California’s $100M dialysis battle comes with ancillary advantages for labor union
OAKLAND — In initiative-happy California, one set of advertisements stands out — these involving dialysis clinics, an trade that is traditionally been a lower-profile participant in politics.
The advertisements are uncommon not solely due to their unlikely matter however their quantity, which is excessive as a result of trade opponents of a labor poll measure are spending greater than any group opposing the opposite 11 proposals California voters should resolve on.
The huge spending hole between the $100 million opponents, together with DaVita Inc., have raised and the $8.9 million by supporters led by SEIU United Healthcare Employees West implies that the dialysis trade has flooded airwaves because it defends itself in opposition to organized labor. The identical chain of occasions performed out two years in the past, leading to a convincing defeat for the union’s poll initiative.
California’s poll wars have escalated lately as industries see little downside spending greater than $100 million — and almost twice that quantity within the gig trade’s case — to influence the citizens. Companies and organizations that do not get their manner within the state Capitol typically use the poll to vary state legal guidelines or as leverage to strain lawmakers and different highly effective pursuits. Proposition 23 is the third most costly poll initiative in 2020, in line with information compiled by POLITICO.
Take a look at POLITICO’s California Poll Tracker right here.
Whereas SEIU-UHW says it’s dedicated to passing Prop 23, political strategists recommend that labor backers could merely be taking part in the lengthy sport by putting an initiative on the poll each two years difficult the trade. Win or lose, the union is placing strain on dialysis corporations to spend gobs of cash every basic election.
“The specter of a poll measure is one thing UHW has used strategically,” stated Brian Brokaw, a Democratic strategist in Sacramento who shouldn’t be concerned within the Prop. 23 marketing campaign. “To ensure that a menace to truly be credible, generally it’s a must to put it on the poll. However showing on a poll and truly working a marketing campaign to help one thing are two various things.”
Proposition 23 faces lengthy odds not simply due to the trade’s $100 million struggle chest, but in addition as a result of it includes a regulatory matter on a crowded poll — an ideal recipe for voter rejection.
Two years in the past, Californians voted 60-40 to reject Prop. 8, one other SEIU-UHW-backed initiative that may have capped dialysis income. However to get that win, the dialysis trade, led by the dominant franchises DaVita Inc. and Fresenius Medical Care, invested about $111 million to defeat it, or almost six instances what the proponents spent.
Sooner or later after that Nov. 6, 2018 election, the union vowed to refile the initiative in California and different states. SEIU-UHW did file one other initiative, however Prop 23 appears dramatically totally different, specializing in necessities that clinics should meet corresponding to staffing one physician on web site.
John Logan, director of labor employment research at San Francisco State College, stated unions have lengthy used non-traditional ways like ballot-box campaigns to get corporations to the negotiating desk.
“They don’t have to speculate any of their cash to help it, however the different aspect has to spend tens of hundreds of thousands as a result of it will be a catastrophe if it have been to cross,” he stated.
That David-and-Goliath theme is taking part in out once more this time. The trade has amassed greater than $104 million up to now to defeat the initiative, in comparison with almost $9 million on the sure aspect.
SEIU-UHW is aware of it’ll be vastly outspent by the trade, however says it’s not a part of a method to get the dialysis corporations to cut price with them. Union officers acknowledged they wish to arrange the clinics, however say it is an uphill battle and that they haven’t spoken with the clinic operators in additional than 5 years. They are saying they’re on this to enhance affected person care.
“We have now our sights set on them,” SEIU-UHW President Dave Regan stated. “A part of what we view our mission, our cost and our work is we wish to be a company that places a highlight on the worst actors within the well being care trade and, frankly, DaVita and Fresenius are on the entrance of that line.”
SEIU-UHW and different well being care unions, together with the California Nurses Affiliation, have lengthy used affected person care because the centerpiece of campaigns in opposition to well being care entities — each on the poll field and thru legislative efforts.
“The entire concept of utilizing non-traditional ways to realize better leverage in unionizing has been round for years,” SF State’s Logan stated. “SEIU, particularly, is one in every of quite a lot of unions which have used company campaigning very extensively and fairly efficiently over quite a lot of years.”
SEIU-UHW, since 2012, has filed some 23 native and state initiatives. In recent times, they’ve launched a flurry of measures, concentrating on quite a lot of California hospitals to restrict costs and impose government wage caps, although many did not qualify or have been deserted.
Nonetheless, the union counts as victories its marketing campaign to extend the minimal wage, which in 2016 helped spark a legislative deal. And the failure of Prop. 8 led to a 2019 legislation authored by Assemblymember Jim Wooden (D-Santa Rosa), which was designed to regulate well being prices by deterring dialysis clinics from encouraging their sufferers to enroll in well being plans that supply increased reimbursement charges.
However the brand new legislation, which was supposed to enter impact this 12 months, is on maintain whereas an trade lawsuit winds via the courts.
The dialysis trade has come beneath scrutiny for its relationship with the nonprofit American Kidney Fund, which has been accused of steering sufferers towards higher-paying business insurance coverage as an alternative of Medicare, leading to increased clinic reimbursements. Two corporations have offered the majority of funding for AKF, in line with an audit of the nonprofit.
That monetary state of affairs led to the Wooden laws and fueled the union’s 2018 poll initiative drive concentrating on dialysis revenues.
The Sure on Prop. 23 marketing campaign, endorsed by the California Democratic Get together and the California Labor Federation, now contends the multibillion-dollar trade has put the lives of California’s greater than 70,000 dialysis sufferers in danger via substandard care and staffing.
The No on Prop. 23 marketing campaign refutes these claims, emphasizing that the “particular curiosity proposition” would improve well being care prices by hundreds of thousands and pressure clinics to shut, jeopardizing entry to care most acutely in low-income communities. It notes that no different state requires a physician to be on web site throughout dialysis therapy.
Brokaw described the dialysis trade as a “non-traditional boogie man.”
“These dialysis clinics actually present a life-saving service so it’s not such as you’re taking over the tobacco trade,” he stated. However, nonetheless, the marketing campaign is a tactic of “extracting many, many kilos of flesh out of your opponent at a smaller price to your self. And there may be some worth strategically in doing that.”
Regan did not rule out a run on the trade once more if Prop. 23 falls quick.
“We’ll see what we do in 2021, however that is an trade that must be reformed, to change their enterprise practices and to enhance,” he stated, including that SEIU-UHW has price the dialysis trade a few quarter of a billion to combat again. “The rationale they’re keen to spend it’s this enterprise is so profitable for all of the flawed causes, and it’s clearly of their curiosity to do that.”