Commentary: Kidney patients breathe easier, but wariness advised

For quite awhile this year, it seemed like open season on kidney dialysis patients, the more than 66,000 Californians who depend for life after kidney failure on getting their blood cleansed during sessions of three or more hours three times a week.

The most serious threat came from Proposition 8, which lost at the polls by a 62–38 percent margin, but not before it became the year’s most expensive issueoriented campaign in America, more than $120 million being spent on both sides.

There was also a threat this year from the Legislature, whose strong Democratic majorities are so much under the sway of labor unions which provide much of their campaign funding that they easily passed a measure threatening to throw dialysis patients off their health insurance plans if they accept third-party aid in paying their premiums.

Bear in mind, many dialysis patients are so exhausted and weakened by the constant blood exchanges they undergo that they cannot work, living on fixed disability payments and other forms of welfare. For many, premium assistance is the key to staying alive.

Fortunately for them, outgoing Gov. Jerry Brown vetoed this ill-advised measure sponsored by Democratic state Sen. Connie Leyva, whose Inland Empire district spans many miles between Pomona and San Bernardino.

“This bill goes too far as it would permit health plans and insurers to refuse premium assistance payments and to choose which patients they will cover,” Brown’s veto message said.

Spreading the alarm as the measure sped through committee after committee was the American Kidney Fund (AKF), largely funded by big dialysis companies which stood to lose under the measure. The AKF uses donations to give premium help for 74,000 dialysis patients in all 50 states, including almost 4,000 Californians.

Noting that the bill was largely backed by health insurance companies, a statement from the AKF called the Leyva bill “a thinly veiled attempt by insurers to prevent kidney patients from being able to choose their own insurance plan if they accept charitable premium assistance.”

The fund claimed the bill’s aim was to let insurance companies rid themselves of “sicker and more costly patients.” And make no mistake, dialysis is costly, often running more than $6,000 per month and sometimes more than $50,000.

That high cost was also the ostensible motivating factor behind Proposition 8, primarily sponsored by the Service Employees International Union, which would dearly like to recruit thousands of technicians and nurses working in California’s 550 dialysis clinics.

The measure claimed it would hold costs down by forbidding clinics from charging insurance companies for the work of physician medical directors vital to maintaining quality care. It also would not have allowed clinics to charge for the work of facility administrators, security personnel and professional services like accounting, payroll and legal expenses, all normally considered ordinary costs of doing business.

Cut those costs, the sponsors argued, and everyone’s health insurance premiums would drop. But the two largest owners of dialysis clinics in California, the German-based Fresenius Medical Care and Denver-based Davita Corp. responded by saying the cuts would force them to close many clinics.

No one knows how many they would really have shuttered, but if they closed any significant number, the long rides many dialysis patients now endure several times a week before and after treatment would grow even longer and tax their depleted strength much more.

Fresenius and Davita put their money where their mouths were by becoming the prime funders of the seemingly ubiquitous campaign against Proposition 8.

Had either of these proposals become state law, the lives of thousands of patients figured to become even more difficult.

So there was relief in the clinics when both measures ultimately failed. But there is no guarantee either won’t be back, especially with a new governor taking office Jan. 3 and nobody quite sure how he might deal with similar measures if the Legislature puts them on his desk.

This means dialysis patients who are fit enough to track these developments – and many are not – cannot afford to relax completely even though the two immediate threats were not realized. They must remain wary and ready to respond again if and when similar dangers arise.