Prop 29 Proponents Seemingly Have Little Interest in its Passing

We are well into October, and by now you are likely somewhere between frustrated and nauseated with all the political ads that have saturated all facets of the media leading up to the November 8 General Election. If you are a Californian, those feelings are no doubt significantly pronounced with the Golden State’s apparent obsession with ballot propositions that not only flood the ballot itself, but also deluge us with those ads in the weeks prior to Election Day.

In recent weeks I’ve noticed a couple of interesting things about one of the aforementioned California ballot propositions. First, Propsition 29, known as the Dialysis Requirements Initiative, looks vaguely familiar.  Second, the political ads seeking a “No” vote on the ballot measure far outnumber those seeking its passage. In fact, the “Vote Yes” ads for 29 are nonexistent. 

So, if Proposition 29 looks familiar, you’re not dreaming. 2022 will be the third consecutive election cycle that the main backer of the Proposition, The Service Employees International Union-United Healthcare West (SEIU) has garnered enough signatures to get the measure on the ballot.  In 2018, Proposition 8 was defeated with nearly 60% of voters opposing, and in 2020, Proposition 23 lost with 63% of voters opposing. And as with previous attempts, this one is likely to go down in flames before the voters as the proponents have put most of their resources behind gathering signatures and very little in voter outreach once the measure reached the ballot. An exercise in futility? Not so fast.

For years, the SIEU has been attempting to unionize workers at California’s largest kidney dialysis centers. Of course, owners of the clinics have been opposed, and there has apparently been little interest in unionizing from the employees themselves. So, it would seem that SEIU has developed a new tactic to force unionization on the centers—cause the centers to spend millions upon millions of dollars opposing these referenda in election after election until they finally bend the knee and allow unionization to take place.

Before looking at what Prop 29 would bring forth if enacted–and its relative merits and dangers, it is probably worthwhile to examine the above-referenced union tactic itself.

First, a little history. Around the turn of the 20^th century, the California Populist movement took hold and one of its fruits was the concept of Direct Democracy whereby the people themselves could enact laws through the process of Initiative and Referendum (I & R) and bypass elected legislators lacking political fortitude to get things done or who just might be influenced, if not corrupted by special interests. Over more than 100 years the I & R process has had its successes and failures depending upon your own personal perspectives. Yet, there can be little argument that the process has been hijacked by the aforementioned special interests, which has led to a fairly ignominious reputation not only among Californians, but also from those observing the California political process from outside the state. The tactics of the SIEU certainly underscore that ignominy, and those early Californians who were the champions of I & R more than 100 years ago would be aghast at what the process has become.

It would also be worthwhile to examine the provisions of Dialysis Requirements Initiative which would enlighten us on why the measure has already twice failed and will likely do so again in 2022. Proposition 29 would:

• require clinics to have at least one physician, nurse practitioner, or physician assistant – with at least six months of experience with end-stage renal disease care – onsite during patient treatments.
• require clinics to report dialysis-related infections to the California Department of Public Health (CDPH).
• require clinics to provide patients with a list of physicians with an ownership interest of 5% or more in the clinic.
• require clinics to provide the CDPH with a list of persons with ownership interest of 5% or more in the clinic.
• require clinics to obtain the CDPH’s written consent before closing or substantially reducing services to patients.

And while on the surface some of these provisions apparently have some merit, opponents of the measure claim that all the required additional professional staffing would be superfluous as trained nurses and technicians already on hand are capable of delivering the necessary dialysis treatments to their patients. Many of these dialysis centers operate on shoestring budgets and the millions of dollars in extra costs that would be incurred if Prop 29 passed would likely cause the closure of many of these essential facilities and leave vulnerable patients in desperate if not life-threatening situations.

Kathy Fairbanks, a spokesperson for the “No on 29” campaign said: 

“This isn’t about policy. It’s just about trying to wear down dialysis providers. Their game is not to win the ballot measure. It’s to extort.”

Extortion indeed. And evidently the union’s tactic is not just confined to California. Other states have seen similar attempts to use the I & R process to foment unionization of dialysis centers. The “No on 29” campaign claims:

“Since 2012, UHW has wasted $77.7 million of its members’ dues money funding                                      48 failed ballot initiatives across the country – many of which put patients and their                      members at risk. That amounts to more than $700 per UHW member that they’ve                           wasted on these failed and reckless efforts.”

Not too surprisingly, in addition to the SEIU being a proponent of Prop 29, the California State Democratic Party and the California Labor Federation endorse the measure.  And with little corresponding surprise, the California State Republican Party, The State Chamber of Commerce, and the California Medical Association are in opposition.

As with any ballot measure, the merits and pitfalls need to be carefully examined before any Californian casts a vote.  Once again, it is likely that Golden Staters will shoot this one down on its merits, or lack thereof.  Perhaps though, now that another cynical abuse by special interests of California Initiative and Referendum has been exposed, the state will finally examine the I & R procedure itself and find ways to make improvements even if it means making it more challenging to get these propositions on the ballot in the first place. Then, and only then might we see the efforts of these special interests to commandeer the California Initiative and Referendum process thwarted.