Column: Preexisting conditions, dialysis, rent control and the gas tax: A preelection guide for voters

Figuring out how to bestow your vote can be nerve-racking even in normal elections. Tuesday’s election may be especially fraught with tension, given that Donald Trump’s racist duck calls have sullied the very principle of representative democracy.

Things are especially complicated in California, where voters are confronted not only with races for governor, U.S. Senate and Congress, but 11 ballot measures. We’ve looked into the pros and cons of four of these over the last year or so, so to help readers understand what’s at stake, here’s a digest of what we’ve found. We’ll start with one overarching issue to consider when casting a vote for the House of Representatives — healthcare — and move down the ballot from there.

--Preexisting conditions. Republicans have suddenly awakened to the reality that Americans care about protecting people with preexisting medical conditions. Having spent eight years railing against and trying to repeal the Affordable Care Act, which provides those protections, they lately have been trying to assure voters that they are sworn to uphold them.

They’re lying. Don’t believe them.

Texas and 19 other red states have brought a lawsuit in federal court that would overturn the ACA’s rules on preexisting conditions. The Trump administration supports the lawsuit. A Texas federal judge known to be hostile to the ACA already may have written his ruling in the case, but may be withholding it until after election day to avoid infuriating voters.

The benchmark for GOP opposition to the Affordable Care Act and its provisions barring discrimination against people with medical conditions was a mutant monster called the American Health Care Act, which Republicans in the House of Representative passed overwhelmingly in May 2017.

California had 14 Republican members of Congress at the time. Every single one of them — every single one — voted for this bill. (That includes Reps. Darrell Issa [R-Vista] and Ed Royce [R-Fullerton], who are retiring.)

More recently, a few GOP members, including Reps. Steve Knight (R-Palmdale) and Mimi Walters (R-Laguna Beach), have introduced or co-sponsored bills purporting to save the protections on preexisting conditions even if the Texas judge rules against them.

These measures have major loopholes undermining their effectiveness. They exist merely as window dressing for PR statements by beleaguered Republicans. The sponsors can’t get around their support for GOP efforts to dismantle the consumer protections written into the ACA. Don’t buy what they’re selling.

--Proposition 6: Gas tax repeal. In an apparent effort to pump up Republican turnout in our mostly blue state, conservatives cooked up this measure. Their hope is to get the usual anti-tax crowd to the polls, and they may succeed.

Our assumption is that the same people who grouse about paying the 12 cent-per-gallon tax hike that would be repealed by this measure are also extremely vocal about the poor condition of the state’s roadways. They don’t have too many ideas about where to find the $5.2 billion a year that the gas tax and associated levies generate for roadwork.

State officials have pointed out that the gas tax hadn’t been raised since 1994. In that period inflation had robbed the tax of more than one-third of its value. Increased fuel efficiency, moreover, meant that drivers on average were buying less gas per mile traveled. Altogether, the transportation taxes had lost their ability to keep up with the demand for maintenance and repair. The sad truth: Maintaining infrastructure costs money.

--Proposition 7: Daylight saving time. As we reported in March, when most Americans lost an hour of sleep by “springing forward” (they got the hour back Sunday morning), ending daylight saving time becomes a hobbyhorse twice a year for people who really should be given something else to do with their free time.

This initiative would allow the state legislature to end DST by a two-thirds vote if Congress does so first. Big whoop.

The truth is that almost all the arguments mustered against daylight saving time are wholly or partially fabricated. The most commonly heard claim is that heart attacks spike on the Monday after the spring change, due presumably to the lost hour of sleep.

Couple of points about this: First, it’s based on a single study published by a group of Swedish researchers in 2013. The study was limited to a database of Michigan Blue Cross members, and the authors themselves weren’t sure that the phenomenon they saw was genuine, much less applicable to the nation at large. Finally, they noticed that the overall incidence of myocardial infarction for the week following the spring switchover didn’t change at all — there were more cases on Monday, but fewer in the rest of the week.

Our advice to anti-DST militants: Let it go, already.

--Proposition 8: Dialysis companies. Newspaper editorial boards across the state, including here at The Times, have counseled a No vote on Proposition 8, which would cap the California revenues of dialysis firms operating several hundred clinics in the state.

The editorialists’ general point is that Proposition 8 is sponsored by the Service Employees International Union, which wants to unionize clinic workers. Our view is that the editorial writers haven’t done their homework. So we did it for them.

The dialysis industry — chiefly DaVita and Fresenius, two firms that command 70% of the for-profit dialysis market — has mustered more than $111 million, a record for an initiative campaign anywhere in the U.S., to kill Proposition 8. No wonder: They collect some $3 billion a year in revenues in this state alone, so if they can kill Proposition 8 that’s a bargain.

The firms claim that hundreds of clinics would have to close; their TV commercials feature dialysis patients convinced they’ll die if the measure passes. The source of this scare statistic is a study the firms say is “independent,” but which the No campaign commissioned to the tune of $200,000. Some “independence.”

As for the union versus management aspect of the fight, consider this: The measure is designed to give the firms an incentive to hire more patient staff and pay them better (the more they spend on those employees, the higher the revenues they could collect). The firms have been investigated, and in some cases penalized, for profiteering.

As we reported, the firms appear to have been responsible for driving big insurance companies out of the ACA exchanges, by saddling the insurers with high-cost dialysis patients who otherwise were eligible for Medicare. (Under a 1973 law, dialysis patients are covered by Medicare no matter what age they are.) Medicare reimbursed the firms much less per session than they could charge private insurers, so — lo and behold — thousands of patients somehow were persuaded to change from Medicare to private coverage.

So there’s your choice on Proposition 8: A union wants to force two huge healthcare firms to hire more staff to treat patients and pay them better (the Yes on 8 position); the firms want to protect their billions of dollars in profits (No on 8).

--Proposition 10: Rent control. The No on 10 lobby wants you to think that Proposition 10 would expand rent control statewide. They raise the specter of moms and pops driven out of their rental properties by the law.

Not so. Proposition 10 would not change rent control laws anywhere in the state. Rather, it would remove pro-landlord restrictions placed on rent control laws in 1995. But it would still be up to local city and county legislators to decide whether to take advantage of their newfound latitude.

Real estate developers have spent heavily over the years to keep the limitations in place, and the current campaign is no exception. The No on 10 campaign has raised more than $45 million, much of it contributed by apartment developers such as Michael K. Hayde and Geoffrey H. Palmer. The Yes campaign has raised more than $24 million, much of it from the measure’s sponsor, the AIDS Healthcare Foundation, headed by persistent government gadfly Michael Weinstein.

There’s no justification for allowing a statewide law to hamstring local officials this way. Localities need all the tools they can find to address California’s persistent and worsening housing crisis. Proposition 10 would simply give them a stronger tool — if they want to use it.

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