For three election cycles in a row, California ballots included initiatives about how the state’s dialysis centers should operate. With that debate tabled — at least for now — the state’s most powerful collection of unions may have identified its next target to take on at the ballot.
SEIU California appears to be setting the stage to go after federally qualified health centers, community clinics that rely heavily on public funds to provide primary care regardless of a patient’s ability to pay.
In 2023, health-care workers union SEIU-UHW began including clinic workers in its proposed minimum wage ordinances and sponsored a bill requiring more stringent data reporting by the facilities. This year, the union is sponsoring a proposal to put financial regulations on clinics and is lobbying against other bills, such as AB 1460, which would make it easier for clinics to get access to discounted prescription drugs.
That path resembles the strategy SEIU-UHW used in its battles with hospitals and dialysis clinics. If past is prologue, the union will follow up its legislative push against clinics by asking voters to do what the legislature won’t.
In the last 10 years, SEIU-UHW has filed 35 state and local ballot measures on a range of issues, including worker wages, spending regulations and executive compensation.
The union may be best remembered by local voters for its persistent commitment to the cause of dialysis-clinic oversight. SEIU-backed initiatives to regulate the facility appeared on statewide ballots in 2022, 2020 and 2018. That followed years of sponsored legislation on staffing requirements, data reporting and revenue or spending regulations. All three times, voters rejected the proposal in the face of major spending by national clinic chains DaVita and Fresenius.
For Tia Orr, executive director of SEIU California, there’s nothing underhanded about her union now turning its attention to a different category of clinic. As Orr sees it, the myriad problems facing the sprawling health care system — consolidation, anti-union tactics, ballooning c-suites, staff turnover and corporate waste exist in community clinics, dialysis clinics, hospitals and elsewhere. Fighting on all fronts is a sign of consistency, not conspiracy, she argues.
“Similar bad practices are happening across the board,” Orr said. “We’re seeing it in the dialysis industry, we’re seeing it in the clinic industry, and it’s our responsibility — especially in representing workers — to do something to try to force a changed behavior.”
Orr said voters shouldn’t necessarily expect to see a ballot measure on clinics in the next few years, but still left the door open.
“We haven’t even begun discussions on that ground,” she said.