Proposition 35, the Medi-Cal funding measure on the Nov. 5 ballot, presents another example of special-interest, ballot-box budgeting that limits the discretion of lawmakers and reduces flexibility to respond to fiscal crises.

Voters should reject it.

Medi-Cal provides health services to over 15 million low-income Californians. Prop. 35 is a well-meaning but misguided effort to try to provide more and steady funding for Medi-Cal and potentially improve reimbursement rates for medical providers. Prop. 35 would change the temporary tax that helps fund Medi-Cal to a permanent tax on Managed Care Organizations (MCOs) and require the tax proceeds to be used to support only Medi-Cal and other health programs – making that money unavailable for other priorities and making it difficult to respond to future changes to Medi-Cal that might be mandated by the federal government.

California voters should not lock in funding allocations that favor doctors and hospitals over children and community health workers. Nor should they keep tying the hands of lawmakers who must already contend with, for example, voter mandates for school funding, which must receive about 40% of the state budget; not to mention budget deficits.

At issue with Proposition 35 is a tax on health plans that provides $7.5 billion of the $161 billion needed to annually fund Medi-Cal — the federal-state health program for low-income people.

The tax is based on the number of people to whom the health plans provide coverage. The state leverages the tax money for matching funds from the federal government.

Medi-Cal, in turn, reimburses the health plans for almost all the tax, with the federal government covering the majority of the cost. In other words, it’s a tax that’s not really a tax but rather a way to pull in more federal money.

Proposition 35 is being sold as a measure that would secure that funding by permanently extending the tax on health plans. But this lock-in isn’t needed. State lawmakers, understanding how the tax leverages federal dollars, have generally renewed it for nearly two decades and are incentivized keep doing so.

Meanwhile, Prop. 35 would not only make the tax permanent, it would also dictate allocation of the spoils. Not surprisingly, the winners include doctors, hospitals and emergency ambulance providers, which explains why they are major financial backers of the measure.

Their funding would be protected and, in some cases, increased under Prop. 35.

Among the possible losers are community health workers, private nurses and children under age 5, who are currently protected from losing their Medi-Cal coverage.

To provide the additional funding for the winners under Prop. 35 and still preserve other Medi-Cal programs, the state would need to tap the general fund for another $1 billion to $2 billion annually in 2025 and 2026, according to the Legislative Analyst’s Office.

The League of Women Voters of California opposes Prop. 35, stating the organization is “’opposed to ‘ballot-box budgeting,’ which limits the legislature’s flexibility to make budgetary decisions and adjust priorities based on emerging and essential needs. Budgetary decisions should be made by the legislature, not by earmarking funds through ballot initiatives.”

Proposition 35, 43 pages long, “hamstrings our ability to have the kind of flexibility that’s required at the moment we’re living in,” says Gov. Gavin Newsom.

More funding for health care for the poor is a laudable goal. So are attempts to raise rates for doctors and other health care providers who serve Medi-Cal patients. Indeed, there are legitimate concerns about Medi-Cal patients not being able to find providers because doctors don’t want to take them on at low payment rates.

But the allocation of limited general fund money should be made when all the competing demands are weighed by state lawmakers.

We shouldn’t be locking it in with a ballot measure. Vote No on Proposition 35.