May 8, 2023
In June last year, the Supreme Court ruling on Marietta v. DaVita allowed employer-sponsored health insurance plans to limit outpatient dialysis coverage. This decision put the health of kidney failure patients at risk, especially those from low-income and historically marginalized communities who are unable to absorb increased health care costs. LaVarne Burton, CEO of the nonprofit American Kidney Fund, expressed disbelief at the decision,
“I couldn’t believe the decision. It really singles out patients who have kidney failure and treats them differently.”
Kidney failure, or end-stage renal disease (ESRD), affects nearly 800,000 Americans who depend on dialysis machines to perform functions their kidneys cannot. Missing even a single dialysis treatment can be deadly. As a result, the Marietta v. DaVita ruling remains a matter of life and death for those affected. Additionally, the ongoing battle among dialysis providers and private insurers about managing the skyrocketing costs of treating kidney failure adds to the stress.
The U.S. government's involvement in dialysis began in 1972 when President Nixon signed Public Law 92-603, making most Americans with kidney failure eligible for Medicare. Dialysis transformed ESRD from a death sentence into a chronic disease. The dialysis market, dominated by DaVita and Fresenius, depends on the 20% of patients with private insurance for the bulk of their profits. A study found that private insurers pay an average of $1,287-$1,476 per dialysis session, over six times more than the Medicare base rate.
The high prices that private insurers pay to dialysis clinics put pressure on small plans, potentially leading to bankruptcy. The Marietta v. DaVita decision has left the health care system grappling with its implications for those with ESRD. Bipartisan efforts to prevent insurers from imposing limits on dialysis or other chronic diseases have failed, but organizations like the American Kidney Fund are willing to support future bills.
While some argue that dialysis providers are driven by profit, the American Kidney Fund’s Burton believes the situation is more complex. Without the extra amounts paid by private insurance, she said, dialysis providers wouldn't be able to keep their doors open. However, the American Kidney Fund receives much of its funding from DaVita and Fresenius, potentially influencing its stance on the issue.
Ultimately, no one wants to pay for dialysis, and the health insurance companies involved are attempting to pass the responsibility instead of working towards a sustainable solution. As Burton points out, patients are not "hot potatoes" – they are people who deserve better. The Jack Reynolds Memorial Medigap Expansion Act seeks to address this by mandating equal access to Medigap insurance for ESRD patients under 65 by requiring insurers to offer supplemental coverage.
If you would like to show your support, contact your representative and let them know that you support the Jack Reynolds Memorial Medigap Expansion Act. You can find your local representative here.
Rich Foreman brings over 30 years of technology leadership to his role of CEO and Co-Founder of KidneySoft. As founding CTO, Rich led the team that developed the CordicoShield / CordicoFire Wellness App. Cordico was honored with the Sacramento Innovation Award in 2021. After achieving a 7 digit ARR, Cordico was acquired by Lexipol in 2020. Rich has a BS in Industrial Engineering from the University of Washington, an MPA from Troy State University and was an officer in the U.S. Navy. Rich co-authored his book, "Tap into the Mobile Economy." Rich's blog was listed in Top 20 Marketing Mobile Blogs of 2014. He has been featured on KCRA3, NEWS10, 1170 Tech AM PowerDrive, Business Radio Money 105.5, SiliconIndia, the Sacramento Business Journal, and the Sacramento Bee. Rich is also the Founding Director of the Sacramento Chapter of Startup Grind and served a term as Utility Commissioner for the City of Folsom. Rich is a regular contributor to TechWire.net and StartupSac. Rich was the Co-founder of Apptology which was named Small Business of the Year in 2014 by the Sacramento Asian Pacific Chamber. He was also the Founding Chief Technology Officer at Cordico. Cordico was acquired by Lexipol in 2020. Rich also served 4 years as a Naval Officer in the Civil Engineer Corps.
This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.