CPCA + Open Door File Federal Lawsuit (N.D. Cal.) to Block SEIU-UHW 90% Mission-Spend Ballot — Federal Preemption Argument

California Primary Care Association (representing 2,300+ clinics) and Open Door Community Health Centers filed a federal lawsuit in the Northern District of California April 30, 2026, asking the court to preempt the SEIU-UHW 90% patient-care spending ballot initiative on grounds it conflicts with HRSA Section 330 grant requirements, federal nonprofit governance laws, and PPS reimbursement framework. Major escalation: CPCA shifting from political opposition (already-tracked AB 1113 coalition + CCALAC counter-ballot) to legal preemption strategy. The SEIU-UHW initiative now faces 4 simultaneous opposition tracks: counter-ballot (CalChamber Affordable California 1M signatures), legislative (AB 1113 industry-led oversight), legal (today's federal suit), and political messaging. Strategic implication: every CA FQHC executive should know whether their organization joined as a co-plaintiff or remained on the sidelines — that public posture will shape board, donor, and labor relations through November 2026.