Dialysis Reform Will Be On The California Ballot Yet Again. Does It Stand A Chance?

Once again, California’s largest healthcare workers union is campaigning for dialysis reform — but they face powerful opponents.

It’s deja-vu for the California political scene, where such a battle transpires repeatedly. This time around, SEIU-United Healthcare Workers West is advocating for a ballot initiative that would require a physician assistant, physician or nurse practitioner to monitor patient dialysis treatments.

The union pushed similar policies in 2018 and 2020, but both measures failed by significant margins. On Monday, Secretary of State Shirley Weber said that the 2022 measure had collected over 685,534 valid signatures, making it eligible for the November ballot.

“There’s just so much improvement that can be made, and there’s plenty of resources in the industry to make those improvements,” SEIU-UHW research director David Miller told the Bee. “That’s the tension: there’s enormous profitability, then you meet folks of enormous need, and you realize that some of that money should be diverted to patient care.”

Historically, these measures have faced opposition from organizations like the California Medical Association and giants in the dialysis industry. Now, a coalition that includes the state’s Dialysis Council, the California Taxpayer Protection Committee, the California Chamber of Commerce and many medical societies and associations are organizing to shut down the initiative.

Dialysis reform naysayers hold that forcing clinics to hire more physicians would cost too much. A fiscal report from the state estimates that the measure could raise health care costs for state and local governments “by low tens of millions of dollars annually.” The policy, according to the report, would boost clinics’ costs by by “several hundred thousand dollars” annually.

There are an estimated 80,000 dialysis patients in California. The industry says that the rising costs would end up shutting down clinics. Miller refuted this theory, and said the massive campaign against the proposition has generated misconceptions.

“Most of the misconceptions are generated by the spending against the measure, rather than a thoughtful debate about the policy itself,” he added.

In 2018, the union spearheaded Proposition 8, which would have increased staffing and worker pay by capping revenues clinics could keep. At the time, SEIU-UHW ran a campaign on emotional stories of clinic mistreatment, and on the message that clinic workers were underpaid and overworked.

But Prop 8 failed. It was the priciest proposition on the ballot, and while the union got their hands on $18 million to support it, the campaign was outspent six-to-one by the state’s dialysis industry.

Then came Proposition 23, two years later in 2020. The measure required one physician to be present during treatment; it also would force clinics to report infection data to California — not just to the federal government. Prop 23 failed too, and only 36% of voters approved of the idea.

Now, the union is back for a third time, fighting an uphill battle against an industry that has time and time again proved to be a political powerhouse in the Golden State. In December of 2020, the LA Times reported that the national dialysis industry had poured $233 million into California campaigns in four years. According to Politico, $2.2 million has already been spent against this year’s initiative, and the coalition in opposition has released searing press releases recently.

Some have questioned the aggressive approach of the union, which has funneled significant funds into the effort with little success. In the fall, Politico called the phenomenon “the electoral version of groundhog day,” and suggested that union leaders weren’t necessarily looking for a win on election day — rather, they were looking to weaken the dialysis industry, dollar by dollar.

Regardless of the union’s intentions, the industry has snapped into the defense during each stage of the game. On Monday, the coalition didn’t hesitate to respond to Weber’s announcement with their own take.

“This November 2022 initiative shakedown is just a continuation of UHW’s broader corporate union organizing campaign against health care providers,” the coalition wrote. “Since 2012, SEIU-UHW has wasted $82 million of its members’ dues money on 60 ballot initiatives across the country either directly or through its 501c4. In California alone, UHW has filed 23 state and local initiatives at a cost of $58 million or about $600 per member in wasted dues money.”

One critique of the union, according to Miller, is that the initiative is identical to 2020’s. But it’s not — 2022’s effort expanded the supervision clause to include nurse practitioners and physician assistants. The union also heard criticism about a lack of available providers in rural clinics, Miller said, so this time around the advocates are allowing for a telehealth option.

“We moved toward the critics, both in the industry and outside the industry,” Miller said. “We actually feel better and even more confident that our solutions are closer to being right… that’s how it differs from the last attempt.”

The Protect the Lives of Dialysis Patients Act joins four ballot propositions that Weber had previously named eligible for a spot on the November ballot. The three initiatives and one referendum tackle the sports betting industry, arts funding in schools, flavored tobacco sales and single-use plastics.

Other initiatives are close to making the cut. Initiatives must have their signatures qualified by June 30 to hold their place on the ballot.



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