We have been writing about the vital role of charitable third-party payments of insurance premiums for low-income kidney patients through the American Kidney Fund’s (AKF) Health Insurance Premium Program (HIPP) because insurers are lobbying for public policies that would deny this kind of assistance. We believe that all patients deserve a choice in insurance and that any public discussion about policy in this area ought to have the patient as a focus—not a company or an industry.
That said, we think it is important to talk about who kidney patients are and how having a life-threatening chronic condition like end-stage renal disease (ESRD, or kidney failure) affects their lives. It tells a lot about why health insurance is so vital to their wellbeing.
Health insurance is the gateway to medical care, critical for people with end-stage renal disease ESRD who will die without ongoing dialysis treatment or a transplant. These patients not only need access to dialysis, but they typically suffer from other conditions that require regular medical attention such as hypertension, diabetes and cardiovascular disease, as well as the many complications of kidney failure.
Insurers keep saying that people with ESRD can get Medicare so they don’t need private insurance. Medicare is an important option, but alone covers only 80 percent of medical expenses. A supplemental plan is necessary to cover the 20 percent out-of-pocket costs that have no lifetime cap under Medicare. In about half the states, insurers are not required to offer Medigap to ESRD patients under age 65, and ESRD patients in all states are prohibited by law from enrolling in Medicare Advantage plans which provide comprehensive coverage. For these patients, private insurance may very well be the best option to cap out-of-pocket costs and to achieve effective coordination of care. In other cases, even if Medigap is available, a patient may choose private insurance because Medicare does not offer family coverage, or because the person seeks better access to transplantation, or because the physician network offered in a private plan allows the person to continue seeing the same doctors they saw before they became ill. The reasons are many and cannot be distilled down into a black-and-white declaration that people with ESRD belong on Medicare. The situation may be different for each person. The law provides that they have a choice.
People often don’t understand how devastating ESRD is to a person’s life—and their livelihood. When a person has ESRD, treatments consume a lot of time and they are physically draining. As a result, most dialysis patients are unable to work, and poverty is often a byproduct of this condition—60 percent of the patients we help have annual incomes under $20,000 while facing average out-of-pocket costs each year of $7,000 after paying premiums.
The ultimate therapeutic benefit many dialysis patients hope and strive for is a kidney transplant, but the fact is that patients who have comprehensive health insurance are much more likely to receive a transplant. Many people will have to spend years on dialysis while waiting for a transplant. Many will never be able to have a transplant for health reasons or the shortage of available organs.
Assistance through our HIPP program allows patients to access complete health care services offered under their plan, including transplant workups and transplants. There are currently 79,000 dialysis patients in the U.S. who rely on AKF for insurance support. We help patients pay their premiums for all kinds of health insurance—Medicare, Medigap, commercial, COBRA, employer group health. And, since the passage of the Affordable Care Act, we have helped people access insurance Marketplace policies, though they represent a small fraction of our patient assistance—just 6,400 of the nearly 80,000 people we currently help.
It is important to note that not only does ESRD have an enormous financial impact on patients generally, but also disproportionately impacts certain populations that have been historically underserved. For example, African-Americans and Hispanics have higher rates of ESRD, and are disproportionately affected by the limits of access to health insurance. Over half of the people who receive help under our program are people of color.
That is why when it comes to policy development at both the state and federal level, we believe patients should be the focus—and that health policies should help, not harm, patients.
LaVarne A. Burton is president and chief executive officer of the American Kidney Fund.