Every American deserves access to comprehensive, affordable health care coverage, including patients with end stage renal disease (ESRD). For decades, employer-provided coverage has provided hardworking American families with effective ways to improve their health and financial security – including those with ESRD and other forms of kidney disease.
There are many ways to improve care for patients with ESRD. But as the Supreme Court recently decided in a 7-2 opinion, a tortured reading of a federal statute is not one of them.
In June 2022, the U.S. Supreme Court issued its decision in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc. The case centered on the very narrow issue of whether an employer-provided benefit plan violates the Medicare Secondary Payer statue when the plan provides the same benefits to all of its members. In this case, the employer plan established an outpatient dialysis benefit that applied to everyone enrolled in the plan, regardless of whether or not they lived with ESRD.
In its majority opinion, the Court noted that the statute’s language specifies that a plan may not differentiate in the benefits it provides to all its members – that is, all members must have access to the same benefits, regardless of any health condition.
In its argument, DaVita attempted to manipulate a statute focused on the coordination of care into something it wasn’t. The Supreme Court rejected that approach and observed that not only was DaVita incorrectly interpreting the statute, but that what they were suggesting "would be all but impossible to fairly implement" and "a prescription for judicial and administrative chaos."
Employer-provided coverage plans offer widespread and generous coverage of renal dialysis and treatment services for those with ESRD and other forms of kidney disease – it's in the best interest of employees and dependents.
Beyond the market reality that ESRD coverage is commonplace, there are legal structures already in place to protect coverage based on a disability. The fact is, there are several laws that protect the rights and benefits of people with ESRD and other forms of kidney disease:
- ERISA Section 702 states that group health plans subject to ERISA may not establish rules for a person’s eligibility to enroll in that plan based on health factors, including disability.
- The Affordable Care Act (ACA) requires ACA-compliant plans to provide “essential health benefits.” Today, 49 States and the District of Columbia include dialysis benefits in their essential health benefit benchmark plans.
- Section 2711 of the Public Health Service Act (PHSA) and its implementing regulations at 45 CFR 147.126 further prohibit all group health plans from imposing either annual or lifetime dollar limits on any essential health benefit covered by the plan.
- ACA Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. ESRD meets the definition of “disability” under Section 504 of the Rehabilitation Act of 1973.
We all agree: Americans with kidney disease and ESRD deserve access to effective, high-value care. Employer-sponsored plans continue to cover these patients with the high-level of care that they had access to prior to the ruling. Let’s continue to work together to improve kidney care – and patients’ peace of mind.
Read more about AHIP’s solutions to improve kidney care, including treatments for ESRD patients.
Related: AHIP Joins Kidney Care Campaign to Support Access to Home Dialysis
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