Californians have chosen to make permanent the hospital fee program that helps fund Medi-Cal, the state’s subsidized healthcare program for low-income residents.

Early election returns show the measure passing with more than 70% of the vote. Proposition 52 will hobble state lawmakers’ ability to change or end the hospital fee program.

Through the program, hospitals pay to generate a federal contribution to Medi-Cal that results in a net benefit to the hospitals. During the fiscal year that ended in June 2016, the program generated $4.4 billion in federal funding for Medi-Cal.

The Legislature first authorized the program in 2009. Now, changes to the program will require voter approval or a two-thirds majority vote by state lawmakers.

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