Proposition 8

Outpatient Kidney Dialysis Clinics Regulation

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Would require rebates and penalties if charges for dialysis exceed the revenue limit and would also require annual reporting to the state. This measure would prohibit clinics from refusing to treat patients based on payment source. Proposition 8 is an initiative statute.

Fiscal Impact: The overall annual effect on state and local governments would range from net positive impact in the low tens of millions of dollars to net negative impact in the tens of millions of dollars.

Semi-official results:

Yes: 1,582,307 (38.2%)

No: 2,560,711 (61.8%)



Proponents of Proposition 8 argue that dialysis is a life-saving treatment, but big dialysis corporations making large profits don't invest enough in basic sanitation and patient care. To proponents, Yes on 8 supports investment in quality patient care and stops overcharging that drives up costs for Californians

A YES vote on this measure means: Kidney dialysis clinics would have their revenues limited by a formula and could be required to pay rebates to certain parties (primarily health insurance companies) that pay for dialysis treatment.


Opponents of Proposition 8 argue that it is opposed by thousands of nurses, doctors, patients, the American Nurses Association\California, California Medical Association, American College of Emergency Physicians of CA because it would result in the closure of many dialysis clinics in California—dangerously reducing access to care, putting the lives of vulnerable dialysis patients at risk, and increasing costs for California taxpayers.

A NO vote on this measure means: Kidney dialysis clinics would not have their revenues limited by a formula and would not be required to pay rebates.

In Depth


Most Dialysis Patients Receive Treatment in Clinics. Individuals with kidney failure may receive dialysis treatment at hospitals or in their own homes, but most receive treatment at chronic dialysis clinics (CDCs). As of May 2018, 588 licensed CDCs in California provided treatment to roughly 80,000 patients each month. Each CDC operates an average of 22 dialysis stations, with each station providing treatment to one patient at a time. The California Department of Public Health (DPH) is responsible for licensing and inspecting CDCs. Various entities own and operate CDCs. Two private for-profit entities (DaVita, Inc. and Fresenius Medical Care) operate and have at least partial ownership of the majority (72%) of CDCs in California.

CDCs have total estimated revenues of roughly $3 billion annually from their operations in California. These revenues consist of payments for dialysis treatment from a few main sources:

  • Medicare
  • Medi-Cal
  • Group and Individual Health Insurance

Group and individual health insurers typically pay higher rates—as much as multiple times more—for dialysis than government programs.

Proposition 8 Proposal

Requires Clinics to Pay Rebates When Total Revenues Exceed a Specified Cap. Beginning in 2019, the measure requires CDCs each year to calculate the amount by which their revenues exceed a specified cap. The measure then requires CDCs to pay rebates (that is, give money back) to payers, excluding Medicare and other government payers, in the amount that revenues exceed the cap. The more a payer paid for treatment, the larger the rebate the payer would receive.

The revenue cap established by the measure is equal to 115 percent of specified "direct patient care services costs" and "health care quality improvement costs. In addition to paying any rebates, CDCs would be required to pay interest on the rebate amounts, calculated from the date of payment for treatment.

Source: LAO Analysis of Proposition 8


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Voter Resources

Official California Documents

Official Voter Guide

Prop 8 - California Official Voter Guide

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Nonpartisan Analysis


Authorizes State Regulation of Kidney Dialysis Clinics. Limits Charges for Patient Care. Initiative Statute. Initiative Statute. Legislative Analyst's Office.

Ballot Measure Guide - Prop 8. Berkeley IGS.

"Video Voter Series - Proposition 8" from Rose Institute of State and Local Government at Claremont McKenna College
"Video Voter Series - Proposition 8" from Rose Institute of State and Local Government at Claremont McKenna College
"Proposition 8 Explained in Under 1 Minute" from CALMatters
"Proposition 8 Explained in Under 1 Minute" from CALMatters
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