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Patient Advocacy Or Political Ploy? Union, Industry Square Off Over Dialysis Initiative

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This yr, California dialysis clinics — and their income — are in a robust union’s crosshairs.

On Nov. 6, the Service Employees International Union-United Healthcare Workers West union hopes to ship a stinging blow with a poll measure designed to restrict clinic income.

Proposition Eight, or the “Fair Pricing for Dialysis Act,” would cap dialysis clinic income at 115 % of the prices of affected person care, with income above that quantity to be rebated primarily to insurers. Medicare and different authorities applications, which pay considerably decrease costs for dialysis, wouldn’t obtain rebates.

It’s been a pricey marketing campaign, suggesting excessive stakes for each side. The union, which sponsored the initiative and represents over 150,000 nurses and different well being care employees in California, to date has invested practically $17 million within the effort.

Two main nationwide for-profit dialysis firms, DaVita and Fresenius Medical Care, dominate California’s market and are preventing again arduous, contributing greater than $40 million and $22 million respectively to defeat the measure. Overall, dialysis firms have raised greater than $72 million to oppose the initiative.

In California, near 70,000 sufferers want common dialysis, which basically performs the operate of kidneys for sufferers whose personal kidneys are failing. DaVita and Fresenius management 70 % of the nation’s market. Between them, they reported greater than $four billion in working income final yr.

Proponents say the initiative would spur clinics to cut back govt salaries, enhance funding in affected person care and decrease the costs for sufferers with non-public insurance coverage.

“It will allow these companies to make good profits, but not the obscene profits they make now,” mentioned Steve Trossman, a spokesman for the union and the “Yes on 8” marketing campaign.

Opponents argue the difficulty is just too difficult to be determined on the polls and that it might scale back sufferers’ entry to care, inflicting the overwhelming majority of clinics to lose cash and forcing many to close down.

Fresenius and Davita referred questions on the initiative to the “No” marketing campaign. But in an earnings call last month, DaVita CEO Kent Thiry mentioned the passage of the initiative in California would have principally “unsustainable” results on dialysis facilities.

A win for the union, referred to as SEIU-UHW, might encourage related efforts elsewhere, mentioned Laurel Lucia, director of the well being care program on the Center for Labor Research and Education on the University of California-Berkeley.

“The initiative addresses a national problem,” she mentioned. “If the policy is implemented successfully here, it wouldn’t be surprising if it spread to other states.”

Similar measures pushed by the union in Ohio and Arizona didn’t make the ballots for this November’s election.

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The initiative is a part of the union’s wide-ranging marketing campaign to power modifications within the dialysis trade. In August, California legislators permitted a invoice promoted by the union that may have successfully capped reimbursement charges for dialysis clinics. While that was perceived as a stable victory for SEIU-UHW, Democratic Gov. Jerry Brown vetoed the measure final month.

A couple of years in the past, SEIU-UHW started organizing amongst dialysis clinic employees, elevating issues about poor sanitation, excessive an infection charges, understaffing, exorbitant costs for these lined by non-public insurance coverage and different issues. The union ramped up its efforts on the poll measure after legislative makes an attempt to deal with among the points stalled final yr.

Since 2012, the union has spent tens of thousands and thousands of on a number of state and native poll initiatives in California referring to a variety of well being care points, together with entry to inexpensive insurance coverage, hospital and clinic funding, and coaching for in-home supportive companies.

In 2013, as an illustration, SEIU-UHW launched poll measures in California concentrating on hospital pricing and govt pay, and opponents accused the union of abusing the poll course of to power compliance with its calls for.

According to Thad Kousser, a professor on the University of California-San Diego and an professional within the legislative course of, the technique of utilizing poll measures for political leverage is customary follow and never distinctive to SEIU-UHW. Even if the dialysis initiative is defeated, Kousser mentioned, the trouble will probably present the union with a bargaining edge in future negotiations.

“It strengthens the union’s hand for future bargaining, even if it doesn’t win now,” Kousser mentioned.

The union says it makes use of poll measures to enhance well being circumstances for all state residents, not simply its members. “We made a decision as a union a number of years ago that in order to be successful, we couldn’t just be worried about our own members and our own narrow interests and have blinders,” Trossman mentioned.

Nonsense, say critics.

“The spin from the SEIU-UHW is that the union is crusading for a healthier California, not trying yet again to get leverage over health-care employers,” declared an editorial final yr within the San Diego Union-Tribune. “Californians with failing kidneys have enough worries. They should not be political pawns.”

The “No on 8” marketing campaign, citing findings from the Centers for Medicare & Medicaid Services, notes that California’s clinics fee increased than these in different states on quality-of-care measures, comparable to avoiding pointless transfusions, stopping infections and sustaining correct blood ranges of calcium ranges.

“The ‘Yes on 8’ people talk about a crisis in dialysis and that’s not even close to being the truth,” mentioned Kathy Fairbanks, spokeswoman for the “No” marketing campaign.

But different analysis, comparable to a 2014 research of Medicare beneficiaries nationwide, discovered that sufferers handled at for-profit clinics had increased hospitalization charges than these in not-for-profit facilities.

In June, a Colorado jury discovered DaVita chargeable for the deaths of three sufferers who suffered cardiac arrests following dialysis therapy, ordering the corporate to pay nearly $400 million in damages. Witnesses had accused DaVita of failing to supply ample warning to docs in regards to the attainable dangers of a drugs generally used throughout dialysis. The firm mentioned on the time it could enchantment. In 2016, Fresenius agreed to pay $250 million to resolve 1000’s of lawsuits involving the identical medicine.

In the heated battle over subsequent month’s poll measure, each side have lined up many dozens of endorsements from group and statewide organizations. Proponents have sturdy labor and Democratic Party assist. The California Medical Association, and another medical teams, together with many veterans’ and enterprise organizations, again the “No” marketing campaign, arguing that the change would put dialysis sufferers in danger.

The “No” marketing campaign has spent thousands and thousands on television and online ads because the election nears. The “Yes” marketing campaign has additionally launched an aggressive advert marketing campaign.

Not all dialysis sufferers assist the invoice. Dialysis affected person DeWayne Cox, a 55-year-old impartial filmmaker and Uber driver in Sherman Oaks, mentioned his opposition goes in opposition to his pure inclination to assist labor. But he fears the mandated modifications would power clinics to shut and make it tougher for sufferers like him to get dialysis.

“The thing is, I come from a union family, I believe in unions, but in this case I question their [SEIU-UHW’s] motives,” Cox mentioned.

Use Our Content This story might be republished totally free (details).

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Harriet Rowan:”>, @HattieRowan

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