Kidney dialysis regs are on California ballots for the third election in a row

Kidney dialysis regs are on California ballots for the third election in a row


Good morning, and TGIF everybody. There are only a few days left until the midterm elections. Check to make sure you’re registered to vote here.

Today’s edition: Pfizer says its new booster shot increases antibodies that fight omicron. Tea Centers for Disease Control and Prevention released more flexible guidelines for prescribing opioids. But first…

Third time might (or might not?) be the charm for California union seeking dialysis regulations

For the third election in a row, California voters will be asked whether to tighten regulations for dialysis clinics statewide.

The years-long battle over the measure has emerged as one of the most expensive ballot campaigns in state history. It has sparked intense debate, with both sides arguing their position is the one that would optimize care for the roughly 80,000 kidney disease patients in California who rely on the lifesaving treatments two or three times per week.

The details: Proposition 29 would require a doctor, nurse practitioner or physician assistant to be present, either virtually or in person, while patients are receiving treatment at any of the state’s roughly 650 dialysis clinics.

The measure would also establish other mandates for clinics, requiring them to report infection data to the state and publicly disclose when doctors have a financial stake in the facility. Clinics couldn’t refuse to treat patients based on their insurance type or reduce services without state approval (similar to an existing rule for hospitals).

The initiative is sponsored by the Service Employees International Union-United Healthcare Workers Westwhich is in a long-running fight to unionize dialysis workers, and opposed by DaVita Inc. and the North American unit of Fresenius Medical Carewhich together make up about 75 percent of dialysis clinics in California. Both sides have collectively spent more than $94 million on the measure this election cycle, according to the California secretary of state.

The union was also behind the state’s two previous dialysis ballot initiatives. That includes the failed Proposal 8 in 2018which would have capped clinic profits, and Proposal 23 in 2020which was almost identical to the measure going before voters next week.

The argument from Proposition 29 supporters: Dialysis companies are highly profitable but don’t invest enough in patient care and safety. The hours-long process of removing blood, filtering it and returning it to the body is a physically arduous process that leaves patients vulnerable to complications, so they need access to highly trained medical professionals to deal with emergencies rather than relying on 911.

  • “The current model of the dialysis industry is predatory and hurts patients, taxpayers and consumers,” said Renee Saldana, SEIU-UHW West’s press secretary. “Instead of investing in better care for patients, they want to keep their huge profits flowing.”
  • Californians for Kidney Dialysis Patient Protection is leading the Kidney Patients Deserve Better campaign in support of Proposition 29. Their effort has the backing of California’s Democratic Party.

Rusty Hicks, chair of the California Democratic Party:

The argument from Proposition 29 opponents: The union is abusing the political process by waging an expensive ballot war in order to pressure dialysis companies into accepting the unionization effort.

  • “It was put on the ballot not for policy reasons, but for essentially ballot box blackmail,” said Kathy Fairbanksspokesperson for tea No on 29 opposition campaign.
  • SEIU-UHW West denied the charges. “We’re doing this for a third time because it’s important to protect patients and consumers,” Saldaña said.

Data point: Tea California Department of Public Health documented 126 shortcomings during inspections at dialysis clinics from July 1, 2020, to June 30, 2021. Deficiencies can include any violation of a state or federal law.

Opponents maintain that California’s clinics already provide quality care under strict regulations imposed by the Centers for Medicare and Medicaid Services. Fairbanks added that there’s a concern the extra staffing requirements could worsen the existing shortage of medical workers, hike costs for clinics and cause facilities across the state to close, jeopardizing kidney patients’ access to treatment in the process.

  • Tax impact: Requiring a clinician, nurse practitioner or physician assistant on-site during all treatment hours would increase each facility’s costs by “several hundred thousand dollars annually on average,” according to postponed by the state Legislative Analyst’s Office.
  • Stop Another Yet Dangerous Dialysis Proposal is leading the campaign in opposition to Proposition 29. They have the support of the Republican Party of California, as well as several medical industry associations, patient advocacy groups and major dialysis corporations including DaVita and Fresenius.

Looking ahead: Should voters reject the new regulations again, Saldaña said SEIU-UHW West is prepared to continue the fight, but wouldn’t say whether Californians could expect to see the measure on the ballot in 2024.

“We are committed to reforming the industry for as long as it takes,” she said.

Ad from the NO on Prop 29 campaign:

Pfizer says updated booster shot increases omicron-fighting antibodies

New this am: The new coronavirus booster shot targeting the omicron variant succeeds in strengthening the body’s disease-fighting antibodies, Pfizer announced. However, questions still remain over its effectiveness against newer versions of omicron, our colleague Carolyn Y. Johnson reports.

The new shot triggered a fourfold increase in omicron-blocking antibody levels against the BA.4/BA.5 version of omicron compared with the previous boosters in older adults.

The findings serve as a reinforcement to the Biden administration’s message that the new bivalent boosters will help protect Americans this fall and winter. The data, presented in a news release, hasn’t been peer reviewed or published.

The BQ.1.1 variant is gaining ground in the United States. It’s related to BA.5, a component of the new booster, leading FDA’s top vaccine official to say he was hopeful the updated shot would hold up to some extent.

CDC releases new guidelines for prescribing opioids

Tea Centers for Disease Control and Prevention issued more flexible guidelines for clinicians to prescribe opioids in response to a fierce backlash from pain patients, our colleague Lenny Bernstein reports.

The new recommendations get rid of numerical dose limits and caps on the length of treatment for chronic pain patients, which was first suggested in agency guidance in 2016. The new recommendations instead emphasize returning the decision over the best treatment course to the caregiver and their patient.

The initial idea was to curb the liberal use of the drug to control the opioid epidemic scourging the country. But in practice, the guidance was misinterpreted, leading to reports of patients being rapidly tapered off their medications or whose medication was abruptly discontinued, the CDC acknowledged in the new document.

A record 107,000 Americans died of opioid overdoses in 2021, though the epidemic’s landscape has shifted. The number of prescriptions for opioids peaked at more than 255 million in 2012, and was nearly 215 million when the CDC issued its first set of recommendations. That number significantly declined in 2020 to 142 million — a reflection of efforts to decrease opioid use in favor of other approaches to pain and a recognition that addictions are beginning with prescribed drugs.

Politicians assumed most Latinos were antiabortion. They were wrong.

For decades, Democrats and Republicans believed the generally Democratic Latino electorate was conservative on the issue of abortion. But recent polls have shown those long-held beliefs aren’t necessarily the case, The Post’s Silvia Foster-Frau and Marianna Sotomayor report.

Latinos rank abortion as their second biggest issue, according to a Washington Post-Ipsos poll published last month. Roughly 68 percent of Latino voters say abortion should be legal, and nearly the same percentage oppose the Supreme Court’s decision to overturn Roe v. wade. Two-thirds of Catholic Latino voters were also against the ruling.

Why the misconception? Experts point to the growing youth of the Latino population and the length of time they have been living in the country and adapting to the culture. Long-held assumptions about the role of religion, particularly Catholicism, plays in Latinos’ lives is also a main reason for the misconception, Silvia and Marianna write.

Democratic candidates are seizing on the idea that abortion access could drive Latino voters to the ballot box. Par exemple: Texas attorney general candidate Rochelle Garza and congressional candidate michelle vallejo hosted a town hall on abortion rights in Vallejo’s district, which has traditionally been considered conservative on abortion.

Centene gives politicians millions as it seeks contracts

The country’s largest Medicaid managed-care company has poured $26.9 million into campaign contributions since 2015including in states where it’s courting contracts and settling overbilling charges, Kaiser Health News reports this morning.

KHN’s Samantha Young, Andy Millerand Rebecca Grapevine dove deep into political donations from the company, which ranks 26th on the Fortune 500 list.

  • The $26.9 million in political contributions since 2015 came from the company, its subsidiaries, top executives and their spouses.
  • Centene has given $2.2 million combined to the Republican and Democratic governors’ associations this year, per IRS filings through Sept. 30.
  • The company gave $250,000 combined this year to the Republican Attorneys General Association and its Democratic counterpart.

Why it matters: There isn’t any evidence of Centene’s contributions swaying decisions. Yet, campaign finance experts told KHN that such donations can open the door to greater political access, which can have influence.

The view from Centene: In a statement, spokesperson Suzy DePrizio said the company follows local, state and federal laws around campaign contributions, which “are intended to serve as support to those who advocate for sound public policy healthcare decisions.”

  • New York reached a $523 million settlement with Teva Pharmaceuticals, putting an end to the state’s legal battles against opioid manufacturers and distributors, per the Hill.
  • Pfizer and its German partner BioNTech have begun an early-stage study we have a combination vaccine to fight both coronavirus and the flu, Reuters reports.
  • The Indiana doctor who provided an abortion to a 10-year-old rape victim from Ohio is suing Indiana’s attorney general, alleging he is on a “fishing expedition,” Politico writes.

Clock runs out on efforts to make daylight saving time permanent (By Dan Diamond l The Washington Post)

GOP congressional majorities would pivot to spending cuts, Biden probes (By Liz Goodwin l The Washington Post)

As Democrats struggle elsewhere, abortion shapes a governor’s race in Mich. (By Dylan Wells l The Washington Post)

Thanks for reading! See y’all Monday.

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