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Kidney care offers uncommon opportunity for bipartisanship

By Dr. David Bernstein - InsideSources.com | Apr 5, 2023

The new session of Congress is fully underway, but questions remain about how exactly it will play out. The political environment in Washington is as divided as ever, and complicated hurdles remain in the way of compromise on pressing issues like the debt ceiling, inflation, medication prices and more.

With so many difficult political battles on the horizon, lawmakers must identify common, bipartisan ground where they can achieve meaningful progress. Bipartisanship is essential in a Congress as evenly split as we have, and lawmakers may have several opportunities to deliver a win for an especially vulnerable group: patients with kidney disease.

More than one in seven American adults suffer from kidney disease, while one in three is at risk for kidney disease. Left untreated, patients could need dialysis treatments that last for several hours at a time, multiple days each week. Or, they may need a transplant.

Dialysis patients are a uniquely vulnerable group, being more likely to suffer from additional conditions like heart disease or diabetes and being at a higher risk for complications from other common medical procedures. In addition, research continues to indicate that Black and Hispanic Americans suffer from complications due to dialysis at disproportionately high rates, worsening health disparities.

Thankfully, policies to improve kidney care outcomes are historically bipartisan. Congress has a significant opportunity to pass critical legislation in response to a Supreme Court decision last summer that puts employer-provided insurance at risk for patients nationwide.

In the decision, the court ruled in favor of a private insurer limiting its coverage to 30 dialysis treatments, claiming that since the restrictions applied to everyone on the plan, it did not discriminate. Patients with kidney disease, however, are the only ones who need dialysis, and limiting them to 30 treatments is only enough for a few months. This goes entirely against the protections patients with kidney disease are supposed to have under the Medicare Secondary Payer Act, which allows them to remain on employer plans for up to 30 months before switching to Medicare as their primary coverage.

Forcing patients to switch to Medicare early can result in losing access to crucial benefits like vision or dental care, which are essential to qualify for transplants but are not covered under Medicare. Switching to Medicare early can also come with higher costs for prescriptions and other needs, not to mention placing more burden on a federal payer funded by American taxpayer dollars expected to be insolvent by 2028. Passing legislation reasserting dialysis patients’ rights to remain on employer plans for the entire 30 months after they are diagnosed would be a huge boon for the dialysis community and lawmakers struggling to find ways to make bipartisan progress.

The opportunities for bipartisan wins on kidney care go even further. For many kidney patients who use Medicare for their primary coverage, additional Medigap plans to pay for the costs Medicare doesn’t cover on its own — including 20 percent of every dialysis treatment — remain too expensive, so those costs must come out of pocket. Most states do not have adequate protections to ensure those plans are available at affordable rates.

Beyond this, many patients nationwide struggle with simply ensuring their care meets their own individual needs. They are the sole ones responsible for ensuring their primary care doctor, nephrologist, cardiologist, endocrinologist and others are all on the same page concerning which prescriptions and treatments they are recommending — an impossible task even in the best circumstances.

Unfortunately, care coordination services remain unavailable for most patients.

These issues can be fixed with the proper legislation, and all of them have traditionally enjoyed strong bipartisan support. For a Congress searching for ways to work together in a fiercely divided environment, providing Americans with kidney disease with the help they need is the perfect opportunity to come together for a common cause.

Dr. David Bernstein is an expert in value-based healthcare transformation. He is currently a resident physician at the Harvard Combined Orthopaedic Residency Program at Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital. He wrote this for InsideSources.com.