Proposition 23, Which Would Have Required Full-Time Doctors at Dialysis Clinics, Defeated by Voters

Californians defeated Proposition 23, with 64% of voters saying no to the measure that would have required dialysis clinics to have a doctor on-site at all times.

The loss is not surprising after the opposition, led by the two largest dialysis companies in the country — DaVita and Fresenius — invested more than $104 million into defeating the measure, while proponents, the Service Employees International Union – United Healthcare Workers West (SEIU-UHW), put up roughly $9 million in support.

"Proposition 23 was never about anything other than UHW's political motivations. It wasn't about improving patient care. It wasn't about helping patients," said Kathy Fairbanks, spokesperson for the No on 23 campaign. "It was on the ballot for the wrong reasons and voters saw that."

For the last five years, UHW has been trying to unionize workers at dialysis clinics in California, without success. The union has long turned to the ballot box to seek leverage in its labor disputes. It sponsored a similar initiative in 2018, Proposition 8, aimed at limiting profits at dialysis clinics. When that was voted down, the union went to work almost immediately on Proposition 23, according to spokesman Steve Trossman, with the intention of writing an initiative that would be easier for voters to understand.

But dialysis companies waged a fierce opposition campaign, blanketing the state with ads featuring dialysis patients who were either angry, saying that they were being put in the middle of a labor dispute, or scared, arguing that the cost of complying with the measure would bankrupt and close their clinics, leaving them without the three-times-per-week treatments they need to stay alive.

If the proposition had passed, those mass closures would have been unlikely, as DaVita and Fresenius operate 75% of California’s 600 dialysis clinics and together earned $2 billion in profits last year. However, there is little scientific evidence that the measure would have improved patient health. Research from a decade-long experiment in the Medicare program found that dialysis patients who saw their doctors four or more times per month had the same health outcomes and mortality rates as patients who saw their doctors once or twice a month.

A long list of doctors’ associations and patient groups also opposed the measure. Some argued it was not only unnecessary, but dangerous. The measure did not specify that the doctor on-site needed to be a kidney specialist – any kind of doctor would have been allowed – and that raised concerns among patients on both sides that a doctor without specialized training in kidney failure and dialysis care could do more harm than good.

The union insists that its efforts were aimed at improving patient health and getting the dialysis industry to reinvest more of its ample profits into improving care. It vowed to continue pursuing these goals.

“We are in this for the long haul until the dialysis industry does the right thing," said Carmen Cartagena, a dialysis patient with the Yes on 23 campaign. "We intend to continue seeking to hold the dialysis industry accountable through all means, including in the state Legislature and through ballot initiatives. We won’t stop until it is truly reformed and puts patients before profits.”