A Guide to California’s 2022 Propositions: Prop 29
Among the propositions that are to be voted on during this year’s midterm election is Prop 29, perhaps one of the most divisive propositions up for election this year. Prop 29 deals with dialysis clinics, just like 2020’s Prop 23 and 2018’s Prop 8–both of which were defeated during their respective elections.
So why is it that this issue is on the ballot for the third election in a row? What makes Prop 29 any different than Prop 23 and Prop 8? Advertisements about Prop 29 can seem confusing and contradictory. In order to clear up a few things, here is a breakdown of the proposition: what arguments are being made from both sides, who is supporting those arguments, and what the proposition actually says.
Prop 8 (2018)
In order to fully understand Prop 29, it is also important to take a look at its predecessors, in which Prop 8 was the first of these ballot measures back in 2018.
Had Prop 8 passed, it would have required dialysis clinics to issue refunds to patients for revenue above 115% of the costs of care and improvements to the care that patients receive, and it would have prevented dialysis clinics from refusing care to anyone based on their payment method. These are things that one would expect voters to have supported, yet during the election, 59.93% of Californians voted against Prop 8.
So, what convinced so many people to vote against a measure that would seem beneficial to those seeking dialysis?
The proposition was sponsored by the Service Employees International Union-United Healthcare Workers West (SEIU-UHW West), which is a labor union, while it was opposed primarily by the states two largest dialysis clinics, DaVita and Fresenius Medical Care. The two sides spent a combined $130.43 million dollars on the proposition, which made it the most expensive measure on the ballot that year, but it was the opposition that spent significantly more money on the campaign, spending $111.48 million, with around 90% of that money coming from DaVita and Fresenius Medical Care. As a result, Californian’s were bombarded with arguments against the proposition, while in comparison, there was hardly any support for the measure that they were exposed to.
The opposition for Prop 8 claimed that the measure would lead to the shut-down of dialysis clinics and would make it harder for patients to get the dialysis treatments that they required–the proposition itself does not say anything about shutting down dialysis clinics, and one of the goals of the proposition was to make treatments more accessible financially. This argument was found to be misleading because there was no direct correlation between the proposition and the closure of dialysis clinics. Arguments against Prop 8 also claimed that the proposition would set “artificially low limits on what insurance companies pay for dialysis treatments.”
In contrast, support for Prop 8 cited dialysis clinics overcharging patients–which the proposition would have prevented. The official argument in support of Prop 8–as found in the voter information guide for 2018, and written by dialysis patient Tangi Foster (the president of the Congress of California Seniors Gary Passmore) and Nancy Brasmer (the president of the California Alliance for Retired Americans)–stated: “Dialysis patients should have a clean, sterile environment during their treatments, but big, corporate dialysis providers, which make billions by charging these critically ill patients as much as $150,000 a year, won’t invest enough in basic sanitation. Bloodstains, cockroaches, and dirty bathrooms have all been reported at dialysis clinics.”
Prop 23 (2020)
In 2020, a similar measure was on the ballot, with a similar result as 2018’s Prop 8. If Prop 23 had passed, it would have required dialysis clinics to have an on-sight physician while patients are being treated, report infections related to dialysis, and get permission from the state’s health department before closing, as well as prohibiting clinics from denying treatment to clients based on their payment sources. Once again, Californians voted against the measure, this time with a greater margin: 63.42% voted “no” on the proposition.
This ballot measure would have been arguably more beneficial to dialysis patients than the previous one, yet significantly more people voted against it than they did in 2018. So the question arises once again: what convinced so many people to vote against it?
As with Prop 8, Prop 23 was supported by the SEIU-UHW West, and it was opposed primarily by DaVita and Fresenius Medical Care. The opposition raised $105.24 million, with the majority of that money coming from those two dialysis companies. In comparison, support for the measure raised only $8.99 million–significantly less than the opposition. And once again, Californians were seeing significantly more arguments against the proposition than they were in favor of it–potentially skewing their opinions on it.
Arguments against the proposition once again claimed that the proposition would lead to closures of clinics, despite the proposition specifically including a way to prevent clinics from closing by requiring clinics to get permission from the state’s health department first. The opposition also argued that the measure would cause an increase in cost for patients, which is something that could have happened, as requiring doctors would mean more costs for the clinic, but overall, many of the arguments regarding Prop 23 were misleading.
Meanwhile, the arguments in favor of Prop 23 as written in the official voter guide for the 2020 election cited each of the problems that Prop 23 was meant to address and provided reasoning for why they were beneficial. In regards to the proposition requiring a doctor on-sight during treatment, the argument stated: “Dialysis is a dangerous procedure, and if something goes wrong, a doctor or highly trained nurse should be nearby.”
The argument also addressed the proposition’s requirement that infections would be reported to the state by saying “dialysis patients are prone to infections from their treatments that can lead to more serious illnesses or even death. This initiative requires clinics to report accurate data on infections to the state and federal governments so problems can be identified and solved to protect patients.” The argument also talks about the proposition preventing clinics from closing and preventing discrimination based on a patient’s insurance.
Thus we are left to wonder whether the rejection of these measures were due to misleading information presented by opponents of the measures, or would the propositions have failed regardless?
Prop 29 (2022)
This year, the ballot once again has a proposition about dialysis with Prop 29. This proposition is almost exactly the same as Prop 23, with the additions that clinics would need to notify patients which physicians have 5% or more ownership interest in the clinic and provide the state’s health department with a list of anyone with 5% or more ownership interest.
Prop 29 also expands on Prop 23’s requirement to have a doctor present, changing it so that it is more specific: Prop 29 states that a physician, nurse practitioner, or physician assistant be present during treatment, and that they have at least six months of experience.
The proposition is once again being supported by the SEIU-UHW West, as well as the Democratic Party of California. Meanwhile, the opposition is once again sponsored by DaVita and Fresenius Medical Care, with additional opposition coming from the Republican Party of California and a number of medical organizations in California. The arguments from both sides are almost exactly the same as they were in 2020 when Prop 23 was on the ballot.
It is up to voters to decide if they will follow precedent and vote against Prop 29 just as they did with Prop 8 and Prop 23, or if they will break the pattern and vote in favor of Prop 29.
Sources
Prop 29: https://ballotpedia.org/California_Proposition_29,_Dialysis_Clinic_Requirements_Initiative_(2022)
Prop 23: https://ballotpedia.org/California_Proposition_23,_Dialysis_Clinic_Requirements_Initiative_(2020)
