California Elections 2020: Proposition 23 - Kidney Dialysis Clinic Requirements

Created: 06 September, 2020
Updated: 14 August, 2022
4 min read

What Would This Ballot Initiative Require of Dialysis Clinics?

The ballot measure would require chronic dialysis clinics to:[1]

  • have a minimum of one licensed physician present at the clinic while patients are being treated, with an exception for when there is a bona fide shortage of physicians;
  • report data on dialysis-related infections to the state health department and National Healthcare Safety Network (NHSN);
  • require the principal officer of the clinic to certify under penalty of perjury that he or she is satisfied, after review, that the submitted report is accurate and complete; and
  • provide a written notice to the state health department and obtain consent from the state health department before closing a chronic dialysis clinic.

The ballot measure would also state that a chronic dialysis clinic cannot "discriminate with respect to offering or providing care" nor "refuse to offer or to provide care, on the basis of who is responsible for paying for a patient's treatment."[1]

How Does This Ballot Initiative Relate to 2018's Proposition 8?

In 2018, 59.9 percent of voters rejected California Proposition 8, which would have required dialysis clinics to issue refunds to patients (or patients' insurers) for profits above 115 percent of the costs of direct patient care and healthcare improvements.[2] Proposition 8 (2018) and the Dialysis Clinic Requirements Initiative (2020) were designed to enact policies related to dialysis clinics, but the specific policies are different. Proposition 8 would have capped profits and required refunds, whereas this year's initiative would address minimum physician staffing, data reporting, and clinic closures.

Proposition 8, like this year's dialysis-related ballot initiative, had the support of the SEIU-UHW West, a labor union for healthcare workers. Proposition 8 established a new front in the conflict between the SEIU-UHW West and the state's two largest dialysis businesses, DaVita and Fresenius Medical Care. The SEIU-UHW West said workers at dialysis clinics have been attempting to unionize since 2016, but that their employers were retaliating against pro-union employees. Kent Thiry, CEO of DaVita, argued that "Proposition 8 puts California patients at risk in an effort to force unionization of employees."[3] Sean Wherley, a spokesperson for the SEIU-UHW West, contended that dialysis workers "want these [initiative] reforms regardless of what happens with their union efforts."[4]

What is Proposition 23?

If approved, Proposition 23 will require at least one licensed physician on site during treatment at outpatient kidney dialysis clinics, authorizes the California Department of Public Health to exempt clinics if there is a shortage and there is at least a nurse practitioner or physician assistant. The Proposition will also require clinics to report dialysis-related infection data to state and federal governments. 

Official Ballot Arguments for Proposition 23

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.

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.

See all the arguments in favor of Proposition 23 here.

Official Ballot Arguments against Proposition 23

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.

IVP Existence Banner

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.

See all the arguments against of Proposition 23 here.

Official Websites for Proposition 23

Visit the Yes on Proposition 23 Website: https://yesonprop23.com/

Visit the No on Proposition 23 Website: https://noprop23.com/

Who is Funding Proposition 23

The Californians for Kidney Dialysis Patient ProtectionPAC was registered to support the ballot initiative. The committee had raised $6.11 million from the SEIU-UHW West.[8]

Who is Supporting Proposition 23?

Californians for Kidney Dialysis Patient Protection is leading the campaign in support of the ballot initiative.[7] The SEIU-UHW West is sponsoring the campaign.[8]

Megallan Handford, dialysis registered nurse 

Pastor William Smart, Jr., Southern Christian Leadership Conference of Southern California

IVP Existence Banner

Carmen Cartagena, dialysis patient

Who is Opposing Proposition 23?

Stop the Dangerous & Costly Dialysis Proposition is leading the campaign in opposition to the ballot initiative.[9]


  • Fresenius Medical Care [Source]


  • AMVETS, Department of California [Source]
  • American Legion, Department of California [Source]
  • California Medical Association [Source]
  • California NAACP State Conference [Source]

Marketa Houskova, executive director of the American Nurses Association in California 

Dewayne Cox, Kidney dialysis patient 

Peter Bretan, president of the California Medical Association

For more information, go to ballotpedia.org

IVP Existence Banner

Have an opinion on this ballot measure? Share your thoughts in a written or video commentary! Email it to hoa@ivn.us

Latest articles

US Capitol
'Democracy' or 'Republic': The Debate Distracts from A Much Larger Problem
Once again, the US finds itself having a familiar discussion. Some people will use the term “democracy” to refer to the US, and then there will inevitably be some who respond with, “We’re not a democracy; we’re a republic.”...
20 June, 2024
5 min read
white house
Should A Candidate's Age Matter in Presidential Elections?
Government positions serve as forums for innovation and change. Younger people have new insights and ideas, and they are frequently more aware of the changing societal needs and developments in technology....
19 June, 2024
7 min read
Gov. Lamont
Gov. Lamont: Growing Consensus of Conn. Voters Favor Ranked Choice Voting
Connecticut Governor Ned Lamont formed a task force this month to come up with a comprehensive legislative proposal by the end of the year that would enable state municipalities and parties to use ranked choice voting (RCV)....
18 June, 2024
3 min read