League of Women Voters:  Pros & Cons of Proposition 29

If you're in California, as election day draws near , and you have grown weary of yet another mud-slinging, name-calling advertisement interrupting your day; remember, your vote can impact more than which party fills a seat in congress.  Californians have a proposition state statute that could change how dialysis clinics operate if it passes on November 8th, 2022.

California Proposition 29, the Dialysis Clinic Requirements Initiative, will need a simple majority of the votes cast in order to “pass”, or be enacted. Prop. 29 would bring about quite a few changes, enacting staffing requirements, reporting requirements, ownership disclosure, and closing requirements for all dialysis clinics.  Included with these requirements are the following:

• Staffing requires clinics to have at least one physician, nurse practitioner, or physician assistant, with at least six months experience with end stage kidney disease care, onsite during patient treatments. 
• Reporting requires clinics to report dialysis related infections to the California Department of Public Health (CDPH). 
• Ownership disclosure requires clinics to provide both The California Department of Public Health and clinic patients with a list of physicians with ownership interest of 5% or more in the clinic. 
• Closing requirements require clinics to obtain the California Department of Public Health’s written consent before closing or substantially reducing service to patients. 
• Prohibits Proposition 29 also prohibits clinics from refusing care to a patient based upon the patient’s form of payment, whether the patient is an individual payer, the patients health insurer, Medi-Cal, Medicaid, or Medicare. 

Californians for Kidney Dialysis Patient Protection is leading a Kidney Patients Deserve Better campaign supporting Proposition 29. SEIU-UHW West (Service Employees International Union-United Healthcare Workers West) is the primary sponsor and contributor, giving over $7.94 million to the support committee.  David Miller, who is the research director of SEIU-UHW said of the proposition, “There’s just so much improvement that can be made, and there’s plenty of resources in the industry to make those improvements. 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”.

Stop Yet Another Dangerous Dialysis Proposition is leading a campaign opposing Proposition 29.  The committee has reported over $86.3 million in contributions from DaVita Inc. and Fresenius Medical Care. (DaVita owns approximately 352 dialysis clinics in California and Fresenius Medical Care owns approximately 141).  

Also opposing this initiative are: The Republican Party of California, California Chamber of Commerce, and California Medical Association.

A campaign spokesman said this of Proposition 29, “Since 2012, UHW has wasted $77.7 million of its members’ dues money funding 48 failed ballot initiatives across the country, many of which put patients and their members at risk.  That amounts to more than $700 per UHW member that they’ve wasted on these failed and reckless efforts.  This is the third ballot measure since 2018 sponsored by UHW targeting dialysis providers.  Voters rejected Prop 8 in 2018 by 60% and Prop 23 in 2020 by 63%.  It’s shameful that this union would continue to use vulnerable patients as pawns to advance their political agenda”. 

In this video developed by the League of Women Voters of Marin County, Barbara Strong and Carol Joy Harris discuss the pros and cons of Proposition 29.

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Video Transcript

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Barbara Strong

Hi, I'm Barbara Strong and this is Carol Joy Harris. We're here to talk to you about proposition 29. You'll see it on your ballot as requires on-site licensed medical professional at kidney dialysis clinics and establishes other state requirements. Carol Joy, what is the question behind proposition 29?

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Carol Joy Harris

Well, the question is should outpatient dialysis clinics be required to have a physician, nurse practitioner, or physician assistant on site at all hours when patients are being treated and

should they be required to provide various clinic related information to patients and the state.

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Barbara Strong

Can you tell us about the background behind proposition 29?

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Carol Joy Harris

Sure. About 80, 000 patients in California receive dialysis services from 650 chronic dialysis. Clinics dialysis clinics are licensed by federal standards. Two out-of-state for-profit companies DaVita Incorporated and Fresenius Medical Care operate almost three quarters of the dialysis clinics in California. The remaining clinics are operated by a variety of non-profit and for-profit

entities and currently Federal Law requires clinics to report any infections related to treatment.

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Barbara Strong

What is the current Staffing at dialysis clinics?

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Carol Joy Harris

All patients have their own Physicians whom they must see once per month.  All clinics have a medical director who is a physician on staff.

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Barbara Strong

And how are insurance companies involved?

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Carol Joy Harris

Most patients on dialysis are covered by Medicare and or Medi-Cal which pay a fixed rate for dialysis services.  About 10 percent of dialysis patients are covered by group and individual

health insurance plans that often pay multiple times the amounts paid by Medicare and or Medi-Cal because their rates are negotiated with each insurance company.  After a period of time, all dialysis patients are covered by Medicare.

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Barbara Strong

What is Proposition 29 proposing?

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Carol Joy Harris

Proposition 29 would require that a licensed physician, nurse practitioner or physician assistant in each case with at least six months of experience in Kidney Care must be on site at all times when dialysis is being performed. Telehealth may be used for up to one year if no such person is available on site. 

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Barbara Strong

Anything else?

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Carol Joy Harris

Yes, clinics could not discriminate among patients based on their source of payment and could not close or reduce hours without permission from the state. Clinics would also be required to report information about dialysis related infections among their patients and Clinics would be required to report to patients the name of any physician with more than a five percent interest in the clinic.

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Barbara Strong

And what would be the fiscal effects the clinics would probably have to pay?

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Carol Joy Harris

Hundreds of thousands of dollars more annually for staff salaries.  State and local governments might have to pay tens of millions of dollars more annually if clinics close and patients must go to more expensive facilities such as emergency rooms or if clinics negotiate higher reimbursement rates.

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Barbara Strong

What do supporters say supporters say requiring a physician nurse practitioner or physician

assistant to be present during a dangerous procedure like dialysis?

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Carol Joy Harris

It’s common sense and a matter of patient safety. Supporters also say the big corporations operating dialysis clinics can easily make the required Staffing changes and still profit hundreds of millions of dollars a year.

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Barbara Strong

And what do opponents say?

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Carol Joy Harris

Opponents say clinics already use specially trained technicians and every patient is under the care of their own kidney doctor.  So more oversight is unnecessary.  Opponents also say prop 29 would take thousands of skilled medical staff from hospitals where they're needed and place them in administrative jobs.

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Barbara Strong

Can you tell us about campaign financing?

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Carol Joy Harris

Yes, 7.9 million dollars has been contributed in support by the Californians for Kidney Dialysis Patient pProtection pack.   You can see the top donor on your screen and 36.9 million dollars has been contributed in opposition by the No on 29,  Stop Yet Another Dangerous Dialysis Pack Again.  The top donors are on your screen.

Barbara Strong

In summary, what does a yes vote mean?

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Carol Joy Harris

A yes vote supports this ballot initiative to require dialysis clinics to have at least one physician nurse practitioner or physician assistant while patients are being treated; report data on dialysis related infections and not discriminate against patients based on the source of payment for care.

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Barbara Strong

And what does a no vote mean?

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Carol Joy Harris

A no vote opposes this ballot initiative to require dialysis clinics to have at least one physician nurse practitioner or physician assistant while patients are being treated; report data on dialysis related infections and not discriminate against patients based on the source of payment for care.

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Barbara Strong

Thank you, Carol Joy. 

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Carol Joy Harris

 My pleasure, Barbara

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About the League of Women Voters of Marin County

The LEAGUE OF WOMEN VOTERS OF MARIN COUNTY is a local League that was established in 1936. The are active in both Voter Service (promoting voter registration, education and participation) and study and advocacy  related to issues/policy in the areas of Justice, Health, Education & Libraries, and Transportation/Land Use/Housing. Local League members are also members of both the state (LWVC) and national (LWVUS) Leagues.

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About the Author

Monica McCarthy has bachelors in Political Science and Criminal Justice from Central Washington University.  A majority of her career was spent as a political consultant.   She currently works at KidneyLuv as a staff writer.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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