newsom rejected. Sources said the compromise was first offered in a press release and did not reflect any serious negotiation.

Regan set a goal to add 25,000 new members by this year and has so far added around 8,000, according to the union’s website.

In exchange for removing the billionaire tax from the ballot, sources said one of Regan’s demands was for Newsom’s office to get involved with battles for union contracts at hospitals in Fresno and San Diego and a clinic in the Imperial Valley.

The union is tied up in labor disputes over recent attempts to unionize facilities in two of those places — Rady Children’s Hospital in San Diego and Innercare, a community clinic in El Centro.

The dialysis industry became a ballot target for Regan three election cycles in a row as he attempted to unionize its workers.

The battle is on pause after dialysis companies agreed to not oppose a $25 minimum wage increase for healthcare workers and UHW agreed to not target the industry in legislation or ballot measures through the end of this year, but the fight turned DaVita and Fresenius Medical Care into major political donors in state campaigns.

California’s billionaire class is also increasing its presence in state politics.

Billionaires pushed two measures on the November ballot that seek to neutralize the billionaire tax and block new taxes on personal property and assets and require audits of new programs funded with special taxes.

The billionaire tax has also become a national rallying cry for the political left, drawing the high-profile support of U.S. Sen. Bernie Sanders (I-Vt.) and others who are fed up with wealth inequality. Opponents of Proposition 40 have questioned whether any of the solutions Regan proposed would have been enough for him to remove the measure from the ballot and avoid the wrath of progressives who backed the tax.

Sacramento political observers say the unintended consequences of Regan’s tax measure are already reshaping California politics.

“When he did the billionaire tax, all these people who never engaged in politics finally woke up,” said Jim DeBoo, a Democratic consultant and former chief of staff to Newsom. “And they aren’t going away.”

The measure is causing a rift within the SEIU California State Council, an umbrella organization that represents more than 700,000 workers from all SEIU unions including UHW.

The billionaire tax only benefits healthcare. SEIU, which also represents workers in the public sector, nursing homes, child care and other service industries, has become a target of California’s wealthiest new political players despite most of its union members gaining nothing from the measure.

Billionaires and their companies, including Ripple co-founder Chris Larsen, venture capitalist Tim Draper, Google and Meta have spent nearly $30 million on a successful campaign to oppose SEIU-backed progressive candidates or boost moderate Democrats in legislative races. The same donors spent only $50,000 on independent expenditures in legislative races in the entire 2024 election cycle.

Shaudi Fulp, a political strategist working with Larsen and Draper, said a new governor and lawmakers present an opportunity to build fresh governing coalitions around issues that matter most to Californians.

“California is entering a unique moment of transition,” Fulp said.

The billionaires’ strategy is whittling away at SEIU’s influence in the state Legislature, where the state council has historically used its endorsements and army of volunteers to boost progressive candidates aligned with their cause. Moderates backed by billionaires beat nearly every SEIU-endorsed candidate in more than a dozen races in the June primary, with record spending knocking union candidates out of the top two in places such as Bakersfield and Orange County.

The SEIU California State Council declined to comment for this story.

The battle over the billionaire tax is also expected to become the most expensive ballot measure campaign of the election cycle, if not ever. The opposition is poised to exponentially outspend UHW.

“Look, the only thing that stands down a bully is when you punch him in the face,” said Brandon Castillo, a political consultant who has represented healthcare providers against UHW on more than a dozen initiatives. “You can’t sit back and continue to take punches or nothing will change.”

Staff writer Nicole Nixon contributed to this report.

SACRAMENTO — For all the media attention California’s proposed billionaire tax has generated nationally — with some blasting it as a foolish Left Coast assault on American enterprise — the November ballot item has actually triggered a rift among progressive labor unions and Democrats, groups critical to the measure’s success.

Championed by California’s largest health workers union, Proposition 40 would levy a one-time, 5% tax on California’s roughly 200 billionaires. The measure aims to backfill Medicaid cuts signed into law last year by President Donald Trump, and would raise an estimated $100 billion.

Dave Regan, the measure’s architect and president of Service Employees International Union-United Healthcare Workers West, said the tax was intended to prevent “the imminent collapse of California’s health care system because of the Trump cuts in the ‘One Big Beautiful Bill.’”

Regan, who has become well-known for using ballot measures as leverage in negotiations with state lawmakers and the healthcare industry, seemed poised to channel public anxiety over economic affordability, access to medical care and anti-Trump sentiment when the initiative was announced last fall.

Today however, the initiative not only faces heavy and well-funded opposition from those it aims to tax, but also divided support among groups who traditionally favor taxes on the wealthy — labor unions. Both the powerful California Teachers Association and the State Building and Construction Trades Council of California have come out against Prop. 40, while Teamsters California and AFSCME California support it. Others unions have yet to weigh in, including the California Federation of Labor Unions and SEIU California, a parent organization for Regan’s healthcare worker union.

Establishment Democrats are also divided. Gov. Gavin Newsom aggressively opposed the measure and sought to negotiate with Regan to remove it from the ballot beginning last year. Days before a state deadline to withdraw ballot measures in late June, Regan publicly offered to trim the wealth tax to 2% over two years, an offer Newsom quickly rejected.

To some close observers, the offer signaled that Regan may have been looking for a way out of an expensive ballot fight.

“I found it unusual that he did that because he’s usually not that kind of negotiating type — he’s no nonsense,” said Democratic political consultant Steven Maviglio. “I don’t know if he felt it was a hot potato or what.”

Regan’s union spent $31 million to gather 1.6 million voter signatures to put the tax on the ballot.

“At the outset, this may have looked like the replay of a strategy he’s employed successfully many times in the past, but he ended up painting himself into a corner, and so now he’s stuck with an initiative that he knows he probably can’t pass,” said Dan Schnur, a politics and communications professor at Pepperdine, USC and UC Berkeley.

A March poll by UC Berkeley’s Institute of Governmental Studies showed 52% of registered voters support the billionaire tax while 33% opposed it and 15% were undecided. However, campaign experts say its position remains precarious, due in part to the deep pockets of its opponents.

Several billionaires, including Google co-founder Sergey Brin, have so far pumped a combined $118 million into a campaign committee that gathered enough signatures to place two other measures on the ballot aimed at undercutting the billionaire tax.

Groups that might otherwise support more revenue for healthcare have also come out against Prop. 40, including Planned Parenthood Affiliates of California and the California Medical Assn.

“The dangerous wealth tax directly threatens vital funding for education and schools, healthcare and clinics, public safety, and infrastructure projects by making California’s revenue even more volatile,” leaders of the California Medical Association, California Primary Care Association and California School Boards Association wrote in a joint statement.

Regan and fellow supporters insist that, without approval of the tax measure, Trump’s “Big Beautiful Bill” will gut the state’s healthcare resources.

“This will take between $20 and $25 billion annually out of our healthcare system, meaning three and a half million people are going to lose insurance, 150,000 health care workers will be laid off and over 20 million consumers are already paying more in premiums, deductibles and copays,” he said.

While prominent progressives such as Sen. Bernie Sanders (I-Vt.) and Rep. Ro Khanna (D-Fremont) have voiced support for the measure, some progressive opponents say its near exclusive focus on healthcare is a problem. (Only a small portion of tax revenues would go toward education and food security.)

The CTA said after reviewing the measure, its council of delegates “determined that this policy will not provide the sustainable and long-lasting funding that our schools and communities deserve.” Leaders of the state’s largest teachers union plan to focus their efforts on passing Proposition 3, which would make permanent an existing tax on certain high earners to fund schools and community colleges.

Labor unions have typically aligned in support of tax-raising ballot measures, including earlier temporary versions of this year’s Prop. 3 and an unsuccessful 2020 proposal to revamp commercial property taxes.

But the billionaire tax “doesn’t benefit everybody. It benefits workers in the healthcare sector primarily, and I think that’s why not everybody’s on board. It’s not a ‘rising tide lifts all boats’ kind of proposal,” Maviglio said.

In the 15 years he has led SEIU-UHW, Regan has become known for using expensive ballot measures — or the threat of them — to bring lawmakers and industry opponents to the negotiating table.

In a landmark 2023 deal, Regan secured a statewide $25 wage floor for healthcare workers after qualifying initiatives to raise industry wages in Los Angeles and other cities. The deal included a 10-year moratorium on minimum wage propositions. He also pushed ballot measure regulations on kidney dialysis clinics for three subsequent election cycles. Though none of them passed, the dialysis industry spent hundreds of millions between 2018 and 2022 to defeat them.

“Everybody knows that he is wielding ballot measures as a weapon to leverage his unionization or political demands. It’s not a secret. He’s admitted it,” said Brandon Castillo, a ballot measure strategist who often finds himself opposite Regan in ballot fights including the dialysis clinic propositions.

The measure retroactively applies a tax on billionaires who were residing in California as of Jan. 1. Newsom and other opponents say the initiative would drive the ultra-wealthy out of the state and their departure would blow a hole in the state budget.

California’s budget is dependent on income taxes the rich pay on stock market profits. The Legislative Analyst’s Office said the measure would “likely” result in an “ongoing decrease in state income tax revenues of hundreds of millions of dollars or more per year.”

“You may not be able to pick up and move to Texas or Florida to shelter your income from taxation, but I promise you that billionaires can, and do,” Newsom wrote in a post on Substack in late June. “Wealth is movable, and it shops for the state with the lowest taxes.”

After the talks ultimately failed to result in a deal, Newsom endorsed the idea of a national wealth tax instead.

“It’s easy to see how they may have believed that Newsom’s strongest incentive was simply to stay out,” Schnur said. “There’s a huge potential downside for a Democratic governor [to weigh in] on either side of this initiative. If you oppose it, you’re alienating your base. If you support it, you’re putting your state in dire fiscal peril.”

Focusing on raising taxes at the federal level allows the governor to support a popular idea nationally, which he can campaign on if he runs for president. His opposition to the measure in California could still leave him vulnerable to criticism from progressives in a national Democratic primary.

Times staff writer Taryn Luna contributed to this report.

Pembina Pipeline (PBA) has signed a preliminary agreement with Canadian federal and provincial governments, alongside Trans Mountain, to participate in a major nation-building energy infrastructure initiative aimed at expanding global market access for Canadian crude oil.

The multi-stakeholder partnership aims

The looming impact of federal Medicaid cuts has reignited a long-simmering, costly battle between California’s medical industry and one of its largest health worker unions.

SEIU-United Healthcare Workers West, with about 120,000 members, has put forward two ballot initiatives to cap the pay of medical executives and require community clinics to spend the bulk of their revenues on patient care.

The California Hospital Assn. has responded with its own ballot proposal that would make it tougher for unions to spend money on political initiatives in the future. It would require approval by a union’s rank-and-file membership for any spending of $1 million or more on statewide measures, or $100,000 or more on local ones.

The competing measures, which have drawn enough verified signatures to qualify for the November ballot, come at a time when the rising cost of healthcare is emerging as a top voter concern.

The Service Employees International Union affiliate has seized upon affordability angst to resurrect a proposal for a cap on healthcare executive compensation, which it has failed to achieve multiple times before. The proposed measure garnered more than 1 million petition signatures.

“This initiative reflects the serious crisis we face and that affordability is a real thing,” said Vikas Saini, president of the Lown Institute, a Massachusetts-based healthcare think tank. “I think it also reflects grassroots anger and a desire to do something.”

Mikey Vaughn, a certified nursing assistant at Cedars-Sinai Medical Center, said the hospital often lacks supplies and staffing levels that he and his colleagues need in order to do their jobs effectively and without undue stress, despite its reputation as the go-to place for the rich and famous.

“The executive pay initiative would, I hope, be used to hire staff and to actually provide better resources for our patients,” he said. Vaughn is also a member of SEIU-UHW’s executive board and political committee.

Thomas Priselac, then-president and CEO of Cedars-Sinai Medical Center, made $8.8 million in fiscal year 2024, according to the organization’s most recent available federal tax filing. Kaiser Permanente’s CEO, Gregory Adams, made nearly $13 million in 2024. Warner Thomas, head of Sutter Health, made just under $12 million.

Cedars-Sinai spokesperson Duke Helfand said the hospital would be unable to recruit and retain physicians, nurses, and specialists if the measure passed, dramatically impairing its ability to provide healthcare.

“Such a scenario would be disastrous not only for Cedars-Sinai but for hospitals across Los Angeles and California,” Helfand said.

The union wants to cap compensation at $450,000 a year for senior hospital and medical group executives, as well as other administrative and managerial staff. However, the initiative does not stipulate how dollars diverted from payroll must be spent.

The union has dubbed the latest proposal the Health Care Executive Compensation Act of 2026. A coalition of medical industry heavyweights opposing it — hospitals, physicians, and clinics, among others — has rebranded it the Health Care Endangerment Act.

Carmela Coyle, CEO of the hospital association, called the measure a cynical political ploy.

“It’s bad policy and it’s going to have bad consequences across California,” she said.

Glenn Melnick, a healthcare economist at the University of Southern California, said even if the initiative were fully implemented and pay cuts enacted, he doubts it would reduce the cost of healthcare for patients.

SEIU-UHW does not have an estimated total amount the initiative would claw back from pay packages that exceed the limit.

Opponents of the initiative note that it doesn’t just target executive pay; it would affect medical practitioners who are also managers. That could include chief medical officers and chief nursing officers, as well as heads of surgery, emergency rooms, oncology, obstetrics, cardiology and other specialties, they say.

It would be up to each hospital, health system and physician group to report which staff members exceed the cap and by how much.

Ultimately, who is subject to the pay cap “probably will have to be battled out in court,” Coyle said . “That’s why we are throwing everything we can at it.”

The second SEIU-UHW ballot initiative, on community clinics, is already in court. The California Primary Care Assn., which represents clinics, filed a federal lawsuit in April seeking to invalidate it before it reaches the November ballot.

The proposed measure would require federally designated community clinics to spend at least 90% of their revenues on activities directly related to their mission of providing care for low-income populations. If it were to pass, more than 90% of those clinic organizations would be on the hook for penalties totaling $1.7 billion in the first year alone and “would face similarly crippling penalties every year,” according to a report commissioned by the primary care association and conducted by the Berkeley Research Group, an international consulting company.

Louise McCarthy, president and CEO of the Community Clinic Assn. of Los Angeles County, said many pivotal services the clinics provide — such as translation and transportation — would likely not be counted toward the spending requirement.

“They are targeting a group of what they see as employers and we see as the safety net,” she said.

The lawsuit cites the harm to clinics and claims the proposed spending requirement would interfere with federal authority.

Renée Saldaña, a spokesperson for SEIU-UHW, characterized the lawsuit against the initiative as “a really desperate attempt by the clinic industry to try and avoid accountability.”

SEIU-UHW, proud of its political activism, is also behind a controversial billionaire tax proposal that would impose a one-time 5% levy on California residents with fortunes over $1 billion to backfill the funding gap created by federal cuts coming down the pike under Republicans’ One Big Beautiful Bill Act. The law, passed last July and signed by President Trump, is projected to squeeze nearly $1 trillion from the Medicaid health coverage program for low-income people by 2034, including as much as $30 billion annually in California.

The hospital association, the community clinic group and the California Medical Assn., which represents physicians, are neutral on the wealth tax proposal thus far. But Saldaña said all three of the union’s ballot proposals tie into an overarching strategy to counter the widening healthcare disparities caused by the federal law.

“We believe the primary concern of healthcare providers, including executives, should be to serve the community, heal patients, and not be in healthcare just to enrich themselves,” she said on the proposed pay cap.

Over the years, the union has submitted dozens of local and statewide ballot initiatives, including ones to cap the pay of hospital executives, regulate dialysis clinics, and raise the minimum wage of healthcare workers.

The hospital association calculates that SEIU-UHW has spent nearly $125 million on local and statewide initiatives since 2012. But healthcare industry groups have spent far more opposing them. The hospital association data shows that the union spent nearly $36 million on three ballot proposals to regulate the dialysis industry, but dialysis companies poured in $302 million to defeat them, according to state campaign finance records.

The union’s ongoing political efforts “threaten patient access to quality health care,” according to the hospital association’s ballot initiative, which could limit how much unions spend on future ballot measures.

Saldaña hinted at a possible lawsuit should that measure pass, saying “we don’t see the legal viability” of it. The proposal, she said, is an attempt “to silence the front-line healthcare workers.”

Ultimately, a ballot initiative won’t cure the ills that plague healthcare in the United States, said the Lown Institute’s Saini. What’s needed, he said, is “an evaluation and reimagination of healthcare.”

Wolfson writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.