How are ESRD Program issues faring in the health insurance reform process?

By Bill Peckham

Tomorrow is the big bipartisan meeting at Blair House which may open a path to passage of a health insurance reform bill. My understanding is if health insurance reform legislation were to pass, that the bulk of the legislative language would come from the Senate bill, which is the Senate's HR 3590, the relevant ESRD Program language was voted through initially in November and then revised with a Managers Amendment in December. For that language to go to the Presidents desk to be signed, all that would have to happen would be for the House of Representatives to vote on the amended Senate bill; this has been true since December.

The problem is that the House passed a health insurance reform bill significantly different from the Senate's and there needs to be a second bill with a package of changes to the Senate Bill, for the House to be willing to pass the Senate's bill. This package of changes will be the subject of tomorrow's meeting. One can imagine that anything could be added to the package but I would think that extending immunosuppressant drug coverage and/or mandating that the dialysis payment include oral drugs (as the House's health insurance reform bill, HR 3962, did) are not big enough issues to enter the discussion. Meaning extending immunosuppressant drug coverage is out.

The a package of changes will be about big things; the ESRD pieces are small in comparison. However, things get slipped into legislation all the time. Illinois Senator Durban, a supporter of extending immunosuppressant drug coverage, is attending tomorrow's meeting. Representative Stark, a proponent of including oral drugs in the dialysis payment bundle to pay for immunosuppressant drug coverage will not be in attendance.

Until changes to the Senate legislation are written into a bill and voted on by both Houses of Congress we can't be sure of the final ESRD provisions, except to say that in the absence of additional language, the Senates HR 3590 ESRD language will become law.

Comments

[Toastie]

I don't think this adds much, but for what it's worth, my congressman, David Price (D, NC-6), gave me this email response recently (which at least reflects that he's very well-aware of what's at stake for us):

As a cosponsor of the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 1458), I am pleased that the House-passed health insurance reform bill, Affordable Health Care for America Act (H.R. 3962) includes a provision that would lift the current 36-month limitation on Medicare coverage of immunosuppressive drugs for kidney transplant patients. Because the provision is in the House-passed bill, which I supported, but not in the Senate-passed bill, it is important that my colleagues and I continue to advocate for this important policy fix as the final legislation is developed.

[Bill Peckham]

Thanks Tostie. The question is, if health insurance reform does somehow pass do we need to extend immunosuppressant drug coverage? The need arises from the preexisting condition exclusion, if that could be resolved does that solve the problem?

[Rich Berkowitz]

Bill, I don't think so. Since immunosuppressants wouldn't fall under bundling because it's not dialysis specific, it would then be a Part "D" med. Each individual insurance company that has a Part "D" plan can decide which meds are covered. I would doubt they would have immunosuppressants in their plans.

Also, if the Dems go ahead with reconciliation, the House would have to pass the Senate version and hope differences can be ironed out afterwards. And the only items that can be changed are those that have to do with the budget. Adding immunosuppressants in without taking something out would obviously not be budget neutral. I certainly wouldn't want to see them take something else away from dialyzors.

[Bill Peckham]

The Senate Bill doesn't extend coverage, that's why I wrote immunosuppressants are out. If health insurance reform does somehow pass in the form of the Senate bill, again what I wrote above, then the preexisting condition exclusions goes away.

It seems to me that the preexisting condition exclusion is the reason why people who have transplants need Medicare immunosuppressant coverage extended. People with a transplant can't obtain health insurance in the individual market.

Medicare Part D never enters the equation.