Proposition 8

NephJC is taking a sharp turn from this week’s basic science on the molecular structure of proteins into state policy regulating outpatient chronic dialysis for end-stage kidney disease. This is a US only chat and will be at our usual time next Tuesday, October 16th.

Since this is a last minute addition and because it addresses a ballot measure that will be put to the voters of California on November 6th we are taking the additional step of lighting the Emergency NephJC Signal

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Proposition 8 is a California general ballot measure. This time Proposition 8 is not about marriage equality, as it was back in 2008

This time, Prop 8 is about dialysis care.


The proposition limits what private insurance companies pay for dialysis and tries, unsuccessfully, to define what costs are warranted to operate a safe, effective and CMS compliant dialysis center. Prop 8 leaves out funding for several key roles including the dialysis center Medical Director. Medical Directors are required under the CMS conditions for coverage and are the individuals charged with ensuring that the dialysis care delivered in a center is safe, effective, and high quality. By not accounting for required costs and limiting what insurance companies pay, Prop 8 would likely result in the majority of California dialysis centers operating at a loss.

The bottom line is that if passed, Proposition 8 would likely lead to dialysis center closures resulting in less availability of treatment time choice, increased  commute times, missed treatments, and increased hospitalizations, ER visits and potentially deaths. 

Given the above, Prop 8 is opposed by a broad group of organizations including the Renal Physicians Association, the National Kidney Foundation, and dialysis organizations. 

Proposition 8 was funded and is supported by the Service Employees International Union United Healthcare Workers West (SEIU-UHW) who have been attempting to unionize dialysis center staff in California. 

The SEIU-UHW had also submitted a November ballot measure impacting dialysis patients in Ohio that was invalidated by the Ohio Supreme Court on procedural grounds and are employing a similar political approach to labor negotiations with Stanford Health Care through the city of Palo Alto measure F. 

The devil, as with most things, is in the details of Prop 8. No one would disagree with trying to improve the quality of care for dialysis patients or fairly paying those who care for them. Unfortunately Prop 8 does neither of these things and putting the lives of dialysis patients in jeopardy with a general ballot measure is not an acceptable approach. Firm No on 8.  


Graham Abra, MD
Private Citizen 

COI: I care for patients on dialysis, serve as the Medical Director at a home dialysis center and work for a non-profit dialysis organization.