Healthcare policy agenda driven by elections in Congress, states

There are two major state healthcare ballot initiatives voters will decide this fall: a measure regulating California dialysis clinics and a proposal to give Oklahoma lawmakers more flexibility to fund the state’s Medicaid expansion.

Proposition 23 in California, which is supported by the influential Service Employees International Union-United Healthcare Workers West union, would require chronic-dialysis clinics to have an on-site physician while patients are treated, report data on infections and get permission from the state before closing clinics.

Dialysis industry giants DaVita and Fresenius have poured money into defeating the measure—$93 million to proponents’ $6 million, according to state disclosures—claiming it would create arbitrary bureaucratic requirements and cause some clinics to close.

Proponents say the measure would improve patients’ quality of care. SEIU-UHW spokesman Steve Trossman said the dialysis industry makes massive profits and could afford to comply with the regulations.

A 2018 SEIU-UHW-backed initiative that would have capped dialysis clinics’ profits failed, and newspaper editorial boards across California urged voters to reject this year’s proposal, calling it an intentional negotiating ploy.

Oklahoma voters will decide whether to take annual funds from a tobacco company settlement and let lawmakers use it to fund Medicaid programs, including the Medicaid expansion voters approved in June. Republican Gov. Kevin Stitt supports the measure, while the Oklahoma Hospital Association has not taken a position.

States across the country will be facing a fiscal crunch as tax revenue plummets, and state government elections will determine how states face down their deficits.

Medicaid provider payments are likely targets, as states have limited options to cut other Medicaid expenditures as a condition of accepting federal aid.

“The question is how states react to fiscal constraints that they are facing. Will they cut Medicaid? Will they cut elsewhere or create new sources of revenue?” said Heather Howard, a Princeton University lecturer and director of a program that gives states technical assistance on healthcare policy reform.