Prop. 29

Impose new rules on dialysis clinics

What did voters decide?

This is the third time since 2018 that a measure similar to Proposition 29 failed, with 68% voting “no” this year.

What would it have done?

This measure would have required kidney dialysis clinics to have at least one physician, nurse practitioner or physician assistant with six months of relevant experience available on site or, in some cases, via telehealth. It also would have required that clinics report infection data to the state, as well as publicly list physicians who have ownership interest of 5% or more in a clinic. The measure also would have prohibited clinics from closing or reducing services without state approval and from refusing treatment to people based on their insurance type. 

Why was it on the ballot?

This is the third time a labor union, Service Employees International Union-United Healthcare Workers West, goes after dialysis clinics via the ballot process. The union says it wants to reform the booming industry and increase transparency, while dialysis companies that spent millions to defeat the two prior measures say it’s a union ploy to pressure clinics and organize dialysis workers. 

There are about 650 dialysis clinics across the state and about 80,000 Californians receive the life-saving treatment. State analysts estimate that the clinics have total revenue of about $3.5 billion a year and that two private, for-profit companies — DaVita Inc. and Fresenius Medical Care — own or operate three-fourths of the clinics.   

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Prop 29



Supporters argue that dialysis companies do not invest enough in patient care and safety despite being highly profitable. The hours-long process of removing blood, filtering it and returning it to the body is a physically draining process that leaves patients vulnerable to medical complications. Having a physician or nurse practitioner, in addition to current staff, available at all times could help reduce hospitalizations, proponents say. Meanwhile, adding reporting requirements would increase transparency in the dialysis business. 


  • Service Employees International Union-United Healthcare Workers West
  • California Democratic Party


Opponents say that this measure is unnecessary as clinics already provide quality care and have the needed staff to treat and monitor people.  Patients may also reach their nephrologists via telemedicine if needed. Plus, opponents say, clinics already report infection data to the federal government. The opposition warns that these new requirements could result in dangerous consequences — adding physicians would increase costs for clinics, pushing some to potentially reduce hours or close. 


  • American Nurses Association 
  • California Medical Association 
  • California Chamber of Commerce
  • California Republican Party

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Prop 29