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California Voters Back $1.5B Pediatric Hospital Bond Initiative

Analysis  |  By John Commins  
   November 07, 2018

Healthcare-related initiatives were on the ballot in several states on Tuesday, with mixed results. 

California voters on Tuesday voted to approve a ballot initiative that authorizes $1.5 billion in bonds to fund capital improvements at the state's 13 children's hospitals.

Proposition 4, the Children’s Hospital Bond Act of 2018, passed with more than 60% of the vote. It will cost California taxpayers $80 million a year for the next 35 years, for a total of $2.9 billion, according to the state's Legislative Analyst's Office.

California Children’s Hospital Association President and CEO Ann-Louise Kuhns said the state's pediatric hospitals were "grateful to voters."

"These funds will allow our hospitals to upgrade their facilities to meet new seismic safety requirements, update technology and expand capacity so that we can continue to provide the best care and save more lives," Kuhns said.

Some observers questioned whether a ballot initiative was the proper way to secure a bond offering. California voters approved a $750 million bond in 2004 and a $980 million bond in 2008.

"I think it's a misuse of the initiative process for private groups to sponsor ballot measures that are intended to benefit them exclusively," Elizabeth Ralston, a former president of the League of Women Voters of Los Angeles, told Kaiser Health News.

The league had recommended a "no" vote on the measure.

Another healthcare-related California ballot initiative did not fare so well. Proposition 8 would have capped the profits of kidney dialysis providers at 15% above direct patient costs, but it was roundly defeated 62% to 38%.

"Yes of Prop. 8" leader Emanuel Gonzales said dialysis corporations used scare tactics in a $111 million campaign to defeat the initiative, but Gonzales said he hopes to have it back on the ballot in 2020.

"We're proud to have exposed the unacceptable conditions in many clinics caused by understaffing, including reports from patients about cockroaches and unclean facilities," said Gonzales, a dialysis technician whose father is a dialysis patient.

"We exposed the massive profits this industry makes off people who literally can't live without this treatment," he said.

Nevada Nixes Sales Tax on Medical Equipment

Voters in Nevada approved a ballot initiative to remove the sales tax from medical equipment.

Local media in Nevada are reporting that more than 67% of voters in state voted for Question 4, which amends the Nevada Constitution to require the state legislature to exempt some durable medical goods, including oxygen delivery equipment and prescription mobility-enhancing equipment, from sales tax.

The proposal passed a first time in 2016 and would become law if it passes again. Proponents of the initiative argued that it would but Nevada in line with other states, but critics said the measure is vaguely worded, as the Reno Gazette Journal reported.

OK Not OK with Optometrists in Walmart

Oklahoma voters rejected the Walmart-backed Question 793, which would have amended the Oklahoma Constitution to give optometrists and opticians the right to practice in retail stores.

Walmart gave nearly $1 million in the third quarter alone to proponents of the initiative, which was narrowly defeated by less than 6,000 votes. Those opposing the measure consist primarily of individual optometrists, as reported.

The Oklahoma Council of Public Affairs, which backed the initiative, accused opponents of mounting "a scare campaign that worked."

"To protect their profits, a special interest convinced Oklahomans that a few more choices for eye care would be dangerous," the council said. 

The ad hoc group "Yes on 793" said it was "disappointed" with the outcome, but would seek "legislative remedy" to resolve the impasse.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


Oklahoma voters narrowly reject initiative that would have allowed optometrists to practice in Walmart and other retail settings.

Nevada voters approve exemption of durable medical goods from state sales tax.

California voters roundly reject an initiative to cap the profits of kidney dialysis providers at 15% above direct patient cost.

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