Oppose the Deeply-Flawed Dialysis Proposition

Special Interest Proposition Jeopardizes Access to Care for Vulnerable Patient Population

United Healthcare Workers West (UHW) union, with a long history of pushing controversial ballot initiatives to leverage its political agenda, is behind a deeply-flawed dialysis proposition aimed for the November 2018 statewide ballot. The proposition limits what private health insurance companies pay for dialysis treatment in California. In doing so, this measure would dangerously reduce access to care for Californians with kidney failure who need dialysis treatments three days a week, three to four hours at a time, to survive. That’s why the measure is opposed by more than 50 organizations representing doctors, patients, nurses and caregivers.


Jeopardizes Access to Dialysis Care for Patients Who Are Very Ill

Sets artificially low limits on what insurance companies pay for dialysis treatments.

These arbitrary limits fail to cover all costs necessary to provide high quality patient care. Specifically, the measure requires community dialysis clinics to issue annual rebates to private health insurance companies if any fee for treatment exceeds 115% of what the initiative defines as “patient care services costs”. Nothing in the initiative requires one dollar of these potential rebates to be passed along to consumers.

Fails to account for actual cost of providing care.

The proposition’s definition of “patient care services costs” prohibits clinics from billing insurance companies for many necessary costs for operating a clinic, including some of those required by the Centers for Medicare & Medicaid Services. This definition excludes:

  • physician Medical Director
  • nurse Clinical Coordinators
  • staff who help patients navigate insurance options
  • community-based kidney disease education
  • regulatory compliance
  • facility administrators
  • facility security
  • non-clinical information technology
  • professional services like accounting, human resources, payroll and legal

Would result in clinic closures and cutbacks in services.

If payments from health insurers do not cover clinic operating costs, clinics will likely be forced to make changes to operations, including cutbacks in clinic services and clinic closures.

Dangerous for Patients

Reduces access for California's most vulnerable patients.

Dialysis patients need treatment three days a week, for three to four hours at a time to survive. With demand for dialysis growing at about five percent a year in California, patients already have difficulty finding appointment times convenient and close to home. This proposition would result in clinic closures, and cutbacks in services forcing patients to travel further distances or seek treatment in a hospital, increasing the likelihood that they might miss a treatment. Research shows that missing even one dialysis appointment increases the risk of death for dialysis patients by 30%.

Hardest on disadvantaged communities.

The proposition disproportionately harms dialysis patients in poor, disadvantaged and rural communities where dialysis clinics already struggle to stay open.

Distressing for families.

For many patients, family members are their lifeline, taking them to and from dialysis treatment. Forcing farther travel for treatment could cause significant disruption to patients and their families.

All patients and taxpayers negatively impacted.

When dialysis clinics shut down, more patients would seek treatment in the more expensive hospital setting or suffer severe complications from missing treatment, ending up in hospital emergency rooms. That means more ER and hospital overcrowding, and potentially hundreds of millions of dollars in higher costs for Medi-Cal and Medicare to treat dialysis patients – and higher costs for taxpayers.

An abuse of the initiative system.

  • This proposition is being promoted by United Healthcare Workers West (UHW) union as part of a broader union-organizing strategy and pressure campaign.
  • While unions have the right to try to organize workers, it’s not right to abuse the initiative system and use vulnerable patients as political pawns.
  • Since the 2012 election cycle, UHW has spent nearly $22 million in California on multiple ballot measures in an attempt to further its political and financial interests.
  • In 2018 alone, UHW is bankrolling two statewide measures and seven local measures. The local measures target hospitals where UHW is trying to unionize workers or negotiate contracts.