Editorial

August 31, 2022

Endorsement: Dialysis patients aren’t bargaining chips. Vote no on Prop. 29

San Francisco ChronicleBy San Francisco Chronicle Editorial Board

No, you’re not experiencing deja vu.

For the third time in the past six years, California voters are being asked to weigh in on a seemingly obscure measure that would impose new requirements on in-state dialysis clinics — at the behest of the union that wants to organize these clinics’ workers.

Yes, voters overwhelmingly rejected these measures in the past. Proposition 8 went down in 2018 by a nearly 60-40 split. Voters tanked Prop. 23 in 2020 by an even greater margin.

And yet here we are again.

Prop. 29 only makes marginal changes to the failed 2020 effort. The most substantial amendment is that, whereas Prop. 23 would have required all clinics to keep a physician on-site during treatment hours, the new measure would require either a physician, physician assistant or nurse practitioner with at least six months of experience providing care to kidney patients to be available on-site. If clinics can’t find the personnel, they can request an exemption to provide this service through telehealth.

The union behind the measure continues to assert that these new medical supervision requirements will improve patient care. Clinic operators — including nonprofits — still say these staffing requirements are arbitrary, expensive and unnecessary, and will put the financial health of smaller and rural clinics in jeopardy. Dialysis facilities are already required to employ a physician medical director and keep a registered nurse on site.

Are Prop. 29’s changes significant enough to make the third time a charm?

Not even close.

Just like in 2020, an independent review by California’s nonpartisan Legislative Analyst’s Office found that this measure would “increase each clinic’s costs by several hundred thousand dollars annually on average.” This could force clinics to close, putting patient health at risk.

For those suffering from life-threatening kidney diseases — over 80,000 people in California — missing even one dialysis appointment per month can be deadly. Any effort that could shut down the clinics patients rely on — absent widely substantiated safety concerns — should be a nonstarter.

Independent review further found that the clinics that can withstand the cost of these new requirements will likely pass those expenses off onto taxpayers, as the vast majority of dialysis patients are on Medicare or Medi-Cal.

If these risks and costs were truly justifiable, you would no doubt see public health and patient advocates signing on to support the measure en masse. They are not.

That’s because this bill is about political hardball, not patient health.

Nearly 75% of licensed dialysis clinics in California are owned or operated by two for-profit companies: DaVita Inc. and Fresenius Medical Care. Proponents of Prop. 29 don’t hide the fact that they see this measure as part of a strategy to unionize the facilities owned by these companies. Fighting a ballot measure like Prop. 29 is expensive. Sooner or later, it will be cheaper to meet the union at the bargaining table instead of in the political realm.

But using the health of patients as a bargaining chip is unconscionable — more so now than ever. COVID-19 decimated dialysis patients — deaths were 20% higher in 2020 then they were before the pandemic — in part because it made patients’ ability to stick to regular in-person appointments so difficult.

Voters should reject Prop. 29’s cynical tactics in November — and as many times as they need to in the future.