By Bijal Patel, MD, MBA
End-stage renal disease (ESRD), or kidney failure, represents a significant and growing public health challenge in California. As of 2021, over 100,000 Californians are living with kidney failure – a chronic condition for which there is no definitive cure, only management.
In clinical practice, we frequently encounter patients who, despite leading otherwise healthy lives, suddenly present with alarming symptoms such as severe hypertension, edema (swelling), and profound nausea and fatigue.
When these individuals seek medical attention, they are often confronted with the harsh reality that their kidneys are failing. This diagnosis is life-altering, as the only treatment option available aside from a kidney transplant is dialysis, a vital treatment that filters toxins from the bloodstream.
Unfortunately, only about 15% of Californians with ESRD receive a kidney transplant in any given year, leaving over 81,000 individuals dependent on dialysis.
Black and Latino populations disproportionately suffer from ESRD, and they face additional barriers to accessing quality healthcare. As a nephrologist and patient advocate, it is incumbent upon us to use our collective privilege and influence to dismantle these barriers.
However, a recent Supreme Court decision has done the reverse by stripping many ESRD patients of their insurance, which exacerbates systemic challenges and further compromises health outcomes.
Historically, newly diagnosed patients have relied on their employer-provided insurance to cover the costs associated with their treatment, physician visits, and necessary medications. Patients were allowed to maintain private insurance as their primary coverage for the first 30 months, offering continuity of care and financial relief.
The Supreme Court’s ruling, however, has granted group insurance plans the ability to discriminate against patients on dialysis by limiting coverage and reducing reimbursement rates for life-sustaining dialysis treatments. This effectively forces patients off their plans and into Medicare far earlier than before. The implications of this ruling are profound.
While essential, Medicare may offer fewer options regarding physician networks and medications. Moreover, the abrupt transition to Medicare coverage places an undue burden on patients, who must quickly devise strategies to cover the 20% of costs that Medicare does not cover.
Previously, the 30-month window provided a buffer for patients to plan financially; now, they are left scrambling to secure supplemental coverage or, in many cases, deplete their assets to qualify for Medicaid. In California, the lack of affordable Medigap plans for those under 65 further compounds this issue, leaving many patients facing insurmountable financial obstacles.
The only viable solution is the passage of the Restore Protections for Dialysis Patients Act (H.R. 6860). This critical legislation seeks to restore the 30-month period when dialysis patients can retain their private insurance.
We are fortunate in California to have a large and influential congressional delegation, with many members serving on key committees such as the U.S. House Committee on Ways & Means and the Committee on Energy & Commerce.
Yet, despite the significance of this legislation, only Congressmen Raul Ruiz (D-CA) and Jimmy Panetta (D-CA) have cosponsored H.R. 6860.
It is imperative that Representatives Judy Chu (D-CA), Mike Thompson (D-CA), Linda T. Sánchez (D-CA), Jimmy Gomez (D-CA), Michelle Steel (R-CA), Tony Cárdenas (D-CA), Anna Eshoo (D-CA), Doris Matsui (D-CA), Scott Peters (D-CA), Jay Obernolte (R-CA), and Nanette Diaz Barragán (D-CA) follow suit.
The Restore Protections for Dialysis Patients Act is essential to ensuring that patients on dialysis in California are afforded the protections they need to navigate their diagnosis with dignity. As nephrologists and patient advocates, we must champion this cause, using our expertise and influence to safeguard the well-being of those who entrust us with their care. Let us fight for what is right.
Bijal Patel is a board-certified nephrologist and fellow at the Johns Hopkins Center for Innovative Leadership.
