What is the reckless dialysis amendment and what would it do?

  • The proposed Constitutional amendment would place artificial limits on the revenue that Ohio’s 326 community dialysis clinics receive for providing life-saving services to Ohioans suffering from kidney failure.
  • These artificial revenue limits would force the consolidation and closure of some dialysis clinics and threaten to reduce access to dialysis care, particularly in disadvantaged, underserved or sparsely populated areas of Ohio.
  • It would require clinics to pay rebates to health insurance companies for revenue that exceeds “reasonable charges for dialysis treatments,” which is arbitrarily defined as “115% of the sum of all direct patient care services costs and all health care quality improvement costs.” Medicare, Medicaid and other government payers would not receive these rebates.
  • Private health insurance companies are under no requirement to forward these rebates to patients. The proposed amendment requires the rate and rebate calculations to be made and enforced by the Ohio Department of Health, which has no experience setting medical rates or rebate structures.
  • The proposed amendment is sponsored by the Service Employees International Union – United Healthcare Workers (SEIU-UHW) – West, a California-based labor union that has no expertise in the medicine, management or regulation of kidney disease.
  • In 2018, the SEIU commissioned a $4 million paid petition drive to gather voter signatures, with the intent of placing the proposed Constitutional amendment on the November statewide ballot (it failed to qualify for the ballot when the Ohio Supreme Court found that the sponsors didn’t follow Ohio law and deemed the entire petition invalid).


What is dialysis and who receives this treatment?

People with kidney failure or “end stage renal disease” (ESRD) receive dialysis treatments, which cleans their blood using special equipment, usually at an out-patient dialysis clinic. A team of medical professionals that includes a physician, nurse, dialysis technician, dietitian, and social worker cares for people who need dialysis, following carefully regulated rules and procedures for treatment.

There are about 18,000 Ohioans currently receiving dialysis, with each patient typically receiving treatment three times a week, four hours at a time. If a patient misses even one treatment, their chance of an emergency room visit increases 82% and their risk of death increases 30%.


Who is behind the proposed amendment?

The reckless dialysis amendment was written and sponsored by the SEIU-UHW – West, a California-based labor union with a long history of using controversial ballot issue campaigns to leverage their political agenda, often to the detriment of the people it claims to want to help.  SEIU lawyers in California wrote the proposed Constitutional amendment, and campaign finance reports indicate the SEIU spent approximately $4 million in 2018 on a failed Ohio petition drive, including paying many out-of-state petition circulators.


Who currently pays for dialysis treatment in Ohio?

Medicare, Medicaid and other government entities such as the Veterans Administration cover an estimated 89% of dialysis patients in Ohio. Private health insurance companies cover 11% of dialysis patients.


Would the proposed amendment save Ohio dialysis patients money?

No.  Even though Medicare, Medicaid and other government sources pay an estimated 89% of the dialysis treatment cost in Ohio, the amendment excludes them from receiving any rebates mandated by the proposal.  Instead, the rebates would go to private health insurance companies, with no requirement that the rebates be passed on to patients.


Would this proposal save Ohio taxpayers money?

No.  Because dialysis services paid for by Medicare, Medicaid and the Veterans Administration are not financially impacted by the amendment, taxpayers should not expect to see any decrease in dialysis expenses billed to government agencies.  In fact, its artificial revenue limits would force the consolidation and closure of some dialysis clinics and threaten to reduce access to dialysis care, particularly in disadvantaged, underserved or sparsely populated areas of Ohio.  Medical groups opposed to the amendment are concerned that reduced access will force many dialysis patients to seek treatment in hospital emergency departments or worse, fail to receive treatment, thus driving up costs and mortality rates.


Does the proposed amendment impact dialysis treatment for Ohio Medicaid and Medicare recipients?

Yes.  The proposed artificial revenue limits would force the consolidation and closure of some dialysis clinics and reduce access to dialysis care, particularly in disadvantaged, underserved or sparsely populated areas of Ohio.


Why did backers propose a Constitutional amendment instead of a proposed law or regulation?

Proponents wrote this proposal as a Constitutional amendment, without any apparent attempt to try a normal legislative or rule-making process that would bring knowledgeable stakeholders to the table.

There is no evidence that the SEIU spoke with kidney care experts in Ohio, or made an effort to learn about the current system of care in Ohio.  Many Ohioans opposed to the dialysis amendment are concerned that the out-of-state proponents are using this extreme measure, changing our state’s Constitution, to achieve their own organizational goals.

History shows the SEIU has spent heavily on ballot issues to increase their bargaining leverage in their efforts to unionize government agencies or businesses.  Public records show the SEIU-UHW budgeted a total of $40 million of SEIU members’ dues over the last three years for “political activities and lobbying” or “organizing activities.”


If passed, how could problems that arise be fixed?

Not even the Governor or General Assembly can fix a flawed Constitutional amendment.  If a proposed amendment such as this were to pass, problems arising in its implementation could only be fixed by another Constitutional amendment, which would require another statewide ballot issue vote.  This cumbersome and lengthy process could endanger the thousands of Ohioans who depend on dialysis treatments to stay alive.


Who opposes this reckless dialysis amendment?

The people who know the most about medicine – and specifically the care of those with kidney failure – strongly oppose this amendment, saying it’s a flawed and dangerous ballot issue. It’s opposed by a broad and growing coalition of kidney care and medical organizations representing dialysis patients, caregivers, nurses, doctors, and other healthcare professionals. See the full list of groups opposing this amendment.


Why is this amendment bad for Ohio?

It will harm patients who need reliable, convenient access to quality dialysis care. As written, the amendment proposes arbitrary revenue caps on community dialysis clinics. Kidney care experts in Ohio say the proposed revenue caps would make many clinics financially unviable, causing providers to consolidate services and close locations. This would force many of Ohio’s 18,000 patients with kidney failure to travel further distances for treatment or miss treatments, which would be harmful for many patients.


Proponents say Ohio dialysis clinics have unhygienic conditions, is this true?

No. Proponents’ claims of dirty conditions with bugs, urine, blood and mice in the dialysis clinics are blatantly false. Experts, advocates and medical professionals in dialysis care – and most important, Ohio dialysis patients – know these claims are not truthful and in no way reflect the reality of care in Ohio.


The amendment calls for dialysis centers to be regulated and inspected, doesn’t this happen already?

Yes. The proposed amendment is deceptive because it leads people to believe there is no current oversight, inspection or regulation of clinics in Ohio. Ohio dialysis clinics already follow strict federal and state rules and procedures for treatment and cleanliness:

  • The Ohio Department of Health is charged with oversight of dialysis clinics and conducts regular surveys and inspections,
  • The Ohio Board of Nursing licenses dialysis care technicians and
  • The federal government oversees dialysis care clinics through the Centers for Medicaid and Medicare Services.