Kidney health organizations, people with kidney disease and medical professionals are asking Congress to move quickly to protect private insurance coverage for people with end stage renal disease (ESRD) by passing the Restore Protections for Dialysis Patients Act.
A bipartisan group of representatives are sponsoring the proposed legislation. The Kidney Foundation of WNY joins the American Society of Nephrology, American Kidney Fund, American Nephrology Nurses Association and others in calling for its passage.
Background
A person reaching ESRD needs dialysis or a kidney transplant to survive. The condition is also called end-stage kidney disease or kidney failure.
In the early 1980s, Congress passed the Medicare Secondary Payer Act to protect the private health insurance coverage of people with ESRD and also limit the expenses to the Medicare Trust Fund. Until recently, people who qualified for Medicare due to ESRD could retain their private coverage for 30 months. During that time, the primary responsiblility for medical costs stayed with the private insurer, with Medicare designated as a secondary payer.
The U.S. Supreme Court’s 2022 decision in the case of Marietta v. DaVita struck down provisions of the Medicare Secondary Payer Act. This decision allows insurance companies to limit coverage of kidney care services, including dialysis.
“The Marietta v. DaVita decision will force people who have kidney failure off their private insurance into Medicare," Lori Hartwell, founder of the Renal Support Network, explained in a news release. “Health plans should not be able to decide they don’t want to cover you when your kidneys fail, a critical time when you need your insurance and care team the most. It is an unfair, discriminatory policy and a slippery slope for other chronic conditions.”
“Unfortunately, my health insurance plan continues to restrict my access to the therapies that my nephrologist has prescribed to delay my kidney disease progression,” Hrant Jamgochian of Dialysis Patient Citizens said in the same release. “Without action by Congress, millions of Americans could see their insurers follow suit, as the sooner they can push CKD patients like me into Medicare without paying any cost for doing so, the more likely we are to progress to end-stage renal disease.”
Proposed Legislation
A bipartisan group of representatives introduced the Restore Protections for Dialysis Patients Act (H.R. 6860) in December 2023. The act is aimed at restoring the Medicare Secondary Payer Act protections for ESRD patients by ensuring that private health plans do not discriminate against such patients or adversely classify dialysis as compared to other covered medical services.
“Americans deserve access to adequate health care coverage, especially those who need dialysis,” said Congressman Neil Dunn (R-FL), a co-sponsor of the act. “ESRD patients who rely on dialysis should not see their benefit disappear overnight. We must renew the safeguards that protect dialysis patients and ensure their access to care.”
"Nearly 40 million Americans live with kidney disease, and the millions more at risk deserve our support in their fight against kidney disease — from prevention through post-transplant living," said Representative Yvette Clarke (D-NY). "Unfortunately, far too many patients affected with the disease, which disproportionately impacts communities of color, have complex health care needs that create incentives for plans to discourage enrollment. I’m proud to join my colleague, Congressman [Mike] Kelly (R-PA), to introduce the Restore Protections for Dialysis Patients Act, a bipartisan bill which seeks to ensure people on dialysis receive the care they need."
Representatives Danny Davis (D-IL), John Joyce (R-PA), and Raul Ruiz (D-CA) also helped to introduce the legislation in 2023. In 2024, an additional 19 members of the House have joined as co-sponsors. The bill has been referred to the Committee on Ways and Means, and to the Committee on Energy and Commerce.
In addition to the organizations listed above, supporters of the proposed legislation include the Chronic Disease Coalition, Kidney Care Partners and the Renal Physicians Association.
Ways to Take Action
Several organizations have created sample letters and templates for advocates to contact their elected officials.
The American Kidney Fund has a template for emailing members of Congress at https://www.kidneyfund.org/action/ask-your-representative-cosponsor-restore-protections-dialysis-patients-act-hr-6860.
Dialysis Patient Citizens has a template for contacting Congressional represenatives at https://kidneyaction.org/esrd/.
Nephrology nurses can submit a letter through ANNA at https://www.congressweb.com/anna/46/.
Learn more:
Statements of support and information from kidney health organizations:
Announcements from Congressional representatives:
Track the bill’s progress in Congress:
See co-sponsors:
U.S. Supreme Court decision in Marietta Memorial Hospital Employee Health Benefit Plan et al v. DaVita Inc. et al: