Prop 8 Jeopardizes Access to Dialysis Treatment that Patients Need to Survive

Patients on dialysis have failed kidneys and are very ill. A single missed dialysis treatment increases the risk of death for dialysis patients by 30%. That is why Proposition 8 is opposed by the American Nurses Association\California, the California Medical Association, American College of Emergency Physicians - CA, patient advocates including Dialysis Patient Citizens, and many others. Prop 8 jeopardizes access to dialysis care that patients need to survive.

Prop 8 jeopardizes access to dialysis care patients need to survive.

Proposition 8 sets severely low limits on what insurance companies are required to pay for dialysis care. These limits do not cover the cost of providing care, forcing many clinics to cut back services or even close.

An independent study by the state’s former Legislative Analyst and the economic think tank, Berkeley Research Group, found that, under Prop 8, eighty-three percent (83%) of dialysis clinics in California would operate at a loss.

In a report to the state Legislature in May, the independent state Legislative Analyst’s Office said, “In some cases, CDCs (community dialysis clinics) and their parent companies may decide to open fewer new clinics or close…”

Prop 8 puts the lives of vulnerable dialysis patients at risk.

Dialysis does the job of a patient’s failed kidneys to remove toxins from the body. Dialysis patients cannot survive without regular treatments, three days a week, four hours at a time.

Without access to community clinics, patients will have to travel long distances or end up in already overcrowded hospital emergency rooms to receive care.

Worse, many patients might miss treatments and become very ill. Research shows that missing even one dialysis treatment increases the risk of death for dialysis patients by 30%.

The number of people needing dialysis in California is increasing at about five percent a year. Because California clinics are already the 5th most constrained in the nation, we should be doing everything we can to expand access to dialysis, not limit it as this proposition would do.

Prop 8 excludes key caregivers and services vital to providing high-quality, comprehensive care.

Prop 8 narrowly defines what insurance companies are required to reimburse dialysis clinics for patient care. In fact, Prop 8 excludes critical staff and services necessary to provide high-quality care, as well as services required by federal regulators, including:

  • physician Medical Director
  • nurse Clinical Coordinators
  • staff who help patients navigate insurance options
  • community-based kidney disease education
  • regulatory compliance
  • facility administrators
  • facility security
  • non-clinical information technology
  • professional services like accounting,
    human resources, payroll and legal


With this limited definition of allowable costs, under Prop. 8 clinics could only recover 69% of their operating costs—thus forcing closures or major cutbacks.

Prop 8 increases costs for all Californians by hundreds of millions per year.

As dialysis clinics shut down, options for treatment would be severely limited. This would force patients to seek regular treatment or treatment for complications in more expensive hospital emergency rooms, meaning more ER and hospital overcrowding, and potentially hundreds of millions of dollars in higher costs for Medi-Cal and Medicare to treat dialysis patients – and higher costs for taxpayers.

Prop 8 is an abuse of the initiative system.

Prop 8 is funded by United Healthcare Workers West (UHW) union as part of an attempt to pressure dialysis clinics to unionize workers. While unions have the right to try to organize workers, it’s not right to abuse the initiative system and use vulnerable patients as political pawns.

Since 2012, UHW has spent $35 million in California and other states on more than 20 punitive state and local ballot measures in an attempt to force hospitals and other healthcare providers to accept their union organizing and contract demands.

California dialysis care quality ranks among the highest in the nation.

California dialysis clinics are highly regulated by state and federal regulators that provide quality reports on every facility. Clinics are regularly inspected and evaluated based on 376 indicators.

According to the federal Centers for Medicare & Medicaid Services, California clinics outperform other states in clinical quality and patient satisfaction. This dangerous measure makes no sense when California dialysis care is highly regulated and saving lives.