Prop 23

a YES vote supports this ballot initiative to require chronic dialysis clinics to: have an on-site physician while patients are being treated; report data on dialysis-related infections; obtain consent from the state health department before closing a clinic; and not discriminate against patients based on the source of payment for care.
a NO vote opposes this ballot initiative to require chronic dialysis clinics to: have an on-site physician while patients are being treated; report data on dialysis-related infections; obtain consent from the state health department before closing a clinic; and not discriminate against patients based on the source of payment for care.

Official Arguments (click ▸ to expand)


Life-Saving Changes for Dialysis Patients Three times each and every week, 80,000 Californians with End Stage Renal Disease go to one of more than 600 commercial dialysis centers in the state where they spend three to four hours connected to a machine that removes their blood, cleans it, and returns it to their bodies. Dialysis literally is what keeps them alive, and they must continue the treatment for the rest of their lives or until they receive a kidney transplant. Because the lives of these fellow Californians are so dependent on dialysis that is done both safely and effectively, we give our absolute support to the Protect the Lives of Dialysis Patients Act, an initiative appearing on the Nov. 3 ballot. This initiative will make common-sense improvements to dialysis treatment that will protect some of the most medically vulnerable people in our society. The initiative does four major things: First, it requires a physician or nurse practitioner to be in the clinic any time patients are being treated, which is not currently required. Dialysis is a dangerous procedure, and if something goes wrong, a doctor or highly trained nurse should be nearby. Second, dialysis patients are prone to infections from their treatments that can lead to more serious illnesses or even death. This initiative requires clinics to report accurate data on infections to the state and federal governments so problems can be identified and solved to protect patients. Third, like all other life-saving health care facilities, the initiative says the dialysis corporations cannot close clinics or reduce their services unless approved by the state. This also is designed to protect patients, particularly in rural communities, to make sure they have access to dialysis treatment, and to stop the dialysis corporations from using closures to pad their bottom line. Fourth, it prohibits clinics from discriminating against patients because of the type of insurance they have, and it protects patients in every clinic. No matter if they are located in a wealthy neighborhood or a poor, rural, Black or Brown community, all clinics will be required to have a doctor or nurse practitioner on site, all clinics will be required to report their infection rates to the state and federal governments, and all dialysis corporations will be prohibited from discriminating against patients because of the type of insurance they have. Don't listen when the dialysis industry claims the initiative will create huge new costs or say patients will be harmed or claim that it will create a shortage of doctors—those fake arguments are just designed to use patients and the coronavirus pandemic as scare tactics in their dishonest public relations campaign. The fact is, these corporations can easily make these changes and still make hundreds of millions of dollars a year without disrupting our healthcare system. Proposition 23 will make the changes we need to truly protect dialysis patients. We urge you to vote YES! MEGALLAN HANDFORD, Dialysis Registered Nurse PASTOR WILLIAM D. SMART, JR. Southern Christian Leadership Conference of Southern California CARMEN CARTAGENA, Dialysis Patient


NURSES, DOCTORS AND PATIENTS URGE NO ON 23—THE DANGEROUS AND COSTLY DIALYSIS PROPOSITION Nearly 80,000 Californians with failed kidneys receive dialysis treatment three days a week to stay alive. Dialysis treatment does the job of the kidneys by removing toxins from the body. Missing a single treatment increases patient risk of death by 30%. Prop. 23 seriously jeopardizes access to care for tens of thousands of Californians who need dialysis to stay alive. That's why the American Nurses Association\California, California Medical Association and patient advocates OPPOSE Prop. 23. PROP. 23 WOULD FORCE COMMUNITY DIALYSIS CLINICS TO CUT SERVICES AND CLOSE—PUTTING LIVES AT RISK Proposition 23 would force dialysis clinics to have a physician administrator on-site at all times, even though they would not care for patients. Each dialysis patient is already under the care of their personal kidney physician and dialysis treatments are administered by specially trained and experienced dialysis nurses and technicians. This useless bureaucratic mandate would increase clinic costs by hundreds of millions annually, putting half of all clinics at risk of closure. “Prop. 23 dangerously reduces access to care, putting vulnerable dialysis patients at serious risk.”—Marketa Houskova, Doctor of Nursing Practice, RN, American Nurses Association\California PROP. 23 WOULD MAKE OUR PHYSICIAN SHORTAGE WORSE AND LEAD TO MORE EMERGENCY ROOM OVERCROWDING “Proposition 23 would take thousands of doctors away from hospitals and clinics—where they’re needed—and place them into bureaucratic jobs at dialysis clinics where they aren’t. This is not the time to make our physician shortage worse.” —Dr. Peter N. Bretan, MD, President, California Medical Association Emergency room doctors strongly oppose Prop. 23. It would force dialysis clinics to close—sending tens of thousands of vulnerable patients to emergency rooms, creating longer ER waits and reducing capacity to deal with serious emergencies. PROP. 23 WOULD INCREASE HEALTH CARE COSTS BY HUNDREDS OF MILLIONS According to a study by the Berkeley Research Group, Prop. 23 would increase health care costs by $320 million annually. This massive increase would be especially damaging when so many Californians struggle financially. DIALYSIS CLINICS ARE STRICTLY REGULATED AND PROVIDE HIGH QUALITY CARE The federal and state governments extensively regulate dialysis clinics. According to the federal Centers for Medicare & Medicaid Services, California dialysis clinics outperform other states in clinical quality and patient satisfaction. “Every dialysis patient is under the care of a physician kidney specialist, and dialysis treatments are administered by specially-trained nurses and technicians. It makes no sense to require physician administrators on-site full-time.” —Dr. Jeffrey A. Perlmutter, MD, President, Renal Physicians Association, representing 3,500 kidney doctors ANOTHER SPECIAL INTEREST ABUSE OF OUR INITIATIVE SYSTEM The same group promoting Prop. 23 spent $20,000,000 last election pushing a similar measure voters rejected. They’re at it again, pushing another dangerous dialysis proposition. DOCTORS, NURSES AND PATIENT ADVOCATES: NO ON 23! • American Nurses Association\California • California Medical Association • Chronic Disease Coalition • NAACP California • Latino Diabetes Association • Women Veterans Alliance • Minority Health Institute www.NoProposition23.com MARKETA HOUSKOVA, DNP, RN, Executive Director American Nurses Association\California LETICIA PEREZ, Kidney Dialysis Patient PETER N. BRETAN, MD, President California Medical Association

🚫 San Francisco Chronicle

"The lives of some 80,000 Californians with kidney failure depend on dialysis, which typically entails three treatments a week lasting four hours each. That they are at the center of a battle over financial spoils for the second time in as many years is an unfortunate comment on the nation’s health care system as well as the state’s initiative process. Vote no in the hope of discouraging any further reliance on this tactic."

🚫 The San Diego Union-Tribune

"The San Diego Union-Tribune Editorial Board acknowledges how much unions have helped their members, but their negotiations — and life or death medical decisions — shouldn’t spill over into the voting public and the state’s initiative process. That’s an abuse of power. Voters should send a clear message not to try this again. No on Proposition 23."

🤐 American Civil Liberties Union SoCal

No stance published.

🚫 Los Angeles Times

"For the second time in two years, California voters will be asked to play the role of healthcare regulators and set rules for how dialysis clinics operate in this state. And once again, they’ll be offered a seemingly appealing way to make clinics safer. But just as they smartly rejected a ballot measure in 2018 that sought to increase clinics’ spending on nurses and technicians, they should reject an initiative this year to increase clinics’ spending on doctors. Proposition 23 — like Proposition 8 in 2018 — would raise costs without delivering a meaningful improvement in the quality of care."

🚫 The Mercury News

"Just as they did two years ago, leaders of a large labor union are trying to use a statewide election to go after the kidney dialysis industry. California voters saw through the political blackmail by the Service Employees International Union in 2018, when 60% of voters rejected Proposition 8, a misguided effort to regulate the industry. ... Votes should send union leaders a strong signal that nuisance ballot measures have no business being on the California ballot."

🚫 Orange County Register

"So this isn’t about Californians’ well-being. The ballot measure wasn’t created by dialysis patients upset by their healthcare options. Its backer is SEIU-UHW West, a healthcare workers’ labor union that has not been successful in organizing employees in dialysis clinics. Its electoral plan is apparently to make the two companies that own most of the state’s clinics spend so much money fighting ballot initiatives every two years that they have a hard time staying in business. That kind of chicanery makes a mockery of California’s initiative system and of your time as a citizen and voter."

🚫 The Desert Sun

“State voters are not equipped to effectively regulate what is indeed a life-saving procedure for some 80,000 of their fellow Californians. Those responsibilities must be left to lawmakers and state and federal regulators. If reforms are needed in this industry, then they must flow from those best able to vet them rather than from the ballot box.

This type of nuisance initiative only serves to increase skepticism about California’s initiative process. Vote “no” on Proposition 23 to send a strong message against such cynical tactics.”

✅ California Democratic Party

"Improves safety and prohibits discrimination in dialysis clinics to protect gravely ill patients."

🚫 Republican Party

"No on Prop 23 – New Dialysis Bureaucracy Increases Health Care Costs

Prop 23 forces unnecessary regulations and costs on dialysis clinics -- shutting nearly half of them down and putting countless patients’ lives at risk."