July 21, 2022
California Federation of Republican Women
Janet Price, President
Submitted by the CFRW Legislative Analyst Committee
Karen Contreras, Elaine Freeman,
Theresa Speake, and Cheryl Sullivan
At the CFRW Board of Director meeting this last weekend, the Board voted to oppose Proposition 1 which was part of last weeks Capital Update dealing with abortion.
QUALIFIED BALLOT MEASURES FOR NOVEMBER ELECTION:
Official Title: Requires On-Site Licensed Medical Professional at Kidney Dialysis Clinics and Establishes Other State Requirements. Initiative Statute
This statute would establish staffing and reporting requirements, require ownership disclosure, and prohibit dialysis clinics (DC) from closing or reducing services without state approval.
- Staffing: requires on-site licensed medical professional, e.g., physician, nurse practitioner, or physician assistant. Telehealth may be used during staffing shortage
- Reporting: dialysis-related infections data must be reported to the state
- Ownership: all persons and physicians’ ownership of the dialysis clinic >5% must be disclosed to patients
- Service reduction or closure: the state must approve any substantial reduction in services or closure of the dialysis center
- Clinics may not refuse treatment based on the source of payment
Fiscal impact: Increased state and local government costs between $229 million and $445 million.
Background:
In California, nearly 80, 000 people receive dialysis treatments at local hospitals and dialysis centers. Various entities own and operate DCs, both not-for-profit and for-profit. Two multinational, for-profit corporations operate or manage seventy-five percent of the dialysis clinics in the state. Kidney dialysis is big business.
The more than 600 clinics employ thousands of workers and therein lies the impetus for SEIU-UHW involvement in “dialysis reform.” The aforementioned requirements ae varied in scope and in practice and deserve critical consideration.
The cost of mandating a physician within the clinic during business hours will significantly increase the cost of treatment, a nurse practitioner or physician assistant, not so much. Increased operating costs can lead to clinics closing or merging with other clinics in higher population areas.
Unlike acute-care and specialty hospitals, physicians are allowed to form a partnership with a for-profit dialysis corporation. A physician who owns a stake in a dialysis clinic may also be serving as the kidney patient’s nephrologist or primary doctor which, according to initiative proponents Fleming and Everhart (SEIU-UHW), creates a conflict of interest.
Previous ballot initiatives were sponsored by the Californians for Kidney Dialysis Patient Protection in 2018 (Prop 8) and 2020 (Prop 23). There is conflict between SEIU-UHW and the state’s two largest dialysis businesses, Da Vita and Fresenius. SEIU is open about attempts to unionize the dialysis workers and blames the dialysis companies for the failure to unionize. As an aside, it has been noted in the Sacramento Bee and the LA Times that the ballot initiative, if it passes, could also pave the way for increased legislative leverage by SEIU-UHW.
Support: paid for by the PAC Californians for Kidney Dialysis Patient Protection: supported by SEIU-United Healthcare Workers West for $3.5 million. Signatures submitted by Sean Fleming and Jonathan Everhart, higher-paid employees of SEIU-UHW.
Opposition: paid for by PAC Stop Yet Another Dangerous Dialysis Proposition for $2.2 million (donors DaVita and Fresenius).
Summary:
Prop 29 should be familiar to voters since it has been rejected by the voters twice before, in 2018 and 2020. So, why does it keep appearing on the ballot? It is difficult to believe that labor unions have become the dialysis patient’s advocate. New and costly regulations would hardly benefit the interests of the patient. Prop 29 is supported by the Service Employees International Union-United Healthcare Workers west and opposed by the Stop Yet another Dangerous Dialysis Proposition, a coalition PAC of doctors, nurses, dialysis patients, caregivers, and dialysis corporations.
Every healthcare industry uses continuing quality improvement metrics to deliver good healthcare and, certainly, every sector of healthcare can improve services. In California, oversight is provided by the California Department of Public Health and CMS. However, one needs to be mindful of the reputations of the proponents and opponents of this initiative.
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