Prop 23: Dialysis Clinics

Prop 23 would increase state regulation of dialysis clinics.

Watch “Prop 23 in a Minute: Dialysis Clinics” to understand what a yes or no vote on this proposition means. ​Click the CC button for Spanish subtitles. 

For a quick look at all the props, here’s a printable guide in English and in Spanish.


Initiative to increase regulation of dialysis clinics.


The Service Employees International Union-United Healthcare Workers is dissatisfied with standards at the for-profit clinic chains.

Vote Yes

Require dialysis clinics to have at least one physician on site at all times, report patient infection data and obtain consent from the state health department before closing a clinic.

Vote No

Oppose new regulations that would require a physician to always be on site, the reporting of patient infection data and consent from the state health department before closing a clinic.

The SEIU-UHW West has been fighting to unionize workers at the state’s two largest dialysis businesses, DaVita and Fresenius Medical Care. The union aimed a 2018 proposition at cutting the companies’ profits. The dialysis industry defeated the measure with a record $111 million campaign that rallied associations representing doctors, hospitals, businesses, seniors, veterans and kidney patients, who fear more regulation will have dangerous unintended consequences.

The ballot measure says clinics cannot “refuse to offer or to provide care, on the basis of who is responsible for paying for a patient’s treatment.” The union has depicted the two big multinational corporations as making windfall profits off dialysis patients and insurers while running unsanitary clinics with outdated equipment in run-down strip malls.

As in 2018, organizations of doctors and nurses and patient advocates oppose the increased regulation. Opponents of Prop. 23 say it would worsen doctor shortages and unnecessarily increase health care costs for taxpayers and consumers by hundreds of millions of dollars a year.

Get Ready to Vote

Nov. 3 may feel far away now, but don’t forget to take the necessary steps to make sure you get to cast your vote! Here are some key details to remember:

  • Register to vote online by or have your mail-in registration postmarked by Oct. 19. If you somehow miss the deadline, all is not lost. You can still conditionally register up to Election Day itself. Not sure what your registration status is? Find out here.
  • Because of COVID-19, California is mailing all active registered voters mail-in ballots this year, so you don’t need to request one.
  • Mailed ballots should be postmarked on or before Nov. 3 and received by your county’s elections office no later than Nov. 20. Scared your ballot is going to get lost in the mail? Don’t fret, the California Secretary of State has a ballot tracking tool so you can get notified of the status of your vote-by-mail ballot via email, text or call. Sign up here.
  • If you want to deliver your ballot in person on Election day, make sure you do so by the time the polls close on Nov. 3.