Prop 29 Isn’t Kidney-ing Around

Health Depositphotos 101319194 l 2015

On this year’s ballot, California voters will have to become armchair medical experts when they vote on Proposition 29, who will be tasked with deciding how dialysis treatment centers should operate.

During the pandemic, suddenly everyone became armchair medical experts – much to the chagrin of actual epidemiologists. We soon learned the dangers of politicizing health issues.


But on this year’s ballot, California voters will have to become armchair medical experts when they vote on Proposition 29, who will be tasked with deciding how dialysis treatment centers should operate.


Individuals with chronic kidney failure need regular dialysis treatments to keep living. The treatments fill the role of healthy kidneys by filtering out waste, salt, and excess water.


If passed, Prop 29 would require each dialysis facility to have either a physician, nurse practitioner, or physician assistant always on-site. Prop 29 would also require facilities to report infections to the California Department of Public Health every three months. Facilities must disclose the owner’s name and will incur penalties if they do not comply. Furthermore, a clinic would not be able to refuse care based on insurance.


At first glance, it seems reasonable to assume that the proposition protects patients. Wouldn’t more doctors on-site be helpful? Shouldn’t everyone in need of life-sustaining care receive it? Shouldn’t we make sure dialysis clinics remain open?


But looking deeper into the dilemma reveals that the increased costs Proposition 29 would likely result in reduced access to care for kidney patients.


According to California’s nonpartisan Legislative Analyst’s Office, requiring a physician, nurse practitioner, or physician assistant to be on-site at all times would “increase each clinic’s costs by several hundred thousand dollars annually on average.”


If passed, it would even require clinic to obtain consent from the California Department of Public Health before closing or reducing services. Rather than gamble with being forced to operate at a loss, it seems likely that if the proposition is passed, many clinics could decide to simply close their doors immediately before the rules would go into effect.


Because those who suffer from chronic kidney failure need four-hour dialysis treatments two to four times a week, any significant clinic closures would be devastating to patients needing regular life-sustaining care.


Additionally, having a doctor on-site or reporting infections would have no effect on patient safety. Research by the Los Angeles Times found that infection rates in California are already lower than the national average and infections rarely result in death.


Voters may remember that this isn’t the first time the issue has appeared on the ballot. Nearly 60 percent of Californians voted no on Proposition 8 in 2018, and more than 63 percent voted to reject Proposition 23 in 2020. Despite this, as predicted by Rowena Itchon in 2020, “we’ll likely be writing about dialysis clinics again in 2022.” And here I am!


Looking at the supporters and opposers of the proposition helps clarify why it repeatedly appears on the ballot. Obviously, major dialysis companies oppose the bill. But so do the major medical organizations concerned with patient care such as the California Medical Association and the American Academy of Nephrology PAs.


The primary sponsor and supporter of the dialysis propositions has always been SEIU-UHW. SEIU-UHW has been trying to force dialysis clinics to unionize for years. As Rowena aptly wrote, the propositions are “simply another attempt by the union to punish dialysis providers by raising their costs by requiring them to pay for expensive doctors.”


Rather than respect the voice of the voters over the last two elections, SEIU-UHW shamelessly continues to play political games with dialysis patients’ access to life-sustaining care.


McKenzie Richards is a policy associate at the Pacific Research Institute.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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