Several years ago, at the behest of the SEIU labor union, the California legislature passed Assembly Bill 290 (AB 290), a bill intended to abolish charitable premium assistance for dialysis patients. In an April 7, 2026, decision, the U.S. Court of Appeals for the Ninth Circuit struck down major provisions of AB 290. The court ruled that the law violated the First Amendment rights of dialysis providers and the American Kidney Fund (AKF), a nonprofit charity.
The Ninth Circuit found that AB 290’s primary provisions unconstitutionally burdened the right of expressive association. The court struck down the provision that capped reimbursement rates for dialysis providers who donated to charities like AKF. It ruled that even if donations were driven by commercial self-interest, they were protected under the First Amendment because the recipient (AKF) engaged in expressive activities like lobbying and education. The court found the cap was not “narrowly tailored” to the state’s interest in preventing insurance risk pool distortion.
The court also invalidated the rule prohibiting charities from conditioning assistance on specific medical procedures, holding that this interfered with AKF’s right to choose its own beneficiaries. Dialysis Patient Citizens joined AKF as a coplaintiff in this critical lawsuit, as many of our members rely on charitable assistance for their care. We were pleased by the court’s decision, but we know that this does not mean that patients will not be put at risk again by the longstanding “dialysis wars” that SEIU has waged in California.
