California dialysis clinics on the ballot for the third time

California ballot measures have generated eye-popping spending by particular curiosity teams and industries, typically even once they have little probability of successful at the ballot field.

Just ask California’s dialysis clinics, who for the third time in as many elections, are combating again a bid by a well being care employees union to alter their enterprise mannequin. And nearing the finish of spherical three, it has turn out to be one in all the most costly proposition fights in Golden State historical past.

Since 2018 the dialysis companies have spent greater than $302 million to oppose the measures, and that quantity is more likely to proceed to develop by November. That is greater than the $205 million Uber, Lyft and Doordash spent in 2020 on a measure to exempt their firms from a state legislation that categorized their drivers as staff. But it’s nonetheless shy of the record-breaking $400 million spent thus far this yr by on-line gaming and tribal casinos on either side of Propositions 26 and 27, which might legalize sports activities playing.

Proposition 29 is the newest try by the Service Employees International Union-United Healthcare Workers West union (SEIU-UHW) to problem the dialysis business status-quo with new laws, even after voters rejected the union’s makes an attempt twice. So why are they making an attempt a third time?

The “No on 29” marketing campaign, backed by the dialysis firms, says the union is abusing California’s direct democracy system, making an attempt to push the firms to the negotiating desk and acquire leverage. But the union says the dialysis business is making large earnings off weak sufferers. Proposition 29 backers insist they’re simply utilizing the instruments accessible to verify company energy, and attain their broader coverage targets.

The spending traits by all sides are telling: The dialysis firms spent over $100 million in 2018 and once more in 2020. This time, as of late September 2022, that they had poured $86 million into opposing Proposition 29, however the union is hardly campaigning for the measure this yr, since getting it on the ballot.

The latest proposition is “a carbon copy” of the 2020 measure, in keeping with Kathy Fairbanks, spokesperson for the “No on 29” marketing campaign. She questions the union’s dedication to getting the measure handed, declaring they solely put up a “Yes on 29” web site final week, in late September. “They got in on the ballot and that was enough for them,” she mentioned. “They’re just walking away.”

SEIU-UHW spent practically $20 million on the first dialysis proposition in 2018, together with hundreds of thousands on promoting. But in 2020 the union spent half that, round $9 million. So far in the 2021/2022 season, the union has amassed $8 million, spent nearly solely on signature accumulating to qualify the measure.

The battle over dialysis clinics isn’t the solely proposition this yr the place victory at the ballot field might not be the finish objective.

Big Tobacco has contributed $16 million to an effort to overturn a state legislation that bans the sale of flavored tobacco merchandise. Even if it doesn’t win, the tobacco business was capable of delay the ban for practically two years simply by qualifying the measure for the ballot, clearing the method for tons of of hundreds of thousands of {dollars} in continued gross sales.

And earlier this yr, after seeing their payments to cut back plastic air pollution defeated repeatedly in the Legislature, environmental teams collected sufficient signatures to position a measure on the ballot requiring firms to make use of much less plastic and take again their merchandise for recycling. Fearing a loss at the ballot field, the firms then labored out a compromise, Gov. Gavin Newsom signed the invoice, and the environmental teams pulled the measure off the ballot.

Not everybody buys the argument that the well being care employees union is simply making an attempt to kneecap the dialysis business to have a greater seat at a future bargaining desk. “If the union had some deep 3D chess political game about union membership, you would think after two defeats they might have picked something else by now,” mentioned Shaun Bowler, a political science professor at UC Riverside.

David Miller, analysis director for the SEIU-UHW, says the union’s objective is straightforward: affected person security.

“We are trying to add one staff person per shift to these dialysis clinics,” he mentioned of the proposition’s requirement that clinics have a health care provider, doctor assistant or nurse practitioner on-site throughout therapy. “It’s not very radical.”

Dialysis clinics are the place about 80,000 Californians with end-stage kidney illness go to get therapies two to 3 instances every week, an costly and life-saving process. The two firms that dominate the business in California, DaVita and Fresenius, function three-quarters of the 600 clinics in the state. The business brings in an estimated $3.5 billion in income from operations in California yearly.

The dialysis firms say the added laws and related prices may drive them to shut clinics, making it a “dangerous” proposition that might harm sufferers. The California Legislative Analyst’s Office predicts the measure “would increase each clinic’s costs by several hundred thousand dollars annually on average.”

Miller mentioned his union was approached years in the past to assist unionize some dialysis employees, which opened their eyes to how the business works and what sort of modifications they might push.

Dave Regan, the present president of SEIU-UHW, has made a popularity for himself and his union by sponsoring native and statewide ballot measures annually, and on their web site, they brag that “Regan is a leading proponent of using ballot initiatives to reduce economic inequality and improve the standard of living for working people and their families.” Those measures have been about points starting from elevating the minimal wage to hospital costs and CEO pay.