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What Is Proposition 23, The Dialysis Clinics Law?

LOS ANGELES, CA — California voters can be forgiven a sense of deja vu, having voted down a law governing dialysis clinics just two years ago. But the 2018 measure and this year’s Proposition 23 are fundamentally different.

Voters in 2018 rejected Prop 8, which sought to cap dialysis clinic profits. Proposition 23, focuses on patient safety and clinic oversight.

So what exactly would Prop 23 do?

It would require dialysis clinics to have a doctor or nurse practitioner onhand when patients are being treated, and it would require clinics to report patient infections to the state and federal government. It would also prohibit clinics from closing without state approval and prohibit them turning away patients because of their source of payment.

Opponents of the measure argue that these requirements are unnecessary and costly. Clinics would be forced to close down, and patients will lose access to the care they depend upon for survival. Supporters, which include the California Democratic Party and the Service Employees International Union-United Healthcare Workers West, argue that the measure is needed to ensure basic standards of care for 80,000 Californians who depend upon dialysis for survival. It is needed to ensure that patients in rural and low-income communities have the same access to quality dialysis care as any patient in the state, they argue.

“This initiative will make common-sense improvements to dialysis treatment that will protect some of the most medically vulnerable people in our society,” reads the official ballot argument in support of the measure. “Don’t listen when the dialysis industry claims the initiative will create huge new costs or say patients will be harmed or claim that it will create a shortage of doctors—those fake arguments are just designed to use patients and the coronavirus pandemic as scare tactics in their dishonest public relations campaign. The fact is, these corporations can easily make these changes and still make hundreds of millions of dollars a year without disrupting our healthcare system. Proposition 23 will make the changes we need to truly protect dialysis patients.”

Opponents of the measure, which include the state Republican Party, the California Medical Association, the California NAACP State Conference and the American Legion, Department of California, argue that this measure will hurt dialysis patients across the state.

“This useless bureaucratic mandate would increase clinic costs by hundreds of millions annually, putting half of all clinics at risk of closure,” reads the official ballot argument against the measure. “Prop. 23 dangerously reduces access to care, putting vulnerable dialysis patients at serious risk…Proposition 23 would take thousands of doctors away from hospitals and clinics—where they’re needed—and place them into bureaucratic jobs at dialysis clinics where they aren’t. This is not the time to make our physician shortage worse.”

Dialysis clinics have spent more than $85 million to defeat the measure, and the Yes on 23 campaign funded by the labor union has spent a little more than $6 million to pass the measure.

This article originally appeared on the Los

California voters weigh in again on care at dialysis clinics

SAN FRANCISCO (AP) — California voters will again weigh in on the quality of care dialysis clinics provide to about 80,000 people in the state with kidney failure.

Proposition 23 would require a doctor or highly trained nurse at each of the state’s 600 dialysis clinics whenever patients are being treated to improve patient care. It was placed on the ballot by unions that represent health care workers.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.

“There are a tremendous number of complications that can occur during and around dialysis, and a doctor onsite will be able to respond not only to emergencies such as cardiac arrest, bleeding, dangerous fluctuations in blood pressure — all other common side effects of dialysis — but they also will be able to oversee the overall quality of care,” said Steve Trossman, a spokesman for the Oakland-based Service Employees International Union-United Healthcare Workers West, which spent more than $6 million in a signature drive to get it on the ballot.

Proposition 23 is the second attempt by the union to increase regulations of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market. Early voting begins Monday for the Nov. 3 contest.

In 2018, the union-backed Proposition 8, which sought to cap dialysis clinics’ profits and force them to invest more of their profits in patient care. Voters rejected the measure but not before it became the most expensive initiative on the 2018 ballot, generating more than $130 million in campaign spending — more than $111 million from dialysis companies to kill the initiative and about $19 million from unions that supported it.

Dialysis providers say most California clinics already offer high-quality care and are regulated by federal and state authorities. They also point out all patients already have a nephrologist — a kidney specialist — who oversees their care and that nephrologists also direct each clinic in California. They say the initiatives are part of a tactic to pressure the dialysis companies to let workers unionize.

“The motive is to force the dialysis community to spend a bunch of money to defeat it because ultimately this is more about a union organizing battle. I have no doubt that in 2022 there will be another initiative on the ballot targeting dialysis providers and dialysis patients,” said Kathy Fairbanks, a spokeswoman for No on Prop. 23, a coalition led by DaVita and Fresenius that also includes the California Medical Association and American Nurses Association-California.

The nonpartisan Legislative Analyst’s Office estimates dialysis companies currently make roughly $3 billion a year from their California operations.

So far this year, the union has raised nearly $6.2 million backing it and the coalition against Proposition