Senate Introduces the Better Care Reconciliation Act

By Troy Zimmerman, National Kidney Foundation’s Vice President of Government Relations

On June 22, the U.S. Senate introduced the Better Care Reconciliation Act, their counterpart to the House of Representative’s American Healthcare Act.  Both bills would significantly reduce access to vital, preventive, and life-saving care for people at risk of, or with, chronic kidney disease.

Despite assurances that people with pre-existing conditions could still purchase insurance in the Marketplaces, this bill allows states to eliminate the essential health benefits currently provided under the Affordable Care Act, and permits insurers to discriminate against people with pre-existing conditions by not covering vital medications and treatments. For kidney patients, this could include treatments such dialysis or transplantation and medications.

In addition, significant changes and cuts to Medicaid could leave many low-income people without access to health insurance and health care services.  This includes preventive care necessary for slowing the progression of chronic kidney disease.  As state Medicaid budgets are tightened across the nation, states may look to reduce the populations they cover and eliminate expensive, but critical, benefits like dialysis treatments.

Instead, NKF believes the Senate should consider these alternative concepts to improve healthcare for chronic kidney disease patients:

• Access to healthcare is critical to earlier detection and management of chronic kidney disease (CKD). Earlier detection and management can often delay or prevent progression of chronic kidney disease and the need for dialysis treatment, improve outcomes for patients and lower healthcare expenditures.  NKF urges Congress to enact policies that maintain or increase the number of insured patients, which will enable earlier detection of CKD.
• People with end stage renal disease (ESRD) require either a kidney transplant or dialysis to survive.  As such, insurers should be required to cover these treatments and be prohibited from limiting coverage to people with ESRD who choose not to enroll in Medicare.
• Over 200,000 ESRD patients have received a life-saving kidney transplant and must take immunosuppressive drugs for the life of the transplant.
  • The insurance practice of placing immunosuppressive medications, including generics, on high cost sharing tiers requiring coinsurance amounts of greater than 20% and up to 50%, while also excluding generic immunosuppressive medications from fixed copayment amounts, severely jeopardizes the long-term success of the transplant.
  • Cutting back on, or skipping doses of, immunosuppressive medications can be detrimental to the transplant and the patient.
  • Each year Medicare spends $87,000 per dialysis patient; opposed to $32,500 for a transplant patient.  Transplantation is far more cost effective and is associated with better outcomes than a lifetime of dialysis.

If you are interested in supporting NKF and kidney patients around the country, please consider reaching out to your Senators by clicking on the button below.