For patients with end-stage kidney disease (ESKD), dialysis is the most utilized treatment method. Unfortunately, a recent Supreme Court ruling may limit access to dialysis for some individuals. Andrew Conkling, a dialysis patient and president of the Dialysis Patient Citizens Board of Directors, explains the ruling and how it can affect dialysis patients.* 

What happened? 

Davita Inc. initially sued private insurer Marietta Memorial Hospital Employee Health Benefit Plan for limiting coverage of dialysis to 30 total treatments, which many if not most dialysis patients will undergo in a matter of months. DaVita, along with many others, claimed that the limitation discriminated against kidney disease patients by differentiating between individuals with and without ESKD, and by factoring in ESKD patients’ Medicare eligibility. Marietta Memorial denied any discrimination. 

In June 2022, the case was brought before the Supreme Court. The court ruled 7-2 in favor of Marietta Memorial, stating that the 30-treatment threshold applied to everyone, regardless of whether or not they had kidney disease. Since dialysis is a treatment almost exclusively needed for kidney disease and traumatic kidney injury, many do not think that the ruling is just.

What does this mean for patients? 

Going forward, patients with this private insurance will be forced to switch to Medicare for primary insurance. That dialysis patients will no longer be able to choose their coverage is unfair, Conkling asserts. Medicare only covers 80% of dialysis costs, and for those under 65 years of age, supplemental insurance may be unavailable or unaffordable.  

Moreover, since 1980, Medicare has given dialysis patients the option to remain on their private insurance for 30 months or switch to Medicare immediately once their private insurance ends. This new Supreme Court ruling has taken that choice, also known as the Medicare Secondary Payer period, away from patients. 

How are leaders fighting this? 

While the ruling has created stress and financial pressure for many people, there are compassionate leaders in Congress who are fighting to correct this. Representatives Terri Sewell (D-AL-7) and Mike Rogers (R-AL-3) are fighting alongside Senate colleagues Bill Cassidy (R-LA) and Bob Menendez (D-NJ) to pass the Restore Protections for Dialysis Patients Act. This bill would allow dialysis patients their right to continue with their private insurance for 30 months. 

Whether or not you use this private insurer, it is important to reach out to your legislators to encourage them to support this bill. If it doesn’t pass, the door would be open for other private insurers to limit treatments for dialysis patients. 

The American Kidney Fund has created a page where you can easily e-mail your U.S. legislators to co-sponsor the Restore Protections for Dialysis Patients Act. 

*Conkling, A. M. A. (2022, October 26). Time is running out: Dialysis patients need Congress to act. Montgomery Advertiser. https://eu.montgomeryadvertiser.com/story/opinion/contributors/2022/10/26/time-is-running-out-dialysis-patients-need-congress-to-act/69591650007/