Midterm elections are almost upon us and many of us are struggling with the choices we have to make, especially with the ballot propositions. Californians will vote on 11 ballot measures come November 6th. Reading the official State voting guide can still leave us with questions –  we have some difficult choices to make as responsible voters. One way to determine how to vote on the measures is to see who supports and stands to benefit from the passage of each proposition and see who is on the opposing side. Following the money trail also helps to gain perspective on how to vote.

There are three Propositions related to health-care  on this ballot. Each one poses a dilemma as both ‘for’ and ‘against’ arguments seem to make sense. We at India Currents would like to provide you with detailed d insight into these three propositions that can have a huge impact on how health-care is delivered to us.

PROP 4:  Children’s Hospital Bonds initiative

What is the deal? This measure authorizes $1.5 billion in general obligation bonds to provide for the Children’s Hospital Bond Act Fund. The fund would be used for construction, expansion, renovation, and equipment projects in order to provide retrofitting and seismic upgrades to facilities that are in dire need of them.

This fund would be distributed among eight private non-profit children’s hospitals, the UC children’s hospitals and other public and private nonprofit hospitals providing services to children eligible for the California Children’s Services program.

Bear in mind:

  • Children’s hospitals provide much needed medical care for California’s most needy children.
  • Voters have approved two statewide bond measures to support children’s hospitals in the past. This money which was used for new buildings, renovations and equipment will run out this summer.
  • The state of California already has $74.2 billion in debt from bonds and Prop 4 will increase that debt.

Vote YES if you think the State should use general obligation bonds to fund improvements to children’s hospitals. These hospitals treat the majority of children who need life saving treatments like organ transplant, cancer treatments and heart surgeries.

Who benefits:

  • 72% of funds would be designated for eight private, nonprofit children’s hospitals
  • 18% allocation for five of the University of California’s children’s hospitals
  • 10% of funds to public and private nonprofit hospitals providing services to children eligible for the California Children’s Services program.

Who is sponsoring:

  • California Children’s Hospital Association.

Supporters: California Teachers Association

Total raised by sponsors: $11.28 million.

Vote NO if you think the funds should come from another source and NOT out of general obligation bonds that will need to paid back with interest. If you believe that State funds should not be used to support private facilities.

Who stands to lose if this measure passes:

  • The State of California and therefore taxpayers, as the Bond would have to be repaid with interest, potentially through higher taxes.

Who is opposing:

League of Women Voters of California and other organizations .

More in-depth information at KQED , Ballotpedia, Voter’s edge

PROP 8: Limits on Dialysis Clinics’ Revenue and Required Refunds Initiative

What is the deal?  This is an initiated state statute, an initiative that seeks to cap the revenue of dialysis clinics to a maximum of 15% over the amount spent on each patient’s treatment. If passed, this measure requires that all revenue above 115% of direct patient care must be reimbursed to private insurance companies or individuals in the form of yearly rebates. The measure would also prohibit clinics from discriminating against patients based on their method of payment.

Bear in mind:

  • Nearly 80,000 Californians with afflicted kidneys need dialysis three times a week.
  • 72% of dialysis clinics in California are controlled by just two for-profit companies called DaVita and Fresenius.
  • This measure does not cap the the amount spent on direct patient care service, it only limits the revenue that companies make out of each clinic.
  • Dialysis clinics are underpaid by Medical and Medicaid and therefore try to recover costs by overcharging private insurance companies
  • Dialysis companies claim that revenue caps might force them to shut down some of their clinics and this will affect patients who critically need the service.
  • This measure, if voted in, will be a groundbreaking regulation in the healthcare industry and is being watched by interest groups all over the country.

Vote YES if you support a 15% revenue cap on dialysis companies so that the companies prioritize life saving treatments for patients– if they want to keep their profit margins.

Who benefits:  

  • Patients suffering from kidney ailments who might face lower costs and better care if the dialysis companies spend more on improving care and take in less revenues
  • The The SEIU-UHW West, a labor union which has been trying to unionize the dialysis industry and have asked for legislative regulation of the industry in the past and have failed in their attempts.

Who is sponsoring:

SEIU-United Healthcare Workers West

Supporters: Californians for Kidney Dialysis Patient Protection  

California Democratic Party, Labor Unions and many other Organizations.

Total raised by sponsors:  $18.86 million

Vote NO if you feel that the proposed revenue cap is too arbitrary and it would force dialysis companies to shut down clinics that are critical to kidney patients. Or if you agree with regulation, but strongly feel that such radical regulations should be brought about through careful legislation and not through ballot initiatives.

Who is opposing:

California Republican Party, Medical Associations, healthcare clinics and firms

Who stand to lose if measure passes:

  • DaVita and Fresenius who own and manage 72% of the dialysis industry. The average profit margin for dialysis clinics in California is 17% — nearly five times as high as an average hospital in California.
  • Kidney patients, some of whom might lose access to dialysis clinics nearby if the companies decide to shut down clinics due to reduced profit margins.

Total raised by opposition: $111.02 million

More in-depth information at KQED, Ballotpedia, Voter’s edge, Institute of Governmental Studies, UC Berkely

Proposition 11: Ambulance Employees Paid On-Call Breaks, Training, and Mental Health Services Initiative

What is the deal? This  initiated state statute is a preemptive proposition by the ambulance industry, paramedics and EMTs. If passed, ambulance companies would be exempt from 2016 labor laws passed by the California Supreme Court that mandates uninterrupted breaks for workers and also requires employers to pay workers at their regular rates during breaks. This initiative requires ambulance companies to provide additional training and some paid mental health services to EMTs and paramedics. The measure also seeks to void pending worker liability lawsuits against ambulance companies for violations (past industry practice of on-call meals and rest breaks) of labor laws passed in 2016.

Bear in mind:

  • Currently ambulance personnel do not take off-duty breaks. This measure will simply preserve the status quo and allow the ambulance industry to write its own law as opposed to following current labor laws.
  • According to current labor laws, workers are entitled to a half hour meal break and two ten minute rest breaks during their shift.
  • Providing uninterrupted breaks would mean ambulance companies have to staff 25% more ambulances to cover those on break, costing $100 million per year. These costs will trickle down eventually to health care customers.
  • However, ambulance personnel are first responders who perform in gruelling and pressure filled schedules, often dealing with life and death situations. Denying them uninterrupted breaks may not improve public safety.
  • The measure would not apply to EMTs and paramedics who work for public agencies, such as fire departments.

Vote YES if you think it should be written into law, that like police officers, (and other essential public safety personnel,) EMTs, paramedics, life flight helicopter crews and 911 dispatchers should remain reachable during their breaks and be paid to do so.

Who benefits:

  • Patients with serious emergencies who can get care fastest if the nearest crew is not on an uninterrupted break.
  • Healthcare customers avoid additional costs incurred by ambulance companies who have to hire additional staff to cover those on break.
  • EMTs and Paramedics who will get paid for being on-call during breaks. They will also receive additional training and paid mental health services.

Who is sponsoring:

Total raised by sponsors: $ 29.93 million.

Vote NO if you want private ambulance companies to follow the same labor laws as everybody else. If you feel this a highly stressful job and that EMTs and paramedics must be given breaks to eat and decompress while not being on call. If you do not want the ambulance industry to be able to write their own laws, then you will need to vote “No.”

Who is opposing:

Who stand to lose if the measure passes:

  • Ambulance employees who have liability lawsuits against ambulance companies for continuing to violate labor laws after the 2016 Supreme Court mandate for providing uninterrupted breaks for workers. These lawsuits and future ones will be voided if Prop 11 passes as this measure states that the past industry practice of on-call meal and rest breaks was allowable. .
  • EMTs and paramedics lose their chance of getting uninterrupted breaks to decompress and be at their best for the next call
  • Ambulance personnel will continue to have their breaks interrupted sometimes by less serious calls–one of the reasons why negotiations broke down between labor union and ambulance industry.

More background and analysis at Legislative Analyst’s Offfice, Ballotpedia, KQED

Vaishnavi Sridhar has a Masters in English and a penchant for the written word. She is also a theater/film enthusiast and on a given day, you might catch her on stage performing in a Telugu/Tamil/English play, or waxing eloquent on socially relevant topics on her Facebook page. Vaishnavi lives in the San Francisco Bay Area and you can reach her atcatchup.vaishnavi@gmail.com

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