California Proposition 4, Children's Hospital Bonds Initiative (2018)
- ️Wed Jan 31 2018
Proposition 4 authorized $1.5 billion in general obligation bonds to provide for the Children's Hospital Bond Act Fund. The fund was used to award grants to children's hospitals for construction, expansion, renovation, and equipment projects.[1] The initiative allocated the $1.5 billion in bond funds as follows:
The state's legislative analyst estimated that interest on the bond would be $1.4 billion over 35 years, bringing the total cost of the bond to $2.9 billion.[2]
The 2018 ballot initiative was the third bond measure related to children's hospitals in California. California Children's Hospital Association developed all three of the ballot initiatives. In 2004, 58.26 percent of electors voted to pass Proposition 61, a $750-million bond measure for children's hospitals. In 2008, 55.26 percent of electors voted to pass California Proposition 3, a $980-million bond measure for children's hospitals. The California Children's Hospital Association developed both of the ballot initiatives.
Voters of California cast ballots on 40 bond issues, totaling $158.829 billion in value, from January 1, 1993, through June 5, 2018. Voters approved 32 (80.00 percent) of the bond measures—a total of $147.409 billion. As of September 1, 2018, California had $74.2 billion in debt from general obligation bonds. The state also had $32.7 billion in unissued bonds.[3]
The California Children's Hospital Association's Yes on Children's Hospital, a ballot measure committee, had raised $11.47 million to support the ballot initiative. About 95 percent of the contributions were from eight children's hospitals that would receive bond revenue from the measure. No PACs formed to oppose Proposition 4.[4]
SECTION 1. Part 6.3 (commencing with
Section 1179.81) is added to Division 1 of the
Health and Safety Code, to read:
PART 6.3. CHILDREN’S HOSPITAL BOND ACT OF 2018
Chapter 1. General Provisions
1179.81. (a) This part shall be known, and may be cited, as the Children’s Hospital Bond Act of 2018.
(b) California’s network of regional children’s hospitals provide vital health care services to children facing life-threatening illness or injury. Over one million times each year, children are cared for at these hospitals without regard to their family’s ability to pay.
(c) Children’s hospitals also provide specialized treatment and care that has increased the survival of children suffering from serious diseases and illnesses such as childhood leukemia, cancer, heart defects, diabetes, sickle cell anemia, and cystic fibrosis.
(d) Children’s hospitals also provide essential training for pediatricians, pediatric specialists and others who treat children, and they conduct critically important medical research that benefits all of California’s children.
(e) However, the burden of providing uncompensated care and the increasing costs of health care seriously impair our children’s hospitals’ ability to modernize and expand their facilities and to purchase the latest medical technologies and special medical equipment necessary to take care of sick children.
(f) Therefore, the people desire to provide a steady and ready source of funds for capital improvement programs for children’s hospitals to improve the health, welfare, and safety of California’s children.
1179.82. As used in this part, the following terms have the following meanings:
(a) “Authority” means the California Health Facilities Financing Authority established pursuant to Section 15431 of the Government Code.
(b) “Children’s hospital” means either of the following:
(1) A University of California general acute care hospital described below:
(A) University of California, Davis Children’s Hospital.
(B) Mattel Children’s Hospital at University of California, Los Angeles.
(C) University Children’s Hospital at University of California, Irvine.
(D) University of California, San Francisco Children’s Hospital.
(E) University of California, San Diego Children’s Hospital.
(2) A general acute care hospital that is, or is an operating entity of, a California nonprofit corporation that received a grant or grants pursuant to Part 6 (commencing with Section 1179.10) or Part 6.1 (commencing with Section 1179.50) that provides comprehensive pediatric services to a high volume of children eligible for governmental programs and to children with special health care needs eligible for the California Children’s Services Program.
(c) “Committee” means the Children’s Hospital Bond Act Finance Committee created pursuant to Section 1179.91.
(d) “Fund” means the Children’s Hospital Bond Act Fund created pursuant to Section 1179.83.
(e) “Grant” means the distribution of money in the fund by the authority to children’s hospitals for projects pursuant to this part or to an eligible hospital pursuant to this part.
(f) “Program” means the Children’s Hospital Program established pursuant to this part.
(g) “Project” means constructing, expanding, remodeling, renovating, furnishing, equipping, financing, or refinancing of a children’s hospital to be financed or refinanced with funds provided in whole or in part pursuant to this part. “Project” may include reimbursement for the costs of constructing, expanding, remodeling, renovating, furnishing, equipping, financing, or refinancing of a children’s hospital where these costs are incurred after January 1, 2018. “Project” may include any combination of one or more of the foregoing undertaken jointly by two or more participating children’s hospitals that qualify under this part.
Chapter 2. The Children’s Hospital Program
1179.83. The proceeds of bonds issued and sold pursuant to this part shall be deposited in the Children’s Hospital Bond Act Fund, which is hereby created.
1179.84. The purpose of the Children’s Hospital Program is to improve the health and welfare of California’s critically ill children by providing a stable and ready source of funds for capital improvement projects for children’s hospitals. The program provided for in this part is in the public interest, serves a public purpose, and will promote the health, welfare, and safety of the citizens of the state.
1179.85. The authority is authorized to award grants to any children’s hospital for purposes of funding projects, as defined in subdivision (g) of Section 1179.82, or to a hospital pursuant to subdivision (c) of Section 1179.86.
1179.86. (a) Eighteen percent of the total funds available for grants pursuant to this part shall be awarded to children’s hospitals as defined in paragraph (1) of subdivision (b) of Section 1179.82.
(b) Seventy-two percent of the total funds available for grants pursuant to this part shall be awarded to children’s hospitals as defined in paragraph (2) of subdivision (b) of Section 1179.82.
(c) Ten percent of the total funds available for grants pursuant to this part shall be available for grants to hospitals that provide pediatric services to children eligible for the California Children’s Services Program that are either (1) a public hospital as defined in paragraph (25) of subdivision (a) of Section 14105.98 of the Welfare and Institutions Code, or (2) a general acute care hospital licensed pursuant to Section 1250 of this code that is, or is an operating entity of, a California nonprofit corporation. The funds shall be used solely for constructing, expanding, remodeling, renovating, furnishing, or equipping the pediatric program of an eligible hospital. A children’s hospital as defined in subdivision (b) of Section 1179.82 shall not be eligible for grants under this subdivision, except that any funds available under this subdivision that have not been exhausted by June 30, 2033, shall become available for an application from any such children’s hospital. The authority shall award grants under procedures it shall adopt to further the purposes of this subdivision.
1179.87. (a) The authority shall develop a written application for the awarding of grants under this part within 90 days of the adoption of this act. The authority shall award grants to eligible children’s hospitals, subject to the limitations of this part and to further the purposes of this part, based on the following factors:
(1) The grant will contribute toward expansion or improvement of health care access by children eligible for governmental health insurance programs and indigent, underserved, and uninsured children.
(2) The grant will contribute toward the improvement of child health care or pediatric patient outcomes.
(3) The children’s hospital provides uncompensated or undercompensated care to indigent or public pediatric patients.
(4) The children’s hospital provides services to vulnerable pediatric populations.
(5) The children’s hospital promotes pediatric teaching or research programs.
(6) Demonstration of project readiness and project feasibility.
(b) (1) An application for funds shall be submitted to the authority for approval as to its conformity with the requirements of this part.
(2) The authority shall process and award grants in a timely manner, not to exceed 60 days.
(c) A children’s hospital identified in paragraph
(1) of subdivision (b) of Section 1179.82 shall not apply for, and the authority shall not award to that children’s hospital, a grant that would cause the total amount of grants awarded to that children’s hospital to exceed one-fifth of the total funds available for grants to all children’s hospitals pursuant to subdivision (a) of Section 1179.86. Notwithstanding this grant limitation, any funds available under subdivision
(a) of Section 1179.86 that have not been exhausted by June 30, 2033, shall become available for an application from any children’s hospital identified in paragraph (1) of subdivision (b) of Section 1179.82.
(d) A children’s hospital identified in paragraph (2) of subdivision (b) of Section 1179.82 shall not apply for, and the authority shall not award to that children’s hospital, a grant that would cause the total amount of grants awarded to that children’s hospital to exceed one hundred thirty-five million dollars ($135,000,000) from funds available for grants to all children’s hospitals pursuant to subdivision (b) of Section 1179.86. Notwithstanding this grant limitation, any funds available under subdivision (b) of Section 1179.86 that have not been exhausted by June 30, 2033, shall become available for an application from any children’s hospital defined in paragraph (2) of subdivision (b) of Section 1179.82.
(e) In no event shall a grant to finance a project exceed the total cost of the project, as determined by the children’s hospital and approved by the authority.
(f) All projects that are awarded grants shall be completed within a reasonable period of time. If the authority determines that the children’s hospital has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant. A children’s hospital receiving a grant under this part shall submit certification of project completion to the authority.
(g) Grants shall only be available pursuant to this section if the authority determines that it has sufficient money available in the fund. Nothing in this section shall require the authority to award grants if the authority determines that it has insufficient moneys available in the fund to do so.
(h) The authority may annually determine the amount available for purposes of this part. Administrative costs for this program shall not exceed the actual costs or 1 percent, whichever is less.
1179.88. The California State Auditor may conduct periodic audits to ensure that bond proceeds are awarded in a timely fashion and in a manner consistent with the requirements of this part and that awardees of bond proceeds are using funds in compliance with applicable provisions of this part.
Chapter 3. Fiscal Provisions
1179.89. Bonds in the total amount of one billion five hundred million dollars ($1,500,000,000), not including the amount of any refunding bonds, may be issued and sold to provide a fund to be used for carrying out the purposes expressed in this part and to reimburse the General Obligation Bond Expense Revolving Fund pursuant to Section 16724.5 of the Government Code. The bonds, when sold, shall be and constitute a valid and binding obligation of the state, and the full faith and credit of the state is hereby pledged for the punctual payment of the principal of, and interest on, the bonds as the principal and interest become due and payable.
1179.90. The bonds authorized by this part shall be prepared, executed, issued, sold, paid, and redeemed as provided in the State General Obligation Bond Law (Chapter 4 (commencing with Section 16720) of Part 3 of Division 4 of Title 2 of the Government Code), and all provisions of that law apply to the bonds and to this part and are hereby incorporated in this part as though set forth in full in this part.
1179.91. (a) Solely for the purpose of authorizing the issuance and sale pursuant to the State General Obligation Bond Law (Chapter 4 (commencing with Section 16720) of Part 3 of Division 4 of Title 2 of the Government Code) of the bonds authorized by this part, the Children’s Hospital Bond Act Finance Committee is hereby created. For purposes of this part, the Children’s Hospital Bond Act Finance Committee is the “committee” as that term is used in the State General Obligation Bond Law. The committee consists of the Controller, the Director of Finance, and the Treasurer, or their designated representatives. The Treasurer shall serve as chairperson of the committee. A majority of the committee may act for the committee.
(b) The authority is designated the “board” for purposes of the State General Obligation Bond Law (Chapter 4 (commencing with Section 16720) of Part 3 of Division 4 of Title 2 of the Government Code), and shall administer the program pursuant to this part.
1179.92. The committee shall determine whether or not it is necessary or desirable to issue bonds authorized pursuant to this part in order to carry out the actions specified in Section 1179.84 and, if so, the amount of bonds to be issued and sold. Successive issues of bonds may be authorized and sold to carry out those actions progressively, and it is not necessary that all of the bonds be issued or sold at any one time.
1179.93. There shall be collected each year and in the same manner and at the same time as other state revenue is collected, in addition to the ordinary revenues of the state, a sum in an amount required to pay the principal of, and interest on, the bonds each year. It is the duty of all officers charged by law with any duty in regard to the collection of the revenue to do and perform each and every act that is necessary to collect that additional sum.
1179.94. Notwithstanding Section 13340 of the Government Code, there is hereby appropriated continuously from the General Fund in the State Treasury, for the purposes of this part, an amount that equals the total of the following:
(a) The sum annually necessary to pay the principal of, and interest on, bonds issued and sold pursuant to this part, as the principal and interest become due and payable.
(b) The sum necessary to carry out Section 1179.95, appropriated without regard to fiscal years.
1179.95. For the purposes of carrying out this part, the Director of Finance may authorize the withdrawal from the General Fund of an amount not to exceed the amount of the unsold bonds that have been authorized by the committee to be sold for the purpose of carrying out this part. Any amounts withdrawn shall be deposited in the fund. Any money made available under this section shall be returned to the General Fund from proceeds received from the sale of bonds for the purpose of carrying out this part.
1179.96. All money deposited in the fund that is derived from premium and accrued interest on bonds sold shall be reserved in the fund and shall be available for transfer to the General Fund as a credit to expenditures for bond interest.
1179.97. Pursuant to Chapter 4 (commencing with Section 16720) of Part 3 of Division 4 of Title 2 of the Government Code, the cost of bond issuance shall be paid out of the bond proceeds. These costs shall be shared proportionally by each children’s hospital funded through this bond act.
1179.98. The authority may request the Pooled Money Investment Board to make a loan from the Pooled Money Investment Account, including other authorized forms of interim financing that include, but are not limited to, commercial paper, in accordance with Section 16312 of the Government Code, for purposes of carrying out this part. The amount of the request shall not exceed the amount of the unsold bonds that the committee, by resolution, has authorized to be sold for the purpose of carrying out this part. The authority shall execute any documents required by the Pooled Money Investment Board to obtain and repay the loan. Any amounts loaned shall be deposited in the fund to be allocated by the board in accordance with this part.
1179.99. The bonds may be refunded in accordance with Article 6 (commencing with Section 16780) of Chapter 4 of Part 3 of Division 4 of Title 2 of the Government Code, which is a part of the State General Obligation Bond Law. Approval by the voters of the state for the issuance of the bonds described in this part includes the approval of the issuance of any bonds issued to refund any bonds originally issued under this part or any previously issued refunding bonds.
1179.100. Notwithstanding any other provision of this part, or of the State General Obligation Bond Law (Chapter 4 (commencing with Section 16720) of Part 3 of Division 4 of Title 2 of the Government Code), if the Treasurer sells bonds pursuant to this part that include a bond counsel opinion to the effect that the interest on the bonds is excluded from gross income for federal tax purposes, subject to designated conditions, the Treasurer may maintain separate accounts for the investment of bond proceeds and for the investment of earnings on those proceeds. The Treasurer may use or direct the use of those proceeds or earnings to pay any rebate, penalty, or other payment required under federal law or take any other action with respect to the investment and use of those bond proceeds required or desirable under federal law to maintain the tax-exempt status of those bonds and to obtain any other advantage under federal law on behalf of the funds of this state.
Chapter 4. General Provisions
1179.101. The people hereby find and declare that, inasmuch as the proceeds from the sale of bonds authorized by this part are not “proceeds of taxes” as that term is used in Article XIIIB of the California Constitution, the disbursement of these proceeds is not subject to the limitations imposed by that article.
1179.102. Notwithstanding any other provision of this part, the provisions of this part are severable. If any provision of this part or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.
James Stein, a pediatric surgeon, Maria Minon, chief medical officer of CHOC Children's, and Roberto Gugig, a pediatric gastroenterologist, wrote the official argument found in the state voter information guide in support of Proposition 4:[7]
Gary Wesley wrote the official argument found in the state voter information guide in opposition to Proposition 4:[7]
There was one ballot measure committee registered in support of the measure—Yes on Children's Hospital, Sponsored by California Children's Hospital Association. The committee had received $11.47 million, with 95 percent of funds coming from eight children's hospitals. The committee had spent $11.52 million.[4]
The following table includes contributions and expenditure totals for the committee in support of the initiative:[4]
The following were the top eight donors who contributed to the support committee:[4]
In California, ballot measure committees filed a total of five campaign finance reports in 2018. The filing dates for reports were as follows:[13]
To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.
The ballot measure made eight private nonprofit children's hospitals and five University of California children's hospitals eligible for bond revenue. The measure set aside 72 percent of the revenue for private nonprofit children's hospitals, 18 percent for UC-system children's hospitals, and 10 percent for other public and private hospitals that treat children eligible for the California Children’s Services (CCS) Program.[1] The following hospitals were nade eligible for bond revenue:
As of 2018, voters in California had approved two ballot initiatives to issue bonds for children's hospitals. In 2004, 58.26 percent of electors voted to pass Proposition 61, a $750-million bond measure for children's hospitals. In 2008, 55.26 percent of electors voted to pass California Proposition 3, a $980-million bond measure for children's hospitals. The California Children's Hospital Association developed both of the ballot initiatives.
Voters of California cast ballots on 40 bond issues, totaling $158.829 billion in value, from January 1, 1993, through June 5, 2018. Voters approved 32 (80.00 percent) of the bond measures—a total of $147.409 billion. Six of the measures were citizen's initiatives; four of six initiatives were approved. Thirty-four of the measures were legislative referrals; 26 of 34 legislative referrals were approved. The most common purposes of bond measures during the 25 years between 1993 and 2018 were water infrastructure and public education, for which there were seven bond measures each.
Click show to expand the bond revenue table.
As of September 1, 2018, California had $74.2 billion in debt from general obligation bonds. The state also had $32.7 billion in unissued bonds.[3]
In California, the number of signatures required for an initiated state statute is equal to 5 percent of the votes cast in the preceding gubernatorial election. Petitions are allowed to circulate for 180 days from the date the attorney general prepares the petition language. Signatures need to be certified at least 131 days before the general election. As the verification process can take multiple months, the secretary of state provides suggested deadlines for ballot initiatives.
Signatures are first filed with local election officials, who determine the total number of signatures submitted. If the total number is equal to at least 100 percent of the required signatures, then local election officials perform a random check of signatures submitted in their counties. If the random sample estimates that more than 110 percent of the required number of signatures are valid, the initiative is eligible for the ballot. If the random sample estimates that between 95 and 110 percent of the required number of signatures are valid, a full check of signatures is done to determine the total number of valid signatures. If less than 95 percent are estimated to be valid, the initiative does not make the ballot.
On November 9, 2017, Ann-Louise Kuhns submitted a letter requesting a title and summary for the initiative. The attorney general's office issued ballot language on January 16, 2018, allowing proponents to begin collecting signatures. Proponents of the initiative had until July 16, 2018, to file 365,880 valid signatures.[26]
In late April 2018, initiative proponents filed 643,221 signatures. Counties had until June 26, 2018, to conduct a random sample of signatures. On June 26, 2018, Secretary of State Alex Padilla said his office received more than the 365,880 required signatures, qualifying the measure for the ballot.[26]
Cost of signature collection:
Sponsors of the measure hired National Petition Management, INC. to collect signatures for the petition to qualify this measure for the ballot. A total of $2,645,311.84 was spent to collect the 365,880 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $7.23.
All polls in California are open from 7:00 a.m. to 8:00 p.m. Pacific Time. An individual who is in line at the time polls close must be allowed to vote.[27]
To vote in California, an individual must be a U.S. citizen and California resident. A voter must be at least 18 years of age on Election Day. Pre-registration is available at 16 years of age. Pre-registered voters are automatically registered to vote when they turn 18.[28]
California automatically registers eligible individuals to vote when they complete a driver's license, identification (ID) card, or change of address transaction through the Department of Motor Vehicles. Learn more by visiting this website.
California has implemented an online voter registration system. Residents can register to vote by visiting this website.
Californians must be registered to vote at least 15 days before Election Day. If the registration deadline has passed for an upcoming election, voters may visit a location designated by their county elections official during the 14 days prior to, and including Election Day to conditionally register to vote and vote a provisional ballot, which are counted once county election officials have completed the voter registration verification process. The state refers to this process as Same Day Voter Registration.[29][30]
To register to vote in California, you must be a resident of the state. State law does not specify a length of time for which you must have been a resident to be eligible.
California's constitution requires that voters be U.S. citizens. When registering to vote, proof of citizenship is not required. Individuals who become U.S. citizens less than 15 days before an election must bring proof of citizenship to their county elections office to register to vote in that election. An individual applying to register to vote must attest that they are a U.S. citizen under penalty of perjury.[29]
As of November 2024, two jurisdictions in California had authorized noncitizen residents to vote for local board of education positions through local ballot measures. Only one of those jurisdictions, San Francisco, had implemented that law. Noncitizens voting for board of education positions must register to vote using a separate application from the state voter registration application.[31]
All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment.[32] As of January 2025, six states — Alabama, Arizona, Georgia, Kansas, Louisiana, and New Hampshire — had passed laws requiring verification of citizenship at the time of voter registration. However, only two of those states' laws were in effect, in Arizona and New Hampshire. In three states — California, Maryland, and Vermont — at least one local jurisdiction allowed noncitizens to vote in some local elections as of November 2024. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.
The secretary of state's My Voter Status website allows residents to check their voter registration status online.
California does not require voters to present identification before casting a ballot in most cases. However, some voters may be asked to show a form of identification when voting if they are voting for the first time after registering to vote by mail and did not provide a driver license number, California identification number, or the last four digits of their social security number.[33][34] On September 29, 2024, Gov. Gavin Newsom (D) signed SB 1174 into law prohibiting any jurisdiction in the state from adopting a local law that requires voters to present ID before voting.[35]