Congress has a chance to improve insurance options for people with kidney failure and help fund opioid crisis treatment
September 18, 2018
Published by The Hill
Taking a powerful jab at two devastating health crises at one time seems like a smart move. Kidney disease threatens the lives of more than 703,000 Americans with kidney failure—an 80 percent increase since 2000. With more than 10,000 new patients diagnosed with kidney failure every single month, 495,000 Americans on dialysis, and 208,000 people living with kidney transplants, the country faces a kidney care crisis. At the same time, another 49,000 Americans die annually from an opioid overdose, making it one of the nation’s leading causes of death.
Thankfully, this fall, Congress has a rare opportunity to address both of these issues by improving choice and access to care for individuals in the most serious stage of kidney disease—kidney failure—while simultaneously helping to offset the cost of fighting the opioid use epidemic.
A provision included in the House-passed opioid package (but not included in the Senate version) would allow kidney failure patients to stay on their private insurance for an additional three months beyond the 30 months currently allowed by law. People with kidney failure are the only group of Americans whose access to private health coverage is time-limited because of their diagnoses. Empowering these patients and their families with more choices, while saving the government an estimated $344 million that can be used to fund opioid use disorder treatment and prevention programs, is a win-win for all involved.
However, large, private insurance companies are trying to block this common-sense legislation.
End-stage renal disease (ESRD) is an irreversible loss of kidney function that is fatal without treatment. Surviving requires either a successful kidney transplant or, more commonly, dialysis treatments several times per week. Because only a limited number of kidneys are available for transplantation, dialysis is often the only option patients have while waiting for a transplant. The government has recognized the unique hardship that individuals with ESRD face, which is why Congress established the Medicare End-Stage Renal Disease (ESRD) program, a successful public-private partnership that allows any American—regardless of age— to enroll in Medicare three months after an ESRD diagnosis.
Current law also allows patients a choice: they may stay on their private health insurance plan if they so choose for a period of up to 30 months. This is often referred to as the Medicare Secondary Payer (MSP) provision. Many patients prefer to maintain their private coverage because it may offer more and better care choices, come with lower out-of-pocket costs, and be less disruptive for themselves and their families. If given the choice, many patients would opt to remain on their private plan even longer, and the House-passed provision gives them the opportunity to do so for three short months.
Large insurance companies that already benefit from covering this vulnerable population only for a limited time are now threatening to block this three-month extension.
A modest three-month extension of the MSP program is a smart way to save money in a fair-shared manner with the Medicare program that can be used to tackle one of the most important public health crises of the day, while offering more choices for vulnerable ESRD patients.
We urge Congress to act quickly to help two groups of Americans who have significant health care needs.
LaVarne A. Burton is President & CEO of the American Kidney Fund; Hrant Jamgochian, J.D., LL.M. is CEO of Dialysis Patient Citizens; and Kevin Longino is CEO of the National Kidney Foundation.