Kidney Care Partners (KCP) – the nation’s largest non-profit, non-partisan coalition of more than 30 organizations, comprising patients, dialysis professionals, physicians, nurses, researchers, therapeutic innovators, transplant coordinators, and manufacturers – today, expressed deep disappointment in the Supreme Court ruling on Marietta Memorial Hospital Employee Benefit Health Plan v. DaVita, citing concern about discrimination in accessing affordable quality care for individuals living with end-stage renal disease (ESRD) and its impact on growing health inequities.
“The insurer practice at issue – shifting patients prematurely to Medicare – will exacerbate inequalities in access and quality care for an already vulnerable population. This ruling is a blow to promoting affordable patient choice and instead unfairly shifts costs to the American taxpayer. We feel this decision leaves patients with ESRD vulnerable to discriminatory and inequitable insurer practices, and in fact, is not consistent with the Administration’s own goals on health equity,” said John P. Butler, Chair of KCP.
Premature loss of private group health coverage can be devastating for some patients living with ESRD. Often, private insurance plans offer more coverage options than Medicare does. Some of these services, such as dental coverage, can be essential in controlling infections that, if not caught early, can exclude a patient from transplant waitlists. More comprehensive disease management services can provide better outcomes by helping to manage other chronic diseases common in patients requiring dialysis. Private insurance may, in some cases, also provide lower copays and deductibles and limits on out-of-pocket costs than Medicare. When a patient living with ESRD loses private insurance coverage, the consequences can also extend to other family members under that policy who do not qualify for Medicare and may face substantially higher costs, deductibles, and other cost requirements resulting from that loss of coverage.
“Despite this ruling, KCP remains steadfast in our commitment to ensuring equitable, affordable access to quality care for the millions of individuals living with or at risk for kidney disease,” said Butler. “We stand ready and willing to work with Congress and other policymakers to address the gap created by today’s ruling and clarify the intent of the Medicare Secondary Payor Act to better protect patients from exclusionary measures like this. More must be done to ensure that no one is denied or discriminated against because of the treatment they need because of their disease.”
The issue in the case was whether a group health insurance plan that limited access to outpatient dialysis treatments violated the Medicare Secondary Payer statute by discriminating against patients based on their need for dialysis. In January, KCP filed an amicus brief that argued that the health plan discriminated against those with ESRD by limiting coverage for life-sustaining treatment, thereby forcing patients to drop private group coverage, and financial protections, in favor of Medicare. The recent Supreme Court opinion disagreed with that argument.
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UnitedHealthcare was the nation’s leading provider of Medicare Advantage plans according to a report shared today by the American Association for Medicare Supplement Insurance.
“UnitedHealthcare accounted for 27 percent of all MA plans followed by Humana with 18 percent,” shares Jesse Slome, director of the Medicare insurance advocacy organization. “As more consumers favor Medicare Advantage plan coverage, we are being asked which plans do people most frequently choose.”
According to the Association, some 29 million Americans are expected to be enrolled in a Medicare Advantage plan this year. “For the first time, that’s more than twice the number selecting a Medigap or Medicare Supplement plan,” Slome adds.
Some 14 percent of MA plans were offered by a Blue Cross / Blue Shield entity followed by CVS Health (Aetna) which was the choice of 11 percent of all plan participants in 2021.
“Picking the best Medicare plan option is more complex than ever,” declares Slome. “And competition for consumers has reached a frenzied pace, just looking at the hundreds of millions of dollars being spent on television ads featuring celebrity spokespeople.”
To help consumers seeking information, the organization makes available a national online directory listing local Medicare insurance agents who offer Medicare Advantage and Medigap plan information and rate comparisons. Access to the directory is free and completely private. Go to www.medicaresupp.org/find-local-agent/ for more information.
The American Association for Medicare Supplement Insurance (AAMSI) advocates for the importance of planning. See the listing of top Medicare Advantage plan insurers at www.medicaresupp.org/top-medicare-advantage-plans/.
Kidney Care Partners (KCP) – a non-profit coalition of more than 30 organizations, comprising patients, dialysis professionals, physicians, nurses, researchers, therapeutic innovators, transplant coordinators and manufacturers – has submitted comments through the Centers for Medicare & Medicaid Services (CMS) to the U.S. Department of Health & Human Services (HHS) in response to the Agency’s request for information (RFI) on kidney care improvements. This request focused on how to advance equity and reduce disparities in organ transplantation, improve life-saving donations, provide individuals with CKD with access to more preventative services, promote greater care coordination for individuals receiving dialysis and empower individuals when making decisions about their treatment options, including removing socio-economic barriers to selecting home dialysis.
“We’re very pleased to see HHS and CMS spotlight the unique needs of the more than 37 million Americans living with kidney disease, kidney failure, and kidney transplants by calling on the kidney community to come together with actionable, tangible recommendations to improve care,” said John P. Butler, Chair of KCP. “Given that individuals with kidney disease are disproportionately from communities of color and often experience inequities in the delivery of care, now is the time to investigate, invest in, and implement policies that will improve access and choice to quality care and innovations for all.”
The response letter, written with input from leadership among KCP members from across the kidney care continuum, addresses a broad range of topics, emphasizing improving the organ and transplantation ecosystem and delivering care to individuals with chronic kidney disease (CKD) and end stage renal disease (ESRD). KCP brought together experts in each of the topic areas of the RFI – CKD, dialysis, and transplant – in a series of half-day working sessions to build the consensus recommendations.
Regarding transplants, KCP’s letter notes that “the current processes involved in waitlisting a patient leads to only a fraction of patients being actually listed.” Policy recommendations to address this issue include enhancing education and communication to patients around transplant, increasing transplant data transparency and addressing patient access issues, among others.
KCP specifically calls on HHS and CMS to “eliminate the silos within the health information system and ensure that all providers in the kidney care community can have a 360-degree view of patients’ health data” to improve care coordination and patient outcomes.
KCP also recommended that “HHS work across its agencies and with other stakeholders to slow the progression of CKD and empower patients to select the modality that works best for them” when considering their health care choices.
The comment letter specifically highlights the work of Senators Ben Cardin (D-MD) and Roy Blunt (R-MO) along with Representatives Terri Sewell (D-AL) and Vern Buchanan (R-FL) who have introduced The Chronic Kidney Disease Improvement in Research and Treatment Act of 2021 (H.R. 4065/ S. 1971) that would address shortcomings of the current Kidney Disease Education benefit (KDE) in Medicare and expand it to allow more patients access to KDE services and permit more providers to offer these services. The legislation would also increase awareness among beneficiaries by incorporating CKD screening in the annual Medicare wellness visit.
Additional recommendations in KCP’s response include expanding telehealth access, increasing education and awareness of kidney disease and incentivizing providers to help slow disease progression to delay or avoid ESRD altogether.
KCP also calls on the Administration to remove artificial restrictions that make it difficult for dialysis facilities and nephrologists to support patients whose socio-economic status creates barriers that can prevent them from accessing home dialysis options or receiving a transplant.
“The potential for individuals with kidney diseases to live longer and fuller lives is better than ever, but there’s still much more to be done,” said Michele Kimball, Executive Director of KCP. “KCP has always been a leading advocate for patients and pro-patient policies, and we look forward to working with HHS, CMS, and other stakeholder groups to expand options and choices for patients that drive changes for even better access to quality care and improved outcomes.”
To view the full response from KCP, click here.