More than 700,000 Americans are living with end-stage kidney disease (ESKD), a fatal condition if not properly treated. A recent Supreme Court decision eliminated longstanding insurance protections for ESKD patients, threatening the access and affordability of life-sustaining dialysis treatments. These individuals and their families deserve better; Congress must take action to restore patient choice for Americans living with kidney disease.
An ESKD diagnosis is devastating. Once a patient’s kidney can no longer sufficiently function, dialysis or a transplant becomes essential. Given the shortage of kidneys for transplantation, virtually all ESKD patients — 97 percent — depend on routine dialysis to survive.
Individuals on dialysis don’t just endure physical and emotional trauma but also a uniquely burdensome treatment regimen. Performed three times per week in three-to four-hour sessions, the most common forms of dialysis pose enormous time, cost and logistical challenges. Families often restructure their lives around this care, coordinating upward of 150 annual treatments.
Beyond dialysis, ESKD patients face unique and complex health challenges, requiring intensive care. They often battle many medical conditions, like diabetes and high blood pressure, and keep track of an average of 19 pills per day, making comprehensive insurance coverage essential for patients and their families.
The Medicare Secondary Payer Act long protected the right to choose between employer group coverage and Medicare. It ensured vulnerable patients could choose the coverage options and treatment facilities best suited to their needs, including remaining on the insurance plans they had been on for years. This is vital because ESKD is one of the only conditions that entitles an individual to Medicare upon diagnosis, putting kidney patients at a greater risk of discrimination.
Unfortunately, these critical protections came under attack in June when a Supreme Court ruling reinterpreted the Medicare Secondary Payer Act. This decision could force tens of thousands of vulnerable patients to forfeit their employer health plans and prematurely transition to Medicare — a move that has dire clinical and financial consequences.
Losing employer health coverage could eliminate many benefits ESKD patients and their families depend on. As a result, dialysis patients with Medicare tend to have worse kidney-related health outcomes and much lower transplant rates than those with employer-sponsored health insurance.
Prescription medications are a prime example. Everything — from hearing, dental and vision care to mental health services — is suddenly at risk. After a transplant, patients with Medicare also face the reality of losing coverage for vital anti-rejection medications. Other coverage gaps — such as medical transportation and palliative care options — further underscore the necessity of patient choice.
Financially, losing employer health coverage can be devastating to patients but profitable to the health plan and employers. Between monthly premiums and coinsurance requirements, ESKD patients may have to pay several thousand dollars out of pocket annually for dialysis — before even considering the cost of other care. Kidney disease rates are also higher in low-income and racial/ethnic minority groups, meaning African-American, Hispanic and Native American patients would experience this burden at greater rates.
The cost burden isn’t just on the patient, either. Transitioning a patient prematurely to Medicare adds significant costs for taxpayers. Many patients will also lose health insurance for their family members, who are already confronting the enormous financial and emotional challenges of caring for someone with a chronic illness.
These patients and families need our support, and there is an opportunity for change.
Congress can close the loophole the Supreme Court’s decision created, restoring these crucial protections for the more than 700,000 Americans living with kidney failure. Doing so would clarify that the intent of the Medicare Secondary Payer Act was to protect these patients from discrimination based on either their diagnosis or the care that they, nearly exclusively, need — dialysis. I urge our elected leaders to pass the Restore Protections for Dialysis Patients Act to protect the rights of one of the country’s most vulnerable patient populations.