Proposition 29: Do dialysis clinics need more stringent regulation by the state?
California voters are being asked again whether dialysis clinics should be required to have a licensed medical professional on-site.
This marks the third time in four years that the union-backed measure has appeared on the November ballot. Voters rejected similar proposals in 2018 and 2020.
Proposition 29 seeks to regulate the for-profit dialysis clinic industry more stringently.
What does a ‘yes’ vote mean?
A “yes” for Prop. 29 would require clinics to have a physician, nurse practitioner or physician assistant on-site during all patient treatment hours. It would also mandate clinics to disclose the names of physicians with an ownership interest of more than 5%; to report dialysis-related infections to the California Department of Public Health, and to obtain written consent before closing a clinic or reducing patient services.
What does a ‘no’ vote mean?
A “no” would maintain the status quo, in which a medical professional is not required to be on-site during all patient treatment hours. Clinics are regulated by the California Department of Public Health, which licenses and certifies them on behalf of the federal government so that they can accept Medicare and Medi-Cal payments.
Who benefits?
The state’s estimated 80,000 dialysis patients, according to Service Employees International Union-United Healthcare Workers West, or SEIU-UHW, which has championed the measure since 2018. They are interested in organizing dialysis workers, but they contend that the issue larger than that.
The union says that the billion-dollar dialysis industry, which in California is heavily consolidated, has cut skilled medical staff and harmed patient health for bigger profits.
“These dialysis initiatives have really been about regulating an industry that has a duopoly, high profit rates and well-documented patient safety concerns,” Laurel Lucia, director of the Health Care program at the UC Berkeley Labor Center, said.
Supporters say the provision requiring dialysis corporations to get approval from the state before closing down clinics, will benefit patients in rural areas.
Who doesn’t?
The state’s estimated 80,000 dialysis patients, according to the two corporations that operate a majority of California’s clinics, DaVita and Fresenius Medical Care. They’ve led the opposition to Prop. 29, joined by the California Chamber of Commerce and the California Medical Association, among other groups.
They argue that patients’ lives will be at risk by forcing community dialysis clinics to shut down due to the increased costs of maintaining medical staff on-site.
Opponents contend that the measure is a tactic to force the industry to the bargaining table.
“What they should continue doing, and what everyone wants them to continue doing, is continue talking to employees, continue meeting them in parking lots, continue doing the visits, continue sending them letters, continue sending them texts,” said Kathy Fairbanks, spokeswoman for the No On 29 campaign. “But don’t put dialysis patients in harm’s way every two years with these ballot measures that won’t improve patient care.”
Follow the money
Both sides have spent a total of nearly $300 million over the course of all three ballot measure fights to regulate dialysis clinics.
The Yes On 29 political action committee has both raised and spent $7.9 million thus far, according to Ballotpedia, which draws its data from the California Secretary of State’s Office.
The major donor in support of Proposition 29 is SEIU-UHW.
The No On 29 PAC has raised in excess of $83.3 million, and spent $76.4 million.
The top donors in opposition, according to Ballotpedia, include DaVita, Fresenius Medical Care, U.S. Renal Care, Satellite Healthcare and Dialysis Clinic.
This story was originally published October 9, 2022 at 5:00 AM with the headline "Proposition 29: Do dialysis clinics need more stringent regulation by the state?."