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