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CA Prop 23: Kidney dialysis, doctor staffing

The state proposition concerns dialysis clinics. Approximately 80,000 Californians depend on dialysis treatments to live.

CALIFORNIA, USA — Two years ago, California voters rejected new, tougher rules for dialysis clinics by a vote of 60-40. It was called Prop 8 in 2018. The same group is back in 2020, asking again for tougher rules, but just a bit less tough than last time.

Dialysis is a procedure for people with failing kidneys. Your kidneys filter and clean your blood. In dialysis, a nurse hooks you up to a machine that cleans the blood outside of your body instead.

You spend hours hooked up to the machine, usually several times per week And as a result, it’s big business.

Two for-profit companies, Davita and Fresenius, own about three-quarters of the clinics in California. Last time, union groups tried to pass a cap on the profit these clinics can make. This time, it’s a more modest proposal to require a doctor to be on-site during all operating hours of the clinics.

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Right now, each clinic needs to have a medical director who’s a doctor, but they don’t have to be there all the time. For perspective, changing that could cost each clinic a few hundred thousand dollars a year.

Prop 23 also requires dialysis centers to report infection data to the state and not just the federal government as they already do. Prop 23 would ban giving patients different treatment based on how they pay.

Despite language in Prop 23 requiring clinics to get state permission to close down, the state’s analysts caution that some clinics could decide to go out of business if Prop 23 passes, mainly because it would make dialysis more expensive for the companies to do.

The prop reads as follows: 

"Requires physician, nurse practitioner or physician assistant on site during dialysis treatment. Prohibits clinics from reducing services without state approval. Prohibits clinics from refusing to treat patients based on payment source. Fiscal Impact: Increased state and local government costs likely in the low tens of millions of dollars annually."

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What is the full name for Prop 23?

"Establishes state requirements for kidney dialysis clinics. Requires on-site medical professional." You can read the full text here.

What does a YES vote on Prop 23 mean?

A yes vote approved the stricter rules on dialysis. It also would require that operators get approval from the state’s health department before closing a clinic, and prohibit clinics from discriminating against patients based on insurance type. 

What does a NO vote on Prop 23 mean?

A no vote keeps dialysis regulated the way it already is.

You can read the sample ballot here.

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