U.S. Representative Mike Kelly (R-PA), along with Representatives Yvette Clarke (D-NY), Neal Dunn, M.D. (R-FL), Danny Davis (D-IL), John Joyce (R-PA), and Raul Ruiz (D-CA), introduced the Restore Protections for Dialysis Patients Act in December 2023. This bipartisan legislation aims to ensure access to private healthcare insurance for people diagnosed with kidney failure.
The legislation is a response to a 2022 Supreme Court ruling, which effectively allows group health plans to act in ways that will force people with kidney failure – who need dialysis or a kidney transplant to live – off their private coverage and into Medicare prematurely. This transition will significantly impact continuity of care and may result in coverage disruptions for both patients and their families.
When you are affected by end stage renal disease (ESRD), a condition where the kidneys can no longer effectively remove waste and excess fluid from the blood it hits the very core of your being. People require either dialysis or a transplant to live. While a transplant is the preferred treatment option, long wait times of deceased donor organs makes it challenging to receive one.
People who have ESRD are eligible for Medicare regardless of their age. Yet, we have always had the option to elect Medicare or keep our group health insurance plan for up to 30 months, during a time frame known as the coordination of benefits period (COB). Congress established the COB under the Medicare Secondary Payer Act (MSPA) to ensure that group health plans retain some financial responsibility for people who have ESRD, while at the same time, protecting the Medicare Trust Fund.
We often opt for a group health plan as we paid for it by working throughout the years. We also want to continue working and with that, comes health insurance. We also might provide coverage for our family. Being forced to Medicare earlier does not help us navigate the illness and have the continuity of care that we so desperately need. Additionally, certain benefits such as dental health, which Medicare covers on a limited basis, are imperative for us to be able to even be considered to qualify for a kidney transplant.
H.R. 6860 will reinstate the protections initially intended by Congress for people who have kidney failure. This legislation ensures that we are given a choice and can maintain our trusted health care team, allowing for vital continuity of care that greatly contributes to our survival and well-being, as envisioned under the MSPA.
The Supreme Court decision in June 2022 interpreted the MSPA in a narrow manner, creating an avenue for group health plans to do exactly what Congress intended to prohibit under the law.
Since this ruling, an increasing number of group health plans are utilizing benefit designs that incentivize premature shifts to Medicare, clearly indicating their unwillingness to support our healthcare. This not only endangers the stability of the Medicare Trust Fund but also puts people who have a serious chronic illness at risk by offering less extensive coverage.
This legislation will restore the intended protections and ensure that people who have this disease can make informed choices about their healthcare coverage without facing pressure from their group health plan to shift to Medicare. H.R. 6860 is not a mandate but aims to restore the protections that Congress originally intended for people with kidney failure.
The legislation does not impose a benefit mandate and saves Medicare dollars to help ensure its solvency.
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Web ID HR6860
