Redux Kidney Dialysis Clinic Initiative Qualifies For November Ballot

Earlier this week, the California Secretary of State’s office announced that a new ballot initiative aimed at boosting the number of requirements for kidney dialysis clinics in the state had verified enough signatures and will appear on the November ballot.

Backed by the Californians for Kidney Dialysis Patient Protection campaign, supporters sent in over 1 million signatures, with a total of 623,212 needed to make the ballot this November. After the long verification process and removing duplicate and unverifiable signatures, a final total of 725,890 had been counted, over 100,000 more than needed.

The ballot initiative hopes to increase the number of requirements for clinics to give patients better choices in choosing clinics, as well as helping protect the lives of dialysis patients with more stringent medical minimums.

Under the proposed initiative, all dialysis clinics would have to have at least one on-site physician, nurse practitioner, or physician assistant with at least six months of experience with end-stage renal disease care be present during patient dialysis hours. Clinics would also have to give the California Department of Public Health (CDPH) and patients a list of those who have at least 5% ownership interest in the clinic. All clinics would have to report dialysis-related infections to the CDPH, as well as get their written consent before closing or reducing patient services, so as to not put patients lives at risk. Finally, care cannot be denied for patients based on how they would pay, with the patient’s insurer, Medi-Cal, Medicaid, Medicare, and out-of-pocket all being valid forms of payment that cannot be turned down.

A similar initiative in 2020, Proposition 23, had many of the same proposed changes as the newly approved 2022 initiative, including the on-site doctor requirement, CDPH infection reporting, only having CDPH approved closings and reductions, and not allowing care denials based on payment.

However, Prop. 23 received much criticism in 2020, with critics pointing out that dialysis costs would skyrocket by hundreds of millions of dollars and have clinics close due to the higher costs, with dialysis patients being put in even greater risk by not being able to see their doctors on time. Medical and patient groups came together in opposition by the fall, with support for Prop 23 quickly vanishing.

” [Prop 23 is] another attempt by a large union to swell its ranks by endangering the lives of dialysis patients,” said Assemblyman Kevin Kiley (R-Rocklin) of the proposition in 2020. “It imposes senseless mandates that will raise costs and close clinics. Medical groups and patient advocates are unanimously opposed. I will be disgustedly voting NO.”

New Kidney Dialysis proposition comes two years after 2020 prop defeat

That November, Prop 23 was soundly defeated. 10,681,171 Californians, or 63.4%, voted no, while only 6,161,457, or 36.6%, voted for it. The opponents believed that the landslide would stop advocates from trying again anytime soon, but a renewed effort and signature drive came up with enough signatures for a rematch this November.

“They didn’t learn a damn thing,” explained Corey Williams, a political researcher who specializes in ballot initiatives, to the Globe on Wednesday. “It’s only been two years and things have not changed that much, especially when it comes to voters on kidney dialysis care. And with 2022 shaping up to be a more conservative bend year thanks to the mid-terms, which we have also seen as likely due to the primaries and special elections that have happened across California, it’s going to have an even less of a chance than it did in 2020, when there was a big swing against Republicans.”

“California is a lot more conservative than people realize, and one of the areas this comes out in often is in ballot initiatives. For such a liberal state, they are one of the few to still vote down affirmative action and keep cash bail. And kidney dialysis is no different. The points made by those who were against it in 2020 still stand on their own, albeit with prop supporters now having the benefit of two years to come up with good counters to those.”

“If I were trying to pass this bill, I’d aim for the heart of voters and ignore the wallet. They didn’t give that appeal in 2020 and instead the opposition grabbed it and condemned them for trying to close dialysis clinics by jacking up costs on them. Those people for this renewed prop this year better have a new playbook, because they really can’t rely on 2020s’. And it better not focus on listing doctors there with a 5% stake or more, because the wheels will just continue spinning in the mud at that point.”

The new proposition, as of yet undesignated with a number, will appear on the ballot this November