2018: A Year of Emerging Threats, Opportunities for Kidney Care

In 2017, charitable giving in the United States topped $400 billion – a mind-boggling, all-time high. Even amid a contentious political atmosphere, individual Americans, foundations, and corporations remained solidly committed to philanthropy and supporting those in need.

With the holiday season in full swing, so too is America’s charitable spirit. On Giving Tuesday – the Tuesday following Thanksgiving – companies and individuals around the country are racing to outdo each other. For example, Amazon encouraged customers to donate toys to needy children through its Alexa app and promised to match each donation toy-for-toy.

Giving is in our blood, and helping our friends and neighbors in need is part of the fabric of our society. Yet, that charitable outlook is called into question when it comes to how some large health insurers treat resource-strapped patients with kidney failure.

For decades, patients with End-Stage Renal Disease (ESRD) unable to afford insurance have been able to benefit from the generosity of groups like the American Kidney Fund (AKF). AKF’s premium assistance program has assisted low income individuals maintain their government or private health insurance under the federally sanctioned Health Insurance Premium Program. It’s a gift that has allowed patients with kidney failure to choose the coverage that works best for them – coverage that they would otherwise be unable to afford.

It’s a gift of life for many, since ESRD is not survivable without regular dialysis treatments or a kidney transplant.

But some insurers are refusing to accept patients who receive charitable assistance, despite the fact that these individuals have paid for their insurance for many years before being diagnosed with ESRD. Many insurers seem to prefer that their patients be forced to join Medicare – even though a private insurance plan might be a better option for them and their families. ESRD patients are already time-limited on private insurance. After 33 months from being diagnosed with renal failure, they must move to Medicare coverage even if they are able to pay the cost of insurance.  More and more large insurers continue to try and deny financially-strapped Americans’ freedom to choose their care.

Treating Americans with limited financial resources as second-class citizens when it comes to kidney care has to stop.

In California, voters recently agreed. Proposition 8 – on the ballot last month – aimed to unfairly dictate what insurance companies were required to pay for dialysis care. If passed, it would have resulted in most dialysis facilities statewide operating at a loss which is simply unsustainable and would have jeopardized patient care. Passage would have increased healthcare costs by driving patients toward Emergency Department care for routine dialysis or complications from lack of access to care.

Proposition 8 was an abuse of the initiative process by a powerful special interest that sought to force providers to accept unreasonable contract demands. Voters saw it for what it was and, thankfully, rejected it. But even so, it was a frightening and very real threat to choice and access for Californians with kidney failure who have very few choices as it is. It used vulnerable patients as pawns in a larger battle – and toyed with the very care that helps keep them alive.

Californians did the right thing by protecting patients, and it’s time that large insurers and policymakers do the same. Americans with kidney failure – particularly those who lack resources – ought not to be treated as budget busters on a balance sheet. ESRD patients deserve quality care, and they deserve the ability to choose how they receive it.

The future of kidney care – and our ability to improve, innovate, and enhance services – rests on having a healthy industry that includes our willingness to act charitably towards patients and each other as we work toward better healthcare solutions.

Allen R. Nissenson, MD

Chair, Kidney Care Partners

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