Impact on Patients with Kidney Disease
Congress and the Obama Administration took an historic step toward expanding access and improving health care for all Americans in passing health reform legislation earlier this year.
The legislation focuses primarily on expanding insurance coverage and increasing its affordability; reducing health care costs; and transforming health care delivery. The legislation aims to ensure coverage for 32 million people, more than 94 percent of all legal U.S. residents, by 2019.
While the legislation does not address kidney disease specifically and at length, there are a number of provisions that affect CKD/ESRD patients, including:
Expanded Access to Health Insurance
The Affordable Health Care Act expands access to coverage, reduces expenses, and promotes prevention through the following provisions:
- Prohibits denial of coverage for pre-existing conditions including kidney disease or kidney failure (end-stage renal disease or ESRD). Effective this year, you can no longer be denied private insurance coverage because you have kidney disease.
- Eliminates annual and lifetime caps on covered services ensuring continued access to all treatment options for dialysis patients. There will no longer be a limit on the amount spent on your care each year.
- Gradually closes the Medicare Part D “donut hole” coverage gap by providing patients with a $250 rebate once they enter the gap. The coverage gap will be phased out by 2020. Click here for information on the American Kidney Fund’s program that helps dialysis patients with prescription medication expenses covered under Part D.
- Offers insurance premium assistance to individuals and families earning less than 400% of the federal poverty level (FPL) to help purchase coverage. Click here for information on the American Kidney Fund’s program that helps dialysis patients with health insurance premiums.
- Expands eligibility for Medicaid under age 65 with incomes up to 133% of the federal poverty level (FPL) allowing more individuals to qualify for Medicaid assistance.
Expands prevention and wellness services to include coverage of annual wellness visits.
The Affordable Health Care Act establishes a shared savings program through which groups of providers coordinate care for Medicare beneficiaries in accountable care organizations (ACOs). ACOs are groups of providers and suppliers with shared governance that meet quality performance standards. These organizations will be eligible to receive payments for promoting efficient service and accountability for a patient population. Nephrologists and other providers would be eligible to participate in this program, which could potentially improve the delivery and quality of care for patients with kidney disease.