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March 25, 2010


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I can imagine four reasons why people have been hesistant to comment on the impact of the new legislation on the endstage renal disease community. First, the law is 2200 pages long, and few will have the patience to read through the whole statute to ensure that some loophole does not trump the apparent rights it formulates. Second, provisions for insuring adults with pre-existing conditions only become effective in 2014, so there is no rush to consider the impact on most dialysis patients. Third, the fines for non-compliant insurers refusing to cover people with pre-existing conditions are ludicrously small, so many insurers may well decide that it is more cost-effective not to comply. Finally, I anticipate that as soon as the Republicans regain power they will undermine or destroy Obama's innovation. As you will remember, after the extension of funding to cover dialysis was introduced in the early 1970s, within a year or two, after costs turned out to be higher than expected, there was a serious effort in Congress to halt the program.

Bill Peckham

One: the KCP and KCC as well as many of their individual components have highly paid people at K Street Lobby shops that are paid to tell them what is in legislation. The Senate Bill passed three months ago and if the 2,400 pages were conventionally laid out it would be less than 400 pages.

Two: the high risk pools go into effect in 2011. If there is a potential gap in coverage between 2011 and 2014 right now would be a good time to start crafting legislation to address those gaps rather than banging on about extending immunosuppressant coverage as if the Affordable Care Act never passed.

Of apparent greater importance to the CKD advocacy community is the possibility that CMS in the next few months will release the final PPS rule and it will include oral drugs. The new legislation provides some great talking points to avert that outcome. If I can read the relevant sections in my free time and realize this, the paid, full time leadership of the CKD advocacy community can figure it out too. When tIme is of the essence, being nimble is required.

Three, I don't think you understand the legislation.

Four, that's farcical. I don't think you understand the American political system.


What wonderful communications skills.


I am not sure where all this hostility comes from; I was just trying to suggest reasons to help explain the phenomenon which you yourself had noticed, and so was simply supporting your observation.

The bill just passed states that insurance companies which reject applicants with pre-existing medical conditions must pay a fine of $100 a day per customer rejected. For extremely expensive conditions like endstage renal disease, which might involve costs of $60,000 a year for dialysis, $260,000 for transplant, $25,000 a year for immunosuppression, plus payments for other co-morbidities, potential insurers might find $36,500 in fines per year less costly than providing insurance.

I don't find the prospect of future Republican efforts to roll back the new healthcare benefits in the future under the slogan of 'cost control' or 'decificit reduction,' both now nearly universal mantras, to be in the least implausible. This is especially true, as you can read for yourself if you check an index of New York Times stories on dialysis in the 1970s, since it has already happened once, when Congress reacted in panic over the 'unexpectedly high' costs of Medicare covering hemodialysis after 1973 and thus moved to end the program.

Bill Peckham

The insurers have to comply to be in the exchanges but either way the role is for the professionals who are suppose to track this stuff to explain it to we hobbyists.

If there is hostility it is towards the continued pursuit of obsolete advocacy objectives when there are tremendous advocacy opportunities that demand new tactics. Time is being wasted.

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