
- Dialysis treatment is expensive and must be performed multiple times per week, for hours each time, to effectively clean the blood.
- “This limits ESRD patients’ means to work full time, and patients cannot afford treatment without insurance,” court records state. “Given the expense and vulnerability of ESRD patients, charitable organizations provide premium assistance to eligible ESRD patients. These charities, such as the American Kidney Fund (“AKF”), often provide assistance to patients based on financial need, regardless of which insurer — whether private or public — the ESRD patient has selected.”
- Many ESRD patients, even if eligible for Medicare, choose to purchase private, commercial insurance because Medicare does not provide coverage for spouses and dependents, the court found, among other key differences.
- When CMS issued a request for information earlier this year, it received 829 responses, a majority of which came from patients, patient advocacy organizations, charities and dialysis providers who supported patients’ right to use premium assistance and explained the rules in place to prevent steering patients to one plan or another. In addition, there were 15 responses from insurance companies that were critical of premium assistance.
- Even so, the government rule is weighted heavily toward insurers rather than the hundreds of comments received from charities, consumers and concerned activists.
- “As to ESRD patients, the Rule will cause them to shift to public insurance options, and many patients would be better served by private insurance options,” court documents state. “Not all ESRD patients qualify for Medicare and Medicare does not cover families. Therefore, some ESRD patients and their family members would lose insurance coverage altogether if forced to change to public insurance.”
- The incoming Trump administration could help to ensure kidney patients have the same choice every other American has over their health plan.