Ensuring Access to Medigap for Dialysis Patients

Americans have long believed that people with serious diseases such as cancer or diabetes should have access to treatment and care. What would Americans think, then, if they knew that people with chronic kidney disease are prohibited in some states from buying health coverage that enables them to afford the care they need?

Such is the case in 23 states that do not allow people with kidney failure, or end-stage renal disease (ESRD), to buy insurance that supplements the coverage they receive under Medicare. Patients in those states are forced to pay thousands of dollars out of their own pockets for lifesaving care, jeopardizing their access to the treatments they need to stay alive.

Most people with kidney failure are on dialysis, which can require at least three visits to a clinic per week, each visit lasting several hours. Because of their dire health status and the time involved in receiving dialysis treatments, ESRD patients usually cannot work full time. Yet dialysis costs an average of $89,000 per patient per year — on top of a patient’s other medical needs.

Congress extended a lifeline to dialysis patients in 1972, when it passed legislation ensuring that ESRD patients are eligible for Medicare at any age. But the law didn’t extend the right of dialysis patients under age 65 to purchase Medigap insurance, which covers health care that Medicare doesn’t pay for. Without Medigap, Medicare recipients are liable for 20 percent of their medical bills, which quickly add up to staggering sums for the care they need.

Of particular concern to dialysis patients is the role that Medigap coverage — or the lack of it — plays in access to kidney transplants. In states where Medigap coverage is available to ESRD patients under 65, transplant centers require that patients have Medigap to be considered for a transplant. In the other states, patients are often asked to show other proof of financial responsibility, such as money on deposit at a bank. This state of affairs perpetuates inequitable access to organ transplants based upon income.

Fortunately, Congress has stepped in to help remedy the problem. Bipartisan legislation was introduced in the U.S. House of Representatives last month to ensure that dialysis patients under age 65 can buy Medigap coverage regardless of where they live. The Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 2644) would improve the care of the more than 675,000 ESRD patients nationwide who require transplantation or frequent dialysis treatments to survive.

The legislation, introduced by Reps. John Lewis (D-GA), Tom Marino (R-PA) and Peter Roskam (R-IL), also would augment research on kidney disease, improve coordination among kidney care providers and expand coverage options for dialysis patients. Dialysis Patient Citizens (DPC), a leading advocacy group for people with kidney disease that represents nearly 30,000 dialysis and pre-dialysis patients nationwide, strongly supports the bill.

On behalf of kidney disease patients and their families across the country, we urge lawmakers to quickly pass this bill so people with kidney failure have the choice of coverage options they deserve.