Texas judge blocks CMS regulation that would harm dialysis patients

LaVarne A. Burton  |  Posted
Judge and gavel

Last month, the Centers for Medicare & Medicaid Services (CMS) issued a regulation that would have given insurers the right to deny coverage to dialysis patients who receive charitable help to pay their insurance premiums. Yesterday, a federal judge in Texas blocked the rule, and thousands of patients nationwide breathed a collective sigh of relief.

We, along with other patient groups, opposed the rule and supported the lawsuit that sought to block it. We know how end-stage renal disease (ESRD, or kidney failure) can devastate a family’s finances. We know that 80,000 patients nationwide depend on our financial assistance to pay their premiums for Medicare and Medigap, we well as private commercial individual and group health plans through our federally approved program. And we know that insurers would rather not insure ESRD patients, whose health care costs are among the highest.

In recent years, insurers have been taking aggressive actions to drop ESRD patients who need help paying for their insurance. The CMS regulation was an outgrowth of their extensive lobbying to be exempt from covering ESRD patients and forcing them onto public insurance programs. It bypassed the normal procedures for this type of regulation, and was rushed in the waning days of the previous administration. Thankfully the judge considered all sides and blocked it.

In his opinion, U.S. District Court Judge Amos Mazzant III demonstrated an understanding of the complexities of insuring patients who live with ESRD: “Not all ESRD patients qualify for Medicare, and Medicare does not cover family members. Further, many health care providers do not accept Medicare. Therefore, some ESRD patients and their families could lose access to their health care providers or even lose insurance coverage altogether.”

He also affirmed the role of charitable organizations in helping low-income patients: “Given the vulnerability of ESRD patients and the expense of treatment, charitable organizations provide premium assistance to eligible ESRD patients. These charities, such as the American Kidney Fund (‘AKF’), often provide assistance to patients based on financial need, regardless of which insurer the ESRD patient has selected. Dialysis providers have long donated to these charities, which HHS has approved of and regulated.”

There is still much work to be done. Insurers continue to look for loopholes that will allow them to do what they did for many years—deny coverage to people with expensive pre-existing medical conditions like ESRD. The federal government stepped in when they tried to do it to HIV/AIDS patients in 2014, and we will continue our fight for similar protections for ESRD patients in 2017.

LaVarne Burton is president and chief executive officer of the American Kidney Fund.

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