NKF notes passage of Affordable Care Act, says it "will benefit Americans with kidney disease"

By Bill Peckham

I was glad to see the National Kidney Foundation take note of the new health insurance law:

With Senate approval of health care reform on March 25, 2010, we wanted to highlight some of the provisions contained in the underlying bill and in the corrections bill (or "reconciliation bill").  (The legislation signed by President Obama on March 23, 2010 was the underlying health reform bill and identical to what the Senate passed on December 24, 2009; the corrections bill made changes to the underlying bill, under agreement with House and Senate leaders.)

The National Kidney Foundation (NKF) did not advocate for or against a specific health care reform bill throughout the process.  However, we signed various letters of support on specific provisions (such as eliminating lifetime benefit caps) that were coordinate by coalitions and organizations. We believe that the legislation will benefit Americans with kidney disease or at risk of developing it. Here are some of the well-known features of the health care reform package that should have a positive impact on the population we serve.

The communication goes on to list some of the top line elements of the legislation.

The communication concludes by reaffirming the NKF's commitment to expanding Medicare to cover immunosuppressant drugs for the the life of the transplant. This has been a long standing organizational commitment, I believe a commitment approved at the board level. This means that it will take board action to change.

I think the NKF board and other advocates for better transplant outcomes need to act quickly by evaluating their public policy advocacy efforts in light of the new law. The law directs the Secretary of DHHS to make numerous decisions on how to implement the high risk pool insurance that is meant to bridge the period between January 2011 and January 2014. The immunosuppressant advocacy opportunity would be to push for a bridge extension of Medicare coverage.

A bridge extension of Medicare coverage for immunosuppressant drugs would cover the period between January 1, 2011 and January 1, 2014 when the expansion of Medicaid and the exchanges (with subsidized access) come into being. The bridge is needed to maintain immunosuppressant drug access for people who can not afford the high risk pool premiums.

You want people with transplants to have access to the high risk pool insurance but the program is designed to offer insurance at the rate you'd get, were you healthy. Even at this lower, "reasonable" rate, health insurance and thus immunosuppressant drugs, would be out of reach of many. This is where the bridge extension would come in: until subsidized health insurance access is available in 2014 the bridge would allow people limited Medicare coverage for immunosuppressant drugs.

Those advocating for lifetime immunosuppressant drug access through Medicare all these years may find it hard to retool their advocacy message but I would describe this as an opportunity. There should be celebration in the CKD community. Within our grasp is lifetime access to health care post transplant. Not just drugs but health care, for everyone living with a transplant. If advocates are nimble they can ensure that this problem of post transplant insurance access is finally comprehensively fixed in a way that improves the medical outcomes of people living with a transplant!. Through retooled advocacy this can be done sooner rather than later.

Comments

[Rich Berkowitz]

Bill, we're lucky to have you around as you so thoroughly grasp the issues and related policy. What you're saying is absolutely correct. If one with a transplant loses their Medicare coverage sfter the usual three years, s/he would then be able to get an insurance policy regardless of pre-existing condition and without a penalty of a higher premium. That with any subsidy should make the insurance policy much easier to handle.

Does this then become the "reform" I'd like to see? No, like many others, I would have likes to see the "reform" go further. But I also recognize this is hopefully just a start, and am hopeful people will come to realize health reform is in the best insterest of the country, bith morally and economically.