Voters: Make 3 times a charm for Prop 29 dialysis reforms

Ben Testani is a 24-year-old digital strategist for progressive political causes. Based in Oakland, he also authors the Substack column I’ve Ben Thinking, where he chronicles his experiences and perspective on topics ranging from politics to internet culture to mental health.


For the third election in a row, Californians have been asked to weigh in on proposed reforms to the state’s dialysis industry. Ballot Proposition 29 may be overshadowed by dueling “yes” and “no” ads surrounding the two gambling measures on the ballot this year, but it importantly builds on the defeated Prop. 23 from 2020 and Prop. 8 from 2018.

Like its predecessors, Prop. 29 is pro-patient and pro-worker. The measure would bring significant changes to the state’s dialysis industry. The most notable of these are a requirement to have at least one medical professional on site at each clinic, greater state-level reporting on infections at clinics, and a requirement that clinics receive state approval before closing.


These reforms would be significant wins for California’s dialysis patients. At present, state licensing law allows dialysis providers to staff clinics with lesser trained medical technicians instead of nurses, physicians assistants, or doctors. This leaves patients vulnerable if a medical emergency occurs during their dialysis treatment. Plus without the expanded reporting requirements called for by Prop 29, it’s hard to even how often these emergencies happen.


Dialysis companies currently can also close clinics with no warning to patients, placing a particular burden on rural Californians and Californians with limited access to transportation. Prop. 29 would alleviate this burden by forcing providers to seek state approval before closing a facility.


The state proposition measure is again sponsored by Service Employees International Union - United Health Workers West (SEIU-UHW), a labor union comprising around 100,000 healthcare workers across California. Likewise for the third time, the reforms are opposed by the same mix of industry groups. The two largest donors to the opposition campaign, the oft-fined DaVita Inc. and Fresenius, own and operate 80% of California’s dialysis clinics. According to sponsors of Prop 29, these two companies profit from dialysis at a rate nearly six times higher than the profit rate of the average U.S. hospital.


The dialysis industry make two main arguments against Prop. 29: higher costs for patients and the potential closure of clinics. However, neither of these arguments hold up to closer scrutiny.


In their ads, DaVita and Fresenius are not subtle in suggesting they may need to close clinics if the measure passes. Seems a scary threat; however, Prop. 29 would actually require the state to approve any clinic closures moving forward. So this is largely a red-herring.


And while the industry warns Prop. 29 would result in higher costs for patients, DaVita and Fresenius are simultaneously fighting a court battle to strike down the cost-reducing AB 209 (2019), which capped dialysis insurance reimbursements at the Medicare rate. So the importance of their patients’ financial interests is another red-herring argument.


2020’s Prop. 23 and 2018’s Prop. 8 were defeated with 63% and 60% of California voters against. This came with the dialysis industry spending $225 million to defeat the proposals, or nearly $200 million more than proponents of reform. But the hope is a third election cycle of public education will make the difference.


Plus, national support of unions is at its highest point since 1965, with 71% of Americans approving of unions. A ballot measure that would create more union healthcare jobs would be a perfect way to build on California labor’s recent wins like securing the right for farmworkers to conduct union votes by mail law and establishing the nation’s first fast food labor council.


Furthermore, as the pandemic approaches its three-year anniversary, Californians of all backgrounds are reckoning with the failed state of our for-profit healthcare infrastructure. In February, we came the closest yet to formally acknowledging these failures and creating a statewide CalCare system before cowardly corporate Democrats killed the bill without even holding a vote. At the time of writing, 2,000 mental health workers with Kaiser have been out on strike for over two months across Central and Northern California, calling attention to communities underserved by Kaiser and company’s alleged violations of a state law that mandates providers offer mental health patients a follow up appointment within 10 days of their initial intake consultation.


Thus the time is right to reverse the outcomes of Propositions 23 and 8. Passing Proposition 29 would be a small but important victory in the battles for an equitable healthcare system and workers’ rights.


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