By Bill Peckham
Senator Blanche Lincoln of Arkansas has put forward two amendments to the Senate Finance Committee's health insurance reform bill, America's Healthy Future Act , aka the Baucus bill. Lincoln's identically worded amendments would fund bone health by taking money out of Medicare's dialysis program. Senate Finance Committee Amendments #33 & #34 (PDF link):
Summary
Improving access to primary and preventive care by adding a modified version of the Medicare Fracture Prevention and Osteoporosis Testing Act (S. 769).Offset
Extend Medicare Secondary Payer (MSP) for privately-insured dialysis patients to Medicare after 30 months by amount necessary to offset the increase in spending.
I'm sure the legislation to improve bone health is a good idea but I am against taking money out of Medicare's dialysis entitlement and this would by definition take money of of the dialysis program. That's what a an offset is and extending the dialysis MSP period would save Medicare money (about $1.2 billion over ten years).
However, if the savings are not being redirected to the benefit dialyzors, if savings from one part of the dialysis program are not being reinvested in treating kidney disease, than it would be a step in the wrong direction. Senator Lincoln's amendment would redirect resources away from treating kidney disease, I am against her amendment(s).
The dialysis industrial complex has been very quite about this. They are very much in favor of extending the MSP because it would increase revenues, dialysis is much more profitable when private insurance is paying. Kidney Care Partners has suggested extending MSP in the context of eliminating the 1% deduction applied to the soon to be yearly inflation adjustment to dialysis reimbursement (under MIPPA if inflation is 3%, dialysis reimbursement is increased by 2%). I don't doubt they'd like that: more private payer money and more Medicare reimbursement.
It isn't their dream legislation but KCP seems happy to see MSP go away for whatever reason and they see this as a step in the right direction. I don't think patients should be so quick to let it go. Check out this list of Senate Finance Committee members, if your Senator is on the Finance Committee write to ask that they vote against Senator Lincoln's amendment(s).
I'm going to send my Senator, Senator Cantwell a note: Don't extend MSP for people on dialysis and if you must, keep the money in the dialysis program to improve our dismal national outcomes.
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