2020 Proposition 23: Kidney Dialysis Clinic Rules Revisited

I'm hoping to give readers an early glimpse of what to expect with the dozen proposals on the November statewide ballot. 

Later on in the season I’ll post more materials on the higher profile measures under consideration.

As has been true with elections since 2012, I’ll endeavor to research and post about as many propositions and local elections as I can. I have no schedule, other than to say it will be done when it’s done.

One thing we can know for sure, tons of money will be spent to support or oppose the various propositions. Where that money comes from is, to me, more important than what the messages being pushed are. I’ll get around to more specifics on funding as the election approaches.

Here’s where we are:

• Monday, July 13: Proposition 14, which asks Californians to continue to support stem cell research funding via bond sales.

• Tuesday, July 14: Proposition 15, which seeks to amend the property tax structure so commercial land isn’t taking advantage of a law passed with protecting elders from excessive increases. 

• Wednesday, July 15: Proposition 16, which seeks to undo the state’s ban on affirmative action.

• Thursday, July 16: Proposition 17, expanding voting rights to include parolees.

• Friday, July 17: Proposition 18, the right to vote for 17 year olds

• Monday, July 20: Proposition 19, Shuffling Tax Breaks & Making Realtors Happy

• Tuesday, July 21: Proposition 20, Do We Really Need to Send More People to Jail?

• Wednesday, July 22: Proposition 21, Rent Control All Over Again

• Thursday, July 23: Proposition 22, Rules of the Road for Uber, et.al.

Proposition 23: Authorizes State Regulation of Kidney Dialysis Clinics. Establishes Minimum Staffing and Other Requirements. Initiative Statute.

For: Kidney Patients Deserve Better - Sponsored by Service Employees International Union – United Healthcare Workers West.

Website | Facebook | Twitter | Text of Measure |

Against: Stop the Dangerous & Costly Dialysis Proposition -  Major funding from DaVita and Fresenius Medical Care.

Website | Facebook | Twitter | Endorsers |

Why: Attempts to reign in and regulate the operations of dialysis clinics come from the Service Employees International Union-United Healthcare Workers West, which has fought an uphill battle to organize employees in the field.

The two main players in the industry have already established a nearly $30 million war chest to defeat the measure, and potentially could quadruple that number. SEIU-UHW spent $5.9 million gathering signatures and preparing to do battle in the fall. 

The union maintains the ballot initiative campaign isn’t a bargaining chip, but an effort to improve care sparked by dialysis workers who came to the union with complaints about the state of the clinics where they worked.

The Rest of the Story: Yes, it’s time for #dialysispalooza2020!.

Who could forget 2018’s epic battle over Proposition 8, the most expensive ballot measure fight in American history, costing a total of $130 million? 

If you’re not part of that world, it’s easy to overlook the way kidney dialysis completely consumes the lives of 80,000 Californians. Three times a week these patients spend fours at a center getting their blood cleansed of waste products, a process their bodies can no longer perform.

High blood pressure and type-2 diabetes are the two leading causes of what’s called End Stage Kidney Disease.

There are more than 588 chronic dialysis clinics in California, averaging 22 dialysis stations, with each station providing treatment to one patient at a time. Nearly three quarters of those clinics are owned by two corporations, DaVita Inc, and Fresenius Medical Care.

2018’s Proposition 8 would have capped the profits for private operators. It was soundly defeated at the polls, thanks to a fear mongering campaign designed to make people think clinics would be closing if restricted to a 15% profit margin. 

In October, 2019, Gov. Newsom signed legislation limiting the amount of reimbursement dialysis clinics could receive from patients getting premium assistance from outside organizations. The bill was intended to temper rising costs by preventing dialysis clinics from steering patients to commercial insurance plans, which provide higher reimbursement rates than government programs. 

From MedCity News:

• Dialysis clinics and nonprofits have faced scrutiny over reimbursement in the past. A past lawsuit filed by UnitedHealthcare in 2016 accused American Renal Associates of fraudulent billing by pushing patients out of government health plans into private plans. The dialysis company later agreed to settle for $32 million.

• A recently unsealed whistleblower lawsuit alleged that the American Kidney Fund provided financial aid to patients of its two biggest donors, DaVita and Fresenius, while denying aid to patients at other clinics. The complaint was filed by a former employee in 2016. The Department of Justice decided not to pursue the case.

In January a federal judge issued a preliminary injunction against the new law. The lawsuit triggering the injunction is making its way slowly through the courts, in part due to the coronavirus pandemic.

So much for the argument that regulation of clinics should be handled by the legislature as opposed to the initiative process. 

This time around, Prop 23 seeks to require every clinic to have at least one physician present during all operating hours. Clinics would have to offer the same level of care to all patients, regardless of whether the treatment is paid for by private insurance or a government-funded program such as Medi-Cal or Medicare. More information about infections among their dialysis patients would have to be reported, and the state Department of Public Health would have a new role in agreeing to changes at a clinic or its closure.

The battle between these very profitable private clinic operators and the union has never been about pay; it’s stress from case overload and working conditions. 

Should Prop 23 pass muster at the ballot box, there is no guarantee that the union would be successful in organizing dialysis clinic workers. But, given the slim margin of error involved in the dialysis process, better staffed and supervised workers might save a few more lives. And that makes this initiative a good idea.

Voter Guide – You’ve Voted for President, what’s next?

I’ll be writing about many ballot measures and candidates between now and the end of September. That work will be condensed into an handy-dandy voter guide just in time for your mail-in ballots to arrive. I’m the guy who coordinated San Diego Free Press’s Voter Guides over the past decade, so this won’t be my first effort. Stay tuned.

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Email me at WritetoDougPorter@Gmail.com