Nation’s Kidney Community Deeply Disappointed with Supreme Court Ruling in Marietta Memorial Hospital Employee Benefit Health Plan v. DaVita
June 21, 2022
WASHINGTON – Kidney Care Partners (KCP) – the nation’s largest non-profit, non-partisan coalition of more than 30 organizations, comprising patients, dialysis professionals, physicians, nurses, researchers, therapeutic innovators, transplant coordinators, and manufacturers – today expressed deep disappointment in the Supreme Court ruling on Marietta Memorial Hospital Employee Benefit Health Plan v. DaVita, citing concern about discrimination in accessing affordable quality care for individuals living with end-stage renal disease (ESRD) and its impact on growing health inequities.
“The insurer practice at issue – shifting patients prematurely to Medicare – will exacerbate inequalities in access and quality care for an already vulnerable population. This ruling is a blow to promoting affordable patient choice and instead unfairly shifts costs to the American taxpayer. We feel this decision leaves patients with ESRD vulnerable to discriminatory and inequitable insurer practices, and in fact, is not consistent with the Administration’s own goals on health equity,” said John P. Butler, Chair of KCP.
Premature loss of private group health coverage can be devastating for some patients living with ESRD. Often, private insurance plans offer more coverage options than Medicare does. Some of these services, such as dental coverage, can be essential in controlling infections that, if not caught early, can exclude a patient from transplant waitlists. More comprehensive disease management services can provide better outcomes by helping to manage other chronic diseases common in patients requiring dialysis. Private insurance may, in some cases, also provide lower copays and deductibles and limits on out-of-pocket costs than Medicare. When a patient living with ESRD loses private insurance coverage, the consequences can also extend to other family members under that policy who do not qualify for Medicare and may face substantially higher costs, deductibles, and other cost requirements resulting from that loss of coverage.
“Despite this ruling, KCP remains steadfast in our commitment to ensuring equitable, affordable access to quality care for the millions of individuals living with or at risk for kidney disease,” said Butler. “We stand ready and willing to work with Congress and other policymakers to address the gap created by today’s ruling and clarify the intent of the Medicare Secondary Payor Act to better protect patients from exclusionary measures like this. More must be done to ensure that no one is denied or discriminated against because of the treatment they need because of their disease.”
The issue in the case was whether a group health insurance plan that limited access to outpatient dialysis treatments violated the Medicare Secondary Payer statute by discriminating against patients based on their need for dialysis. In January, KCP filed an amicus brief which argued that the health plan discriminated against those with ESRD by limiting coverage for life-sustaining treatment, thereby forcing patients to drop private group coverage, and financial protections, in favor of Medicare. The recent Supreme Court opinion disagreed with that argument.