This has been a trying year for everyone. Facing the most pressing public health crisis in at least a century, businesses have been forced to close, and many of us have had to stay inside and lead a very different life than what we’re accustomed to. Now, with COVID-19 cases once again on the rise in many of the country’s largest states, it is more important than ever that we take all steps necessary, both citizens and our government officials, to protect those around us who are facing the greatest risks right now.
One particularly vulnerable group of people includes those who have end-stage renal disease and others who rely on dialysis treatments. Their condition requires a thorough treatment plan, and many patients also have other health complications, such as diabetes or cardiovascular disease, that compromise their ability to withstand COVID-19.
Unfortunately, one step taken by the Centers for Medicare and Medicaid Services this year could make it more difficult for end-stage renal disease patients to find the right treatment plans, forcing them to rely on traditional Medicare options that do not always cover all the treatments they need.
That’s because, in May, CMS made changes to the network adequacy requirements that determine the availability of dialysis facilities in the Medicare Advantage plans offered through private insurance companies. The old rule, which was based on time and distance, clearly specified how far or how long Medicare Advantage networks could require patients to travel to their local clinic depending on where they live. Now, a new rule adopted by CMS is instead based on general community health patterns in patients’ areas.
With this change, large insurance companies simply will be free to cut out dialysis facilities in order to limit their costs. Since these doctors are less likely to be included in their Medicare Advantage network, end-stage renal disease patients will be forced to stick with traditional Medicare, which offers more limited coverage at a higher out-of-pocket cost for patients.
In my home state of Texas, where COVID-19 cases are on the rise and a significant portion of patients live in rural areas, this is especially dangerous. Patients who live in rural areas could be forced to travel hours to their dialysis clinic multiple times each week, just to receive treatments they need to stay alive. Given that each dialysis treatment can last for three or more hours, it quickly becomes apparent exactly how risky this is for patients during an already difficult time.
Another disappointing element of CMS’s decision is that it came just before thousands of end-stage renal disease patients became eligible for Medicare Advantage for the first time. Thanks to the bipartisan 21st Century Cures Act passed by Congress in 2016, countless end-stage renal disease patients who previously didn’t qualify for those plans became eligible to enroll starting this October for plans beginning in 2021. Now, with their doctors less likely to be covered by Medicare Advantage, thanks to this rule change, they’ll effectively have no choice but to stick with their current plans. A landmark piece of legislation for the end-stage renal disease community has essentially been undone in the blink of an eye.
Hopefully, the Trump administration realizes these problems and takes this opportunity to prove that it’s dedicated to making healthcare more available and affordable by listening to patients. Patient-led groups are calling out loud and clear on this issue, with one group, Dialysis Patient Citizens, acting as lead plaintiff in a lawsuit to see to it that the change is overturned. The administration would be right to answer those calls and settle the Dialysis Patient Citizens’s lawsuit.
At a time like this, we cannot afford to leave any patients behind. Unfortunately, as things stand, end-stage renal disease patients could be facing a difficult situation when it comes to finding healthcare that works for them. Now, it is up to us and our elected officials to recognize this and take the necessary steps to fix it.
Matt Mackowiak is the president of the Potomac Strategy Group. He’s a Republican consultant, a Bush administration and Bush-Cheney reelection campaign veteran, and a former press secretary to two U.S. senators.
