Our recommendation on Prop. 29, SEIU’s latest move against California dialysis clinics

For the third time in four years, California voters are being asked to impose new requirements on dialysis clinics despite the fact that they are already highly regulated and by all available measures delivering competent care.

Voters resoundingly rejected nearly identical propositions in 2018 and 2020, and they should do the same this year. Proposition 29, the Dialysis Clinic Requirements Initiative, is not a significant improvement on the earlier attempts. Just like the previous measures, it’s a proposed solution in search of a problem.

About 80,000 Californians with kidney failure must receive regular dialysis treatments to clean their blood of toxins. The treatments generally occur three times a week and take about four hours to complete each time, putting a patient’s blood through a mechanized filtering process before returning it to the body. Just one missed session may put a patient’s life at risk.

Most treatments occur at one of the state’s 650 licensed dialysis centers. Nearly 75% are owned or operated by one of two companies, DaVita Inc. and Fresenius Medical Care.

The organization behind Proposition 29 and its predecessors is a union, Service Employees International Union-United Healthcare Workers West, that represents 100,000 health care workers and wants to add the dialysis workforce to its ranks.

What 29 would do

The chief requirement of Prop. 29, much like Prop. 23 (2020) and Prop. 8 (2018) before it, is that clinics keep a doctor, nurse practitioner or physician’s assistant on site during operating hours. The union argues that dialysis patients can’t be assured of the best care in an emergency without such expertise on hand.

The measure would further require clinics to:

▪ report dialysis-related infections to the California Department of Public Health;

▪ give patients a list of physicians with at least a 5% ownership interest in them;

▪ provide the state with a list of people with at least a 5% ownership interest;

▪ obtain the state’s written consent before closing or substantially reducing services;

▪ and refrain from denying treatment for financial reasons.

Opponents view

A consortium of opponents of the proposition, including the California Medical Association, convincingly rebuts all those points.

Clinics are already required to have a doctor specializing in kidney disease on staff. While those doctors are not on the floors of clinics at all times, dialysis patients tend to see their own doctors while receiving treatment at clinics.

The main clinic staff members are nurses and technicians. Most clinics provide treatment in one large room, fostering close connections among patients and staff. Should an emergency develop, first aid is delivered and emergency personnel are called to get the affected patient to a hospital.

Initiative opponents note that clinics include data on infections, hospitalizations and deaths in quarterly reports to federal authorities and that they already report ownership details to the state.

It is already illegal to deny care for financial reasons, and more than 90% of dialysis patients are on Medicare or Medicaid, making that provision of the measure unnecessary.

As for the requirement that clinics obtain state consent before closing or reducing services, opponents argue it would amount to an unconstitutional “taking” of property that would be unlikely to hold up in court.

Voters should say no

Proposition 29 would significantly raise operating costs for clinics by requiring them to hire more doctors, physician assistants or nurse practitioners. California’s Legislative Analyst’s Office estimates that each clinic would have to spend hundreds of thousands of dollars more each year as a result. The statewide cost would be between $229 million and $445 million a year, opponents say.

Some clinic operators, particularly those run by nonprofit providers, might reduce hours or close entirely. Patients would be left scrambling to secure life-sustaining treatment, which could be a particular challenge in rural areas and for patients with limited mobility.

Instead of threatening clinics, frightening patients and harassing voters, SEIU should try to organize workers the old-fashioned way: by meeting with them and making the case for membership.

Misusing the initiative process to advance unionization by other means, let alone to propose detailed policy on specialized health care for a small number of vulnerable Californians, is nonsensical and irresponsible. Californians should defeat Proposition 29 as decisively as they did its predecessors.

This story was originally published September 16, 2022 at 5:30 AM.