Blog post

What's happening in the states: January 2021

Check out our new What's happening in the states blog series for monthly legislative updates on what we're working on to fight kidney disease nationwide. Though still early in the year, 2021 has already seen a lot of legislative activity!
What’s happening in the states: NJ

Welcome to our new What's happening in the states blog series, where we will provide monthly legislative updates on what the American Kidney Fund (AKF) is working on across the country to improve the lives of those living with kidney disease and protect living organ donors.

In January, 45 of 50 states began their 2021 legislative session. This means there is a lot of (virtual) activity across the country, from supporting living organ donation to protecting affordable access to prescription medicines and treatments. Although AKF will not be advocating in person this year in your state due to the ongoing COVID-19 pandemic, we are doing so remotely and safely, and we hope you can join us in these efforts from the comfort of your own home.


A lot has already happened in the Maryland legislature in 2021. First, there was a hearing for a reintroduced bill that would increase income tax credits from $7,500 to $10,000 for certain expenses paid or incurred by a living organ donor ( HB10 in the House and SB48 in the Senate). The definition of "qualified expenses" for this tax credit would be expanded to include unreimbursed expenses for childcare, elder care and medication. These small, but very significant, changes can greatly help living organ donors with the costs that could go along with making a lifesaving gift, and they can help reduce barriers that would have before blocked would-be donors from deciding to donate. In 2020, this bill unanimously passed out of committees in the Maryland House of Delegates and Senate. We expect the same to happen this year, with the goal of getting this to Governor Larry Hogan's desk for his signature. Maryland currently has a B grade in our brand-new State of the States: 2021 AKF Living Donor Protection Report Card , making it a leader in the nation when it comes to protections for living organ donors. This bill will strengthen their existing laws.

The second bill we are actively supporting in Maryland requires all payments made by patients — either directly by the patient, or on their behalf — to count toward the patient's insurance deductible or out-of-pocket maximum (HB167 in the House and SB290 in the Senate). This bill is in response to an emerging change in insurance plans called copay accumulator policies . These policies prevent copayments made by patients using manufacturer copay assistance or copay coupons from being applied toward their annual deductible or out-of-pocket limit. Many people living with a chronic condition, such as kidney disease, receive and rely on copay assistance, which can help cover as much as 20-50% of the cost of patients' medicine. That assistance is needed now more than ever, as the pandemic has increased the financial strain that high-cost treatments put on patients and their families. Requiring health insurance carriers to count all copayments through this bill will protect patients from high out-of-pocket costs.


In Washington state, there was a hearing and vote on the Living Donor Act ( SB5003 in the Senate). The bill, which passed unanimously out of the Senate Health & Long-Term Care Committee, would prohibit insurance companies from discriminating against people based on their status as an organ donor. Right now, only 14 states have anti-insurance discrimination laws to prohibit life, disability and long-term care insurers from discriminating against living organ donors by charging them higher premiums or denying them coverage altogether. By preventing discriminatory insurance practices, this bill would remove barriers to living donation and increase the supply of organs available for transplantation.

There are more than 93,000 people on the national kidney transplant waiting list right now, but in 2020 only 23,000 people were able to get a kidney transplant. Of the 23,000 transplants, just 5,200 came from a living donor. In Washington, just 76 of 440 kidney transplants were donated by a living donor in 2020. We need to do whatever we can to increase the organ supply and encourage more living donations. Removing financial burdens for living donors can help us accomplish that. Washington currently only has one law on the books to protect living organ donors . If this bill were to pass, it would bump their Report Card grade up from a D to a C.

Other states

Bills similar to the one in Washington have been introduced in Connecticut, Indiana, Kentucky, Texas Vermont and New Jersey, and we expect other states to introduce similar bills in their 2021 legislative sessions as well. Connecticut is currently only one of two states with an A grade on our Report Card. If they were to pass an anti-insurance discrimination bill this year, they would have the widest range of protections for living donors in the country, based on the seven types of legislation we used to grade the states. New Jersey's Living Donor Protection Act has made its way to the desk of Governor Phil Murphy for his signature. If signed, this bill would raise New Jersey's grade on our Report Card from an F to a D.

Stay tuned to this blog series for updates on all of these bills as the states' legislative sessions continue. For now, learn how well your state protects living organ donors in our State of the States: 2021 AKF Living Donor Protection Report Card .

How can you help?

All these bills have a better chance of moving through the legislative process with your help! If you would like to contact your state elected officials about these bills or help with written or live testimony during bill hearings, please reach out to me, Lindsay Gill, AKF's associate director of state policy & advocacy, at

You can also check out our Take action in your state page to see if we have an action alert for your state. If we do, the two minutes it takes to contact your elected officials through our website can go a long way in making sure they prioritize issues of importance to people with kidney disease and living organ donors. If we do not have your state listed on that page right now, keep checking back — we post action alerts as legislation comes up!


Lindsay Gill

Lindsay Gill is the associate director of state policy & advocacy at the American Kidney Fund.