“Health care provider and patient groups in the field have consistently called for amendments in light of this ruling,” the Republican Senate aide told POLITICO, speaking on the condition of anonymity, speaking about advocacy. . Lobbying began around December, when the Biden administration submitted briefs in favor of the group’s health plan, but “gained a ton” after the June 21 decision.
DaVita has exercised political power to close what it called a “loophole” created by its views. Current law is unclear about requiring plans to cover, while plans prohibit providing various benefits to beneficiaries of end-stage renal disease. dialysis service.
Three weeks after DaVita lost the Supreme Court case, the company’s chief legal officer, Kathleen Waters, and one of the company’s top lobbyists, Kelly Filson, said: drafted the text of the proposed legislation According to the metadata in the Word document obtained by POLITICO, it would make additions to the Medicare Act at issue in this case. to equalize coverage for dialysis services. There is no external indication that the text is from her DaVita.
While calling for changes, supporters tried to assure lawmakers that they weren’t trying to expand the scope. summary document Also available from POLITICO. While the loose verbiage may be “manipulated by the plan” to create “a ‘skinny’ plan that does not cover chronic disease benefits,” the summary states that “our intention to create no obligations is emphasized.”
Bipartisan group of 17 members of Congress on July 29 submitted a bill that largely mirrored suggestions, and Sens. Bob Menendez (DN.J.) and Bill Cassidy Following (R-La.) Senate Fellow Generally, instead of creating parity between dialysis care and other services, it would ban mass care plans. Put “restrictions, limits or conditions” Advantages of dialysis compared to services required to treat other chronic conditions covered by the plan.
“After June’s Supreme Court ruling created a loophole, members of Congress concerned about the potential harmful effects on voters of this vulnerable patient population sought protection under the Medicare Secondary Payers Act. E-mailed statement in response to inquiries from POLITICO regarding the company’s involvement in the proposal and its lobbying and campaigning activities.
In addition to spending about $4 million a year on lobbying, DaVita has many political action committees.
Each of the House bill’s 17 co-sponsors has received a total of $67,000 in campaign funding from DaVita’s PAC since January 2021, according to OpenSecrets, which tracks political spending. Five co-sponsors also received contributions to the Leadership PAC, according to Federal Election Commission records.
Industry often contributes to lawmakers working on issues, so it’s not uncommon for DaVita to donate thousands of dollars to most of these members over the past few election cycles.
But in May, deputies. Yvette Clark (DN.Y.), the bill’s primary sponsor and Vice Chair of the House Energy and Commerce Committee, received donations of $14,500 from 10 DaVita executives and employees. Year.
The donation includes $2,500 from Waters, the attorney who drafted the legislative proposal, and $2,000 from its CEO, Javier Rodriguez, according to FEC data. Records show that none of them, or DaVita employees, have previously contributed to her. The company did not comment on the donation.
Clark’s office said in a statement that the issue was “particularly important” for members of the House of Representatives because of the prevalence of kidney failure among voters.
“Throughout the legislative process, we are always seeking input from our stakeholders – patient groups, providers, advocates and our constituents. We will ensure that we have the best information available to make relevant public policy decisions,” the statement said.
Cassidy and Menendez have not received donations to the campaign from DaVita’s PAC since early last year, but donated $10,000 and $5,000 respectively to the Leadership PAC.
“Because kidney disease disproportionately affects minority communities and Supreme Court rulings can adversely affect access to health care, as part of my longstanding commitment to reducing inequity, health care planning I led the introduction of this common-sense bill to ensure that people with kidney disease do not discriminate in our healthcare system,” Menendez said in an email.
A spokeswoman for Menendez said the office had not been in contact with Davita or its lobbyists “recently regarding this bill or any other matter,” but said it had received feedback from patient groups.
Cassidy’s office declined to comment.
“Our teammates have been civic activists for decades and will continue to advocate on behalf of this patient population,” DaVita said in a statement. This includes supporting both Democrats and Republicans in Congress prioritizing better kidney care policies in the United States.”
The Supreme Court ruling was a blow to dialysis companies like DaVita and a source of anxiety for patients worried about plans losing coverage in their networks, but provides a roadmap for fine-tuning the law Did.
Justice Brett Kavanaugh said, “If Congress wants to mandate that collective health insurance provide specific benefits, or that collective health plans ensure parity between various types of benefits, Congress will I knew how to make such a law,” he wrote in the court’s ruling.
Medicare, known for providing insurance to older Americans, is expanding coverage to include people with end-stage renal disease, regardless of age.
If a person with progressive kidney failure received health insurance through their employer, Medicare acts as a “secondary payer” and temporarily receives a portion of the tab. After that, Medicare becomes primary and group health plans become secondary.
Medicare spends $51 billion on end-stage renal disease beneficiaries, according to the American Kidney Data System annual report. People with advanced renal failure require kidney transplants or regular and expensive dialysis treatments to survive.
The Medicare Secondary Payer Act prohibits private plans from considering this eligibility when creating benefit programs. By law, group health plans may end coverage, charge higher premiums, or “discriminate in benefits provided on the basis of the presence of end-stage renal disease, need for renal dialysis, or in any other way.” It cannot be transformed,” he said. ”
DaVita said in the lawsuit that by taking dialysis care out of the network and forcing patients to pay more for these services, the plan unacceptably worsens patients with end-stage renal disease than other beneficiaries. Allegedly, they gave compensation and deliberately enrolled individuals in Medicare. We will refund you at a much lower rate.
Kavanaugh objected, saying the plan would provide the same level of coverage for dialysis services regardless of how advanced a patient’s kidney disease is.
But because nearly all kidney failure patients receive treatment, dialysis is “almost a perfect alternative for end-stage renal disease,” said Justice Elena Kagan in her dissenting opinion. The decision created a “massive and baffling workaround” for employer-based plans, she added. Recently introduced legislation aims to strengthen the “non-discriminatory” part of the law.
Cameron Lynch, senior vice president of government relations at Fresenius Medical Care, another dialysis giant, said both the court’s decision and the dissenting opinion “cited the need for legislative action to resolve the issue. ” he pointed out.
In an email, Lynch said, “Majority in the health care industry cares about patient well-being, but Congress is taking this important step to protect people with newly diagnosed kidney failure from potentially discriminatory behavior. I am happy that the law has been introduced,” he said. statement. The company did not respond to questions about lobbying for the bill.
Groups representing dialysis companies, providers and patients say the decision paved the way for more plans to limit the extent of dialysis to cut costs. For patients, that means having to pay for both employer-sponsored insurance (such as vision or dental) and Medicare for kidney care, or transitioning completely to Medicare for supplemental benefits. must refrain from
Insurers, meanwhile, counter that the legislative effort is a cash grab by an industry that wants to ensure they are reimbursed for the higher in-network fees that private plans offer.
Employers effectively force nearly comprehensive coverage by creating parity between kidney failure and all other chronic diseases, with DaVita and Fresenius, which hold 80% of the dialysis market, raising prices claim to have power.
The bill “would require employers’ health insurance companies to pay a monopoly on kidney dialysis regardless of what the company is asking,” says a lobbyist who supports a group health plan speaks freely about the law. “Ultimately, this means higher medical costs for everyone who purchases health insurance through their employer.”
