Policy At A Glance: August 2018 INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

Prop. 3 Water Infrastructure and Watershed Conservation Bond Initiative

Prop. 4 Children’s Hospital Bonds Initiative

Prop. 8 Limits on Dialysis Clinics’ Revenue and Required Refunds Initiative

Prop. 11 Ambulance Employees Paid On-Call Breaks, Training, and Mental Health Services Initiative

2018 Health-related Ballot

Initiatives

New State Ballot Measures that Affect Health in the November 2018 General Election

Proposition 3, Water Infrastructure and Watershed Conservation Bond Initiative. Proposition 3 is also known as the Water Supply and Water Quality Act of 2018. It issues $8.877 billion in general obligation bonds for water-related infrastructure and environmental projects.

Bringing wholeness to individuals and communities, the Institute for Health Policy and Leadership (IHPL) strives to integrate health policy research and education with

leadership development. Our goal is to improve the health of our communities by building on our strong heritage of health promotion and disease prevention.

To learn more, visit us at www.IHPL.llu.edu

Of the twelve propositions appearing on the upcoming ballot, four will affect health and health care. This issue of ‘Policy At A Glance’ will provide a summary of each of these propositions.

California adopted the ballot initiative process on October 10, 1911, becoming the 10th state in the nation to do so.1 Through this process, Californians are able to “directly propose and enact state laws and amendments to the California Constitution” without the aid of legislators.2

In the upcoming November 6th ballot, there will be 12 measures that cover a wide range of topics from children’s hospitals to bigger cage sizes for farm animals to making daylight savings time permanent. Below is a summary of four health-related initiatives, listed in numerical order.

Continued next page

2

INSTITUTE FOR HEALTH POLICY AND LEADERSHIP August 2018

1

Projects under Proposition 3 include3:

• Safe drinking water and water quality improvements ($3.03 billion)

• Watershed restoration and fisheries improvements ($2.895 billion)

• Wildlife and habitat protection ($940 million)

• Water conveyance improvements ($855 million)

• Groundwater sustainability and storage ($685 million)

• Surface water storage and dam repairs ($472 million)

Proposition 3 will also prioritize $500 million in safe drinking water for disadvantaged communities.

In the primary election on June 5, 2018, voters passed Proposition 68 (California Clean Water and Safe Parks Act), which authorizes a $4 billion bond to fund parks, natural resources protection, climate adaptation, water quality and supply, and flood protection.4 Together, Proposition 3 and Proposition 68 approve almost $9.4 billion in bonds to improve California’s water supply. However, critics contend that Proposition 3 does little to fundamentally solve our water shortage; instead, they believe that California should invest in building new dams to capture water from snow and rain and to improve existing dams’ water storage capacity.

Proposition 4, Children’s Hospital Bonds Initiative

2

According to the California Children’s Hospital Association (CCHA), California has eight private, nonprofit children’s hospitals and five University of California children’s hospitals.6 These hospitals perform 97 percent of all pediatric organ transplants, 96 percent of all pediatric heart surgeries, and 76 percent of all pediatric cancer treatments. 6

Proposition 4, also known as the Children’s Hospital Bond Act of 2018, is authored by CCHA because “the burden of providing uncompensated care and the increasing costs of health care seriously impair our children’s hospital’s ability to modernize and expand their facilities and to purchase the latest medical technologies and special medical equipment necessary to take care of sick children.”5 If passed, Proposition 4 issues $1.5 billion in general obligation bonds to construct, expand, renovate, and equip qualifying children’s hospitals.2 Proposition 4 allots:

• 72 percent of funds to the eight private nonprofit children’s hospitals

• 18 percent of funds to the five University of California children’s hospitals

• 10 percent of funds to other public and private nonprofit hospitals providing services to children eligible for California Children’s Services program

If Proposition 4 passes, eligible children’s hospitals would apply for funds to the California Health Facilities Financing Authority (CHFFA).

3

INSTITUTE FOR HEALTH POLICY AND LEADERSHIP August 2018

1

Proposition 8, Limits on Dialysis and Required Refunds Initiative According to the California Legislative Analyst’s Office, two for-profit companies (DaVita, Inc. and Fresenius Medical Care) operate 72 percent of all licensed dialysis clinics in California.7 Dialysis clinics draw about $3 billion a year from Medicare, Medicaid, and private insurance plans and report profit margins of 18 percent to 19 percent.7,8

Proposition 8, also known as the Fair Pricing for Dialysis Act, caps the profit margins of these facilities to 15 percent, by limiting their revenue to 115 percent of the costs for direct patient care and quality improvement. Dialysis clinics exceeding this cap will be required to:

• Give the money back, in the form of rebates, to commercial health insurers (Medicare and Medicaid are excluded)

• Pay five percent of the rebate amount as penalty to the California Department of Public Health (DPH)

Dialysis clinics will also submit an annual report regarding clinic costs, patient charges, and revenue to DPH and cannot discriminate patients for care based on the source of payment. Proposition 8 is sponsored by the Service Employees International Union – United Healthcare Workers (SEIU-UHW) and is

2

opposed by the California Nurses Association, the California Medical Association, and the American College of Emergency Physicians. While SEIU-UHW argues that the dialysis companies should use their large profits to improve staffing ratios, patient care, and cleanliness, opponents believe that the cap on revenue will force clinics to scale back hours or close their doors, jeopardizing “access to care for 66,000 patients who need dialysis to stay alive.”9

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

Ambulance employees are Emergency Medical Technicians (EMT) and paramedics who respond to 911 calls and provide medical assistance. Due to the nature of their job, ambulance employees are “on call” during their meal and rest breaks as their breaks can be interrupted by 911 calls. However, in 2016, the California Supreme Court ruled that on-call breaks violate state labor laws (Augustus v. ABM Security Services).10 Proposition 11, also known as the Emergency Ambulance Employee Safety and Preparedness Act, allows “on call” meal and rest breaks for privately employed EMTs and paramedics, effectively ensuring that ambulance companies continue to operate as they have in the past.

Continued next page

4

INSTITUTE FOR HEALTH POLICY AND LEADERSHIP August 2018

Proposition 11 also requires ambulance employees to receive:

• Ongoing training to respond to active shooters, mass casualty incidents, natural disasters, as well as to threats of violence against ambulance employee

• Employer-paid mental health benefits to address employee’s stress, depression, grief, loss, and other mental health challenges

Currently, there are no registered opponents against Proposition 11.

What is Next?

Although it is not on this year’s ballot, the California Medical Association and the California Dental Association filed a ballot measure for the November 2020 ballot as a response to Governor Brown’s recent decision to ban local soda taxes for the next 12 years.11 Their proposal would implement a statewide tax of 2 cents per fluid ounce on sugar-sweetened beverages, providing over $1.7 billion in revenue for health programs.11 References

1. http://www.sos.ca.gov/elections/ballot-measures/how-qualify-initiative/initiative-guide/

2. https://oag.ca.gov/initiatives/faqs 3. http://www.sos.ca.gov/elections/ballot-measures/qualified-ballot-

measures/ 4. http://voterguide.sos.ca.gov/propositions/68/ 5. https://www.oag.ca.gov/system/files/initiatives/pdfs/17-

0045%20%28Children%26%23039%3Bs%20Hospital%20Bond%20Act%29_1.pdf

6. http://elections.cdn.sos.ca.gov/statewide-elections/2018-general/prop-4-arg-in-favor.pdf

7. http://elections.cdn.sos.ca.gov/statewide-elections/2018-general/prop-8-leg-analysis.pdf

8. http://www.latimes.com/business/hiltzik/la-fi-hiltzik-dialysis-20180720-story.html

9. http://elections.cdn.sos.ca.gov/statewide-elections/2018-general/prop-8-rebut-arg-in-favor.pdf

10. http://elections.cdn.sos.ca.gov/statewide-elections/2018-general/prop-11-leg-analysis.pdf

11. https://www.cda.org/news-events/cda-cma-file-statewide-soda-tax-measure-for-2020

Are You Ready?

11209 Anderson Street Loma Linda, CA 92354

Phone: 909-558-7022 Fax: 909-558-5638

www.IHPL.llu.edu

Questions? Please contact Helen Jung, DrPH, MPH. Senior Health Policy Analyst at the Institute for Health Policy & Leadership (helenjung@llu.edu)

If you don’t remember whether you have registered to vote in

November, you can check your registration status by visiting:

https://voterstatus.sos.ca.gov