American Kidney Fund Commends the U.S. House of Representatives for Including Provisions for Kidney Patients in the Build Back Better Act

ROCKVILLE, Md. (November 19, 2021)  — The American Kidney Fund (AKF) applauds the U.S. House of Representatives for including provisions in the Build Back Better Act that will help people with chronic kidney disease (CKD) and kidney failure (end-stage renal disease, or ESRD).

"Access to affordable, comprehensive health insurance and primary care physicians is the first step to ensuring that CKD is found early, which can provide kidney patients with early interventions that can slow or halt the progression of the disease," said LaVarne A. Burton, President and CEO of the American Kidney Fund. "Enhancing Affordable Care Act (ACA) tax credits and strengthening the Medicaid program so more people in the United States can access affordable health insurance has been a longstanding policy priority of AKF. We are so pleased to see these provisions in the Build Back Better Act, as they will help kidney patients who rely on Medicaid, Medicare and private insurance."

Medicaid, which currently provides health coverage for one in five low-income individuals, plays a vital role in helping people prevent and manage chronic health conditions. Expanding Medicaid is an important step in helping people with CKD and ESRD. Compared to states that did not expand Medicaid, people living in states that expanded the program had lower mortality rates after going on dialysis and more patients were preemptively placed on the transplant list so they could be on dialysis for a shorter time. Medicaid expansion also resulted in improved measures of blood pressure and glucose, which is meaningful because diabetes and hypertension account for 75% of new cases of kidney failure.

The Build Back Better Act includes a provision that would provide access to ACA coverage to individuals who live in states where there is a coverage gap because the state did not expand Medicaid. These individuals have incomes too high for Medicaid, but too low to qualify for ACA tax subsidies. The Build Back Better Act would expand ACA tax credits until 2025 to the lower income threshold, so they could gain access to health insurance.

Additionally, AKF advocated for increased Federal Medical Assistance Percentage (FMAP), which is the federal portion of the federal-state funded program of Medicaid. The Build Back Better Act would expand FMAP from 90% to 93% from 2023 to 2025. As many states are facing budget shortfalls due to the COVID 19 pandemic, states could roll back Medicaid services. The additional funding is necessary to better ensure people retain access to the health care services they need.

Access to medically-appropriate prescription drugs for kidney patients must be preserved amid federal efforts to address the rising cost of prescription drugs. Patients with CKD, ESRD and who are living with kidney transplants rely on prescription drugs to manage their kidney disease and comorbidities. Most people in the U.S. who are on dialysis are on Medicare, and AKF supports policies that would result in lower drug costs and lower out-of-pocket costs for them, including a restructuring of the Medicare Part D benefit that creates a true out-of-pocket cap for beneficiaries with a smoothing mechanism. The Build Back Better Act includes a $2,000 cap. Patients who reach that $2,000 prescription drug cap in the first month will have a mechanism to pay that $2,000 over the course of months to ensure affordability.

The ACA expanded access to health insurance for millions of Americans, which has helped CKD patients receive early interventions to slow the progression of their disease. AKF supports expanding advanced premium tax credits (APTCs) so insurance is more affordable. The American Rescue Plan expanded APTCs to those who make more than 400% of poverty and capped insurance premium costs to 8.5% of the income. The Build Back Better Act would extend these provisions until 2025. The provision will allow millions of Americans to retain their health insurance, which is vital for those with diabetes, heart disease, CKD and ESRD.