August 05, 2018
Area(s) of Interest: Advocacy Commercial Payors Nephrology Payor Issues and Reimbursement
by Theodore M. Mazer, M.D., CMA President
(This op-ed was originally published in The Desert Sun.)
Not long ago, health insurance companies limited access to insurance and quality health care for millions of Californians, using notorious practices like post-claim underwriting to deny patients care the moment they got sick.
Frighteningly, a new bill introduced in Sacramento would drag us back to that past, giving insurance companies broad new powers to decide which kidney dialysis patients would be allowed to keep private insurance coverage for treatment, and which ones would not, based on how their premiums are financed.
Senate Bill 1156, by Sen. Connie Leyva (D-Chino), would allow insurance companies to deny coverage for low-income dialysis patients just because they receive charitable premium assistance to help pay their insurance premiums.
Patients on kidney dialysis depend on machines to do the job of their failed kidneys. They need dialysis treatment three times a week, for three to four hours at a time, to survive. Dialysis is literally a life-saving treatment.
Because dialysis patients need treatment so often and for such a long period of the day, once diagnosed with kidney failure, many patients can no longer work. As a result, these patients have difficulty maintaining private insurance for themselves and their families. Nonprofit charities often help pay premiums so that these workers can keep private insurance for themselves and their families.
SB 1156 would shut out patients who are dependent on outside help for essential kidney treatment and make it harder for them to find the care they need. It would allow insurance companies to deny coverage just because patients receive charitable assistance. The bill would create a separate and unequal health care system – a premium system for those who can afford it, and one that denies essential health services to people who cannot.
At the same time, SB 1156 would slash what insurance companies must pay to dialysis clinics for treatment of patients who receive charitable assistance, reducing these payments to the Medicare rate, which is notoriously low and barely covers the cost of care. Disturbingly, there is no requirement that insurers must pass along any savings to patients or those insured.
Bottom line? Patients would lose care while insurance companies profit.
This bill is a giveaway to insurance companies that would have disastrous consequences for low-income kidney patients and would inevitably lead to cutbacks in services or even dialysis center closures across the state.
The impacts would be particularly hard felt in areas where access to care is already limited, like rural areas, where there are fewer privately insured patients. Patients could either end up traveling greater distances for treatment or seek treatment in already-overcrowded emergency rooms, where dialysis is far more expensive than in an outpatient clinic.
We must do everything we can to continue to expand access to quality health care for those who need it and ensure that medical decisions are being made by medical professionals – not insurance company middlemen who are motivated only by profit.
Health care choices should be made based on what’s best for the patient. SB 1156 is a step in the wrong direction that would put poor patients at risk and make it even harder for thousands of kidney patients across California to get the care they need.