In California, an initiative known as Proposition 8 asks voters to limit the revenue that kidney dialysis clinics can earn. The proposition pits health care unions against the large companies that run dialysis centers.
In Massachusetts, a ballot question asks voters to consider a proposal to limit how many patients a hospital can assign to each registered nurse at hospitals and other health care facilities. The maximum number of patients per registered nurse would vary by type of unit and level of care, according to a description of the ballot initiative on the secretary of state’s website.
Journalists covering these issues will need to work hard to separate fact from fiction because supporters and opponents of the measures use advocates to convey their messages. In California, patients on both sides are pressing their case. In Massachusetts, an association representing hospital administrators opposes the measure, but nurses’ groups are split on the issue.
One way to identify spin versus false claims is fact-checking, as Gabrielle Emanuel has done in her reporting on the issue for WGBH radio in Boston. In a July report, “7 Questions About the Nurse Staffing Ballot Measure,” that was updated on Oct. 21, Emanuel explained that supporters of the measure include the Massachusetts Nurses Association, a union representing about 20 percent of the state’s nurses. Those opposed include the Massachusetts Health and Hospital Association and the American Nurses Association and the Organization of Nurse Leaders, she wrote.
In a later story, “Breaking Down The Ballot Question 1 Campaign Ads,” Emanuel did an excellent job fact-checking the television ads from both sides. Often two ads representing each side of the issues have been running in succession on TV in the early evenings.
The Massachusetts Health Policy Commission reported that if Question 1 passes, it could cost between $676 million and $949 million annually.
Another way to cover the issue is to focus on how much each side is spending, as some reporters have done in California.
If Proposition 8 is successful, dialysis clinics could be required to pay rebates to certain parties (primarily health insurance companies) that pay for dialysis treatment, according to California’s official voter information guide.
In the Palm Springs Desert Sun, politics reporter Samuel Metz explained that the proposition passes aims to cap a dialysis provider’s profit at 15 percent above what is spent on direct patient care service costs, with a rebate of leftover revenue to insurers.
The petition pits unions against the state’s three large kidney dialysis providers, Davita Kidney Care, Fresenius Medical Care and U.S. Renal Care. As of the end of last week, Sophia Bollag reported for the Associated Press that dialysis companies had spent $111 million to defeat the initiative. An AP analysis showed that this was the most that any side had spent on a ballot issue in any state since at least 2002, and more than the $109 million pharmaceutical companies spent in 2016 to stop a measure to limit prescription drug costs in California, Bollag reported.
On the other side, unions, including the Service Employees International Union-United Healthcare Workers West (SEIU-UHW), had spent more than $18 million in support of the initiative, Metz reported.
Bollag describes one ad, paid for by dialysis providers, in which a woman identified as a patient claims Proposition 8 could force some clinics to close. “Prop 8 literally threatens my life,” the woman said.
In an ad funded by Prop. 8 proponents, Bollag wrote that a patient complained about the conditions at a dialysis clinic, saying there was urine on the floor and cockroaches. “They just care about the money,” a man also identified as a patient said of dialysis providers. “They don’t care about the patients.”