California voters have defeated Proposition 23, the measure that would have required dialysis clinics to have a doctor on site during all operating hours and to report infection data to the state.
The defeat comes as no surprise after the opposition, led by the two largest dialysis companies in the country â DaVita and Fresenius â invested more than $104 million into defeating the measure, while proponents, the Service Employees International Union â United Healthcare Workers West (SEIU-UHW), put up roughly $9 million in support.
Prop. 23 was the latest effort in a pattern long followed by SEIU to use ballot initiatives to gain leverage in its labor disputes. In the last five years, the union has been trying to organize workers at dialysis clinics, without success. It sponsored a similar initiative in 2018 to limit profits at the clinics, which the dialysis companies also spent heavily to defeat. When that was voted down, the union went to work almost immediately on Prop. 23, with the intention of writing an initiative that would be easier for voters to understand and more appealing.
Their strategy appeared to fail, with 62% of voters opposing the measure at 10 p.m. Tuesday.
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 Fresnius operate 75% of Californiaâs 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 doctorsâ 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 â any kind of doctor would have been allowed â 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.
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