Pennsylvania’s congressional delegation must hold health insurance companies accountable for leaving Americans with kidney failure behind. Across Pennsylvania and the country, many patients with kidney failure are being denied the level of health coverage they need and deserve. They need Pennsylvania’s members of the U.S. House Ways and Means Committee — Mike Kelly, R-PA, Lloyd Smucker, R-PA, Brian Fitzpatrick, R-PA, and Dwight Evans, D-PA, to work together to save them.
Following a recent Supreme Court decision, private insurers have more leeway to deny patients with kidney failure the coverage they deserve by rolling back benefits and reimbursement rates, imposing an enormous medical and financial burden on those just coming to terms with their diagnosis. There’s a bill making its way through the House that would address this issue called the Restore Protections for Dialysis Patients Act.
Thankfully, Congressman Kelly introduced the bill and Representative Fitzpatrick has cosponsored the bill, but Evans and Smucker have not. They should both cosponsor the bill, and all of Pennsylvania’s congressional delegation should work together to advance it in the House of Representatives. Doing so would protect America’s vulnerable kidney patient population.
End Stage Renal Disease (ESRD), or kidney failure, sneaks up on most who have it. Ellen Bluestone, a previously healthy Pennsylvanian, learned she had kidney disease from a routine blood test. Ellen had to quickly turn her life upside down to adapt. ESRD patients like Ellen must adapt their busy lives to accommodate dialysis — a grueling, thrice-per-week, hours-long treatment that filters a patient’s blood in place of the kidneys — while waiting for a kidney transplant. Approximately 20,000 Pennsylvanians rely on dialysis to survive. Only about 1 in 5 people with ESRD in Pennsylvania receive a transplant each year, so dialysis remains the necessary option for most patients.
A sudden ESRD diagnosis brings immense stress. Like anyone else, ESRD patients have jobs, families, and responsibilities. What ESRD patients require most of all is stability, especially during those tumultuous first months of care. Many ESRD patients are happy if they can keep their job and continue to work while beginning dialysis treatment. However, many employer-provided private insurance plans have taken advantage of the Supreme Court decision that makes it easier to limit coverage for dialysis patients. And while dialysis patients may lose access to the benefits they need, they rarely complain to their employer, because they simply want to keep their jobs and provide for their families despite their complicated and exhausting health condition.
Some dialysis patients are lucky enough to have private insurance that actually does provide adequate health coverage, and they appreciate the advantages of private insurance, as a primary payer, over Medicare. In those cases, private insurance will provide a broader array of treatment options, covering more medications and visits to specialists. It allows families to maintain continuity of coverage, and enrollees are far less likely to report issues receiving the care they need. Further, private insurance improves the chances that an ESRD patient will receive a kidney transplant. The sad reality is that patients without sufficient coverage remain lower on the transplant list, if not wholly ineligible for a transplant.
By law, all dialysis patients must eventually transition to Medicare. However, because of concerns about financial stability and transplant access, Congress previously guaranteed that dialysis patients could keep their employer-provided private insurance for the first 30 months of care. That way, dialysis patients could continue working without the additional stress of financial instability.
The Supreme Court’s decision opened the door for private insurers to discriminate against dialysis patients and effectively push these patients off their plans and onto Medicare prematurely. That’s unfortunate, because Medicare provides more limited care options and it only covers 80% of treatment expenses. If new dialysis patients suddenly lose their insurance, they must quickly find ways to account for the 20% that Medicare doesn’t cover. In states without affordable supplemental insurance plans, patients must deal with piling medical debt. Representatives Kelly, Smucker, Fitzpatrick and Evans can unite to prevent such an unacceptable state of affairs in the richest country on Earth.
Struggling dialysis patients are depending on our representatives to hear their voices. Pennsylvanians and Americans all across the country with dialysis suddenly find themselves in health insurance situations that fail to meet their needs — through no fault of their own. Fitzpatrick, Smucker, Evans and Kelly can, in their capacity as members of the Ways and Means Committee, continue building momentum for the Restore Protections for Dialysis Patients Act. This legislation would allow Pennsylvanians beginning dialysis to keep their existing private insurance for the first 30 months of care. I’m grateful Representative Kelly introduced the bill and Fitzpatrick cosponsored it, and I strongly urge the rest of Pennsylvania’s representatives to support it too. Let’s hope that they can get this done.
Joan Cullen lives in Hilltown Township.
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