LOS ANGELES – Today, supporters of an initiative to reform the dialysis industry are filing more than 600,000 signatures with county officials up and down the state in an effort to get on the November ballot. The so-called "Fair Pricing for Dialysis Act" would limit dialysis corporations' revenues to 15 percent above what they spend on patient care – and rebate anything above that to insurance companies.

However, it does not require insurers to pass that on to consumers. Sean Wherley, senior communications specialist for the union SEIU-United Healthcare Workers West, says the idea is to incentivize the companies to plow more profits back into patient care.

"Hiring staff is patient care. Getting new equipment is patient care. Improving the facilities is patient care,” says Wherley. “If they do all that, they can charge more. They just can't take more than 15 percent above that cost."

Wherley notes that dialysis giants Fresenius and DaVita made $3.9 billion in 2016 – and says the union has heard complaints that some clinics are dirty, have faulty equipment or are so understaffed, patients with low blood pressure pass out while others soil themselves waiting to be unhooked in order to go to the restroom.

DaVita and Fresenius argue that limiting revenues will cause clinics to cut back or close, limiting access for the 66,000 Californians with kidney disease who could die if they don't get their blood filtered several times a week.

Miguel Estrada, a patient-care tech for almost 20 years, belongs to the group "Patients and Caregivers to Protect Dialysis Patients," which is funded by DaVita and Fresenius. He argues that the initiative's definition of patient care doesn't cover necessary staff such as the physician medical director. And he thinks the union has an ulterior motive.

"Clinics are gonna close, and then my patients are gonna be at risk,” he says. “I mean, this initiative is really just a way to negotiate because the union has been trying to get into dialysis for the last almost two years without success."

Last year, a bill to establish minimum staffing levels in dialysis clinics, Senate Bill 349, passed the state Senate but is still awaiting a vote in the State Assembly. About 16,000 people work at 570 clinics in California.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.