Congress must restore vital protections for kidney care patients

almost 37 million Americans live with chronic kidney disease (CKD)And of those 37 million people, more than 800,000 have progressed to end-stage renal disease (ESRD), also known as kidney failure. For these people, access to life-sustaining kidney care, including vital dialysis treatment, can mean the difference between life and death.

Unfortunately, a recent Supreme Court decision overturns important protections for people with ESRD, protections that Congress first passed 40 years ago. Medicare Secondary Payer Act (MSPA). Congress passed the MSPA in 1980, giving ESRD patients the option to maintain private insurance as their primary insurance for 12 months before transitioning to Medicare. Over the years, Congress has strengthened this protection by extending the MSPA to its current 30-month term. The law also aims to counter perverse incentives for insurance companies to ignore kidney disease, thereby accelerating kidney failure and forcing these beneficiaries into Medicare if they receive dialysis. .

however, marietta vs davitaThe Supreme Court essentially ruled that employer-based group health plans can carve out important kidney care services from insurance coverage, including dialysis treatment and access to nephrologists and other kidney care specialists. was lowered. This effectively allows insurance companies to remove kidney failure patients from their private insurance plans at a time when they most need protection, after decades of having them covered. , would defeat the intent of the MSPA. Patients may also have to change providers at a time when they most need consistent care to ensure the best outcomes.

The Supreme Court’s decision could put ESRD patients in group health plans and potentially lose access to high-quality kidney care, including potentially life-saving transplants and support for their families. That could expose patients to unlimited out-of-pocket medical costs because Medicare has no cap on medical costs, and some patients would be left without benefits such as dental or vision coverage. there is a possibility. Shifting large numbers of patients to Medicare prematurely would place a financial burden on taxpayers and the Medicare program as a whole.

Although the Supreme Court was divided, both the majority and minority opinions said Congress needs to further clarify the law if it wants to ensure that these protections for ESRD patients are maintained.

Fortunately, a bipartisan group of members of the U.S. House of Representatives has introduced a new bill that would do just that. If you pass, Act Restoring Protections for Dialysis Patients (HR 6860) It would amend the MSPA to protect ESRD patients from discrimination by private health insurance systems, including early loss of private health insurance.

People with renal failure are Probability is high Being low-income and from historically marginalized communities is also a health equity issue, as is restoring protections that the Supreme Court overturned. For these disadvantaged patients and communities, the early loss of health insurance and the associated increases in out-of-pocket costs and premiums are especially devastating.

This bipartisan bill provides a much-needed solution that will help protect patients’ access to private or employer-sponsored health insurance and providers, as well as help ESRD patients transition from private insurance to Medicare. It also allows you to better plan your migration. Enabling patients to make the most of this transition period helps manage coverage gaps that may result from this transition, such as vision, dental, and hearing provision, as well as dependent and spousal coverage. Become.

Representatives of the nation’s leading kidney disease patient advocacy groups include Rep. Mike Kelly (Republican, Pennsylvania), Rep. Yvette Clark (New York), Rep. Neal Dunn (Republican, Florida), and Rep. Danny Davis (Democratic). )will be grateful to. (Illinois), John Joyce (R-Pennsylvania), and Raul Ruiz (D-Calif.) came together to introduce this common-sense solution. Now, leaders on both sides of the aisle must support and work to pass HR 6860 as soon as possible to restore critical protections that ensure quality, choice, and the best possible outcomes for ESRD patients. .

Laverne A. Burton is President and CEO of American Kidney Fund and Hrant Jamgochian is CEO of Dialysis Patient Citizens.