A California ballot proposition would increase the cost of kidney dialysis and reduce patient access in the Golden State, says a coalition of opponents.
Proposition 29, which would require the presence of a doctor, nurse practitioner, or physician’s assistant during outpatient kidney dialysis clinics’ treatment hours is eligible for the November 8 election ballot, California’s Secretary of State announced on June 20.
The Service Employees International Union-United Healthcare Workers (SEIU-UHW) spent millions of dollars on the successful petition effort for the measure, which is similar to ballot initiatives they backed in 2018 and 2020 that voters rejected.
‘Endangering Dialysis Patients’ Lives’
No on Prop 29, a self-described “coalition representing kidney patients, doctors, nurses, social justice advocates, and dialysis providers,” says the scheme will increase the cost of dialysis and lead to clinic closures, spokesperson Kathy Fairbanks told Health Care News.
“Prop 29 would cause dialysis clinics to cut back or close, endangering dialysis patients’ lives,” said Fairbanks.
The SEIU-UHW aims to harm the clinics financially through the large cash outlays that will be required to fight the measure, but the members of these unions already suffer, says Fairbanks.
“Wasting their members’ dues money every election cycle on failed dialysis measures does impact their members because they will likely have their dues raised to cover these worthless exercises,” said Fairbanks. “Both the previous measures failed by margins of 20 percent or more. Voters clearly are not buying what UHW is selling and reject putting vulnerable dialysis patients in harm’s way.”
SEIU-UHW members have paid for many ballot measures over a decade, states a No on 29 press release.
“Since 2012, SEIU-UHW has wasted $82 million of its members’ dues money on 60 ballot initiatives across the country either directly or through its 501c4,” states the release. “In California alone, UHW has filed 23 state and local initiatives at a cost of $58 million or about $600 per member in wasted dues money.”
‘Costlier Forms of Treatment’
The cost of caring for dialysis patients would rise as clinics added personnel, according to an analysis of the measure by the Berkeley Research Group (BRG), a consultancy, for opponents of the proposal.
“The initiative’s clinician at-all-times requirement would increase costs statewide for all clinics, collectively, by between $229 and $445 million annually, depending on the type of clinician used,” states the BRG report.
Many nonprofit and for-profit clinics treating the more than 80,000 kidney patients in the state would face negative operating margins and up to half of them could close, says BRG.
“Out of the 622 dialysis clinics in California used in this analysis, this represents between 39 and 56 percent of dialysis clinics treating approximately 16,000 to 27,000 patients,” wrote BRG.
Golden State taxpayers could be left with the tab for patients who lose access, says BRG.
“By reducing clinics operating and forcing some dialysis patients into costlier forms of treatment, the initiative will increase costs to the State of California between $19 million and $1.7 billion to continue treatment for only those patients insured through three partially state-funded programs: CalPERS, Medi-Cal managed care and Medi-Cal fee-for-service, depending on the type of practitioner used,” wrote BRG.
‘Patients’ Only Option’
Currently, the federal government picks up most of the cost of dialysis, says health economist Devon Herrick, a policy advisor to The Heartland Institute and analyst at the Goodman Center for Public Policy Research, which co-publishes Health Care News.
“A law requiring physician coverage at dialysis clinics would drastically increase the cost of dialysis, which taxpayers mostly pay for,” said Herrick. “End-stage renal disease is the only disease that is covered by Medicare for patients of any age, which has resulted in little change in the care of people with kidney failure in 50 years.”
Because kidney dialysis is a federal entitlement, treatment remains cumbersome and inconvenient, says Herrick.
“For example, there are portable dialysis units that could be used at home for longer periods—such as at night while sleeping for, example—but Medicare won’t pay for them,” said Herrick. “Instead, patients have to visit dialysis centers anywhere from once a week to about every day of the week, depending on their condition. A better way would be for patients to take home a small, portable dialysis machine that runs while they sleep, but for now, dialysis clinics are many patients’ only option.”
Kevin Stone (firstname.lastname@example.org) writes from Arlington, Texas.
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