Passage of Health Overhaul Bill will unalterably change the CKD advocacy landscape

By Bill Peckham

I take there to be at least three foundational policy positions in the CKD advocacy community. Not that everyone has the same position but that everyone has a position on: extending immunosuppressant drug coverage for the life of the graft, include/exclude oral drugs in the final dialysis PPS rule, and the length of the Medicare Secondary Payer provision. In the first case everyone in the CKD advocacy community seems to be on the same page, in favor of extending coverage. Positions on including oral drugs are less clear cut, and in the case of MSP, CKD advocates disagree, but generally CKD advocates have positions on these three issues. 

The passage of the Health Overhaul Bill, without specifically addressing it, will take the immunosuppressant issue off the table by providing routine access to insurance. The question of whether to include oral drugs in the final PPS will be moot since the final Health Overhaul Bill will include a call for the GAO to study the issue. And by eliminating the preexisting condition issue, and life time insurance caps, the Health Overhaul Bill leaves me without a strong objection to extending MSP and I agree that there is an opportunity to create an important incentive by extending the MSP period only for those dialyzors who are working or actively seeking paid work.

Am I missing something or will the CKD advocacy landscape unalterably change with the passage of this bill?

Comments

[zach]

To change or not to change, that is the question.

[Bill Peckham]

I think the bill is step down a path we have to travel, as hard as that journey seems. We're just going to have to face the hard questions this process revealed as a price of being human.

Continuing to ignore the many perversities of the current system arrangement is the worst choice.

[Lori Hartwell]

Allowing everyone to have access to insurance (especially pre-existing conditions) is a step in the right direction. But, I am not sure if it solves the problem of transplants recipients having access to immunosuppressant medications. What if the rates are so high people can't afford it or they don't have the funds for premiums or copays?

[Bill Peckham]

There is expanded coverage through Medicaid too. The premiums should be the same for everyone in the exchange - more precisely everyone will have the same options. And the coverage will be more than just the meds - post Tx you need physician coverage too, not to mention insurance if something goes wrong.

I think the base coverage would encompass most immunosuppressant drugs and routine post Tx care. Part of what this bill does is define what is minimally needed to call something acceptable insurance.