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4.20.16 Last week, Chronic Disease Coalition Executive Director Scott Bruun was featured on “House Call” on KISU, an NPR-affiliated radio station in Idaho. He spoke with kidney patient Wesley Thompson, who worked as a long-haul driver and said he relies heavily on social workers to ensure he’s able to get his insurance coverage for his treatments. Leading the interview were doctors Fahim Rahim and Naeem Rahim of the Idaho Kidney Institute, who said they’ve seen a rise in insurance companies discriminating against dialysis patients. Here are five takeaways from his interview. 1. The number of patients losing health insurance coverage is no accident; it is a deliberate and systematic attempt by organizations like Blue Cross of Idaho to design their networks in a way that leaves patients with few options other than to drop their private insurance and move onto Medicare, which we know is not an equal replacement for other insurance. Dr. Fahim Rahim: “These patients with chronic illnesses seem to be facing, the more we learn and the more we understand, a very systematic discrimination from insurers in our state. They seem to be sidelined or coerced into dropping their insurance and moving on to public programs.” 2. That systemic discrimination, once started, will grow rapidly. Policies that deprived kidney patients from getting the care they need are now migrating over to other types of health expenses, such as pharmaceuticals, and other chronic conditions, like cancer. Scott Bruun shared the story of Kuna, Idaho, resident Colin Smith, who has multiple myeloma, a type of cancer: “He had these drugs as part of his therapy and Blue Cross said that because he received assistance his money wouldn’t count toward out of pocket expenses. It started with dialysis, but it’s a real slippery slope and it’s heading to other disease conditions.” Dr. Fahim Rahim: “And Idaho seems to be the testing ground, to see what they can get away with it.” 3. Insurance companies are taking advantage of the limited time, energy and resources patients have to actually fight for the coverage they are entitled to. Dr. Fahim Rahim: “I had a patient in the other day. She’s been with us a while. She is really struggling hard not only to get through three days of dialysis, but to come up with the money to pay for the premiums. And it seems like this is a very systematic effort to push them in the corner so they will just break and throw the towel down.” Scott Bruun: “My guess is that after you get done with that [dialysis], you don’t have a whole lot of energy to fight battles with insurance companies. And so that’s why it’s so important that there are voices of advocacy like ours and others and so that whatever is happening in the health-care community and exploding costs are not borne by patients.” Dr. Fahim Rahim: “The reason the system is so complicated is they are able to get away with it by doing so. And the only way it will change is if voices like ours will stand up and call our legislators and call our governors and make a change.” 4. These discriminatory policies are threatening care for all patients by reducing benefits for patients and reimbursements to providers. Under Blue Cross’s plan it is likely many dialysis units would have to be shut down, or provide care for a much smaller number of patients. Dr. Rahim: “The Department of Insurance and Blue Cross have no idea what the finances of running a four-hour lifesaving treatment looks like. … Their expectation that ‘if we just give you Medicare rates and you accept it for everyone and you can have a sustainable business model’ is just so flawed, because you’ll have to close the dialysis unit.” Scott Bruun: “That’s why this is so important. If what was attempted in Oregon and what is being attempted in Idaho were to become the law of the nation, so to speak, dialysis treatment as we know it would cease to exist. It would be a much reduced level of treatment and care.” 5. The only way that we can hope to affect change on these issues is by standing together with one voice against discrimination on the part of insurance companies. Dr. Rahim: “It’s important that we bring our voices together, because unless we do that we will continue to face discrimination and challenges. We have to stand with our friends, our family, and our community members.” Scott Bruun: “We are not designed to target insurance companies. Frankly, when we see examples of insurance companies do the right thing we will trumpet that like no one’s business. So when we see insurance companies do the wrong thing – and we are seeing them do the wrong thing with dialysis treatment and third-party payments – we’re going to trumpet that as well. Our only bias is protecting chronic disease patients against discrimination, whether its dialysis, diabetes, ALS or anything else.” For the full episode, view our previous post about the radio show here.