Bipartisan Kidney Legislation Aims to Improve Research and Treatment

Rep. Tom Marino


Kidney failure was a death sentence in the 1960s. Since then, remarkable scientific advances and a landmark commitment to the millions of Americans affected by kidney disease have reversed that fact. Today, more than 600,000 Americans are living with kidney failure—and a large majority of those lives are sustained by life-saving dialysis treatments. I represent Pennsylvania’s 10th District in the U.S. House of Representatives, and in my home state, more than 17,000 people rely on dialysis therapy, and another 8000 have received the gift of life through a kidney transplant.

In 1972, Congress developed the Medicare End-Stage Renal Disease benefit. This vitally important program ensures that every American, regardless of age or income, has access to life-saving dialysis care. The time has come for Congress to sustain this commitment by modernizing kidney health policies, intensifying research, improving care coordination, and expanding patient choice.

I recently introduced legislation—the Chronic Kidney Disease Improvement in Research and Treatment Act (HR 1130)—that I am confident will be instrumental in accomplishing these goals. I am very proud to be the bill’s lead sponsor and honored to have my friends and colleagues John Lewis (D-GA) and Peter Roskam (R-IL) standing by me in this effort. We are joined by our colleagues in the Senate, Mike Crapo (R-ID) and Ben Cardin (D-MD), who introduced corollary legislation, S. 598.

In April 2015, I hosted a roundtable discussion with fellow Pennsylvanians to hear their thoughts about this legislation. I had the opportunity to learn how these patients and their families, physicians and health professionals, and other constituents are affected by kidney disease, and how my fellow members of Congress and I can best advocate for them—through this bill and in other aspects of our work in Washington. I was gratified that ASN Board of Advisors member and Biosciences Research Advisory Group chair Larry Holzman, MD, participated in this roundtable discussion to share his perspectives, and to reiterate the American Society of Nephrology’s support and enthusiasm for this legislation: “I was pleased to participate in Congressman Marino’s roundtable on his kidney legislation,” Holzman said. “Clearly, he is dedicated to kidney care issues and was sincerely interested in what I and the other participants had to say about the bill and about other opportunities to improve the lives of people with kidney disease—as well as the scientific understanding of kidney disease.”

The legislation is built on three primary tenets. First, investments in medical research can lead to a deeper understanding of kidney disease prevention and to innovations in treatment that reduce cost and improve patients’ lives. Second, coordinating care is essential to bettering their outcomes and reducing health care costs for individuals living with chronic diseases—including kidney failure. Third, ensuring stability in the Medicare program is central to an ESRD program that guarantees patients’ access to kidney care and delivers optimal results.

HR 1130 would improve research efforts to prevent, treat, and cure chronic kidney disease and kidney failure in the future by helping to develop a strategic plan to better direct biomedical research funding. The legislation also asks the Government Accountability Office (GAO) to develop a comprehensive report to Congress that assesses the adequacy of federal investments in kidney research given the prevalence of kidney disease in the population and the cost of care. The United States is the undisputed leader in medical innovation, and with adequate investments in kidney research I am confident we will continue to lead the global fight against kidney disease.

Studies show that promoting collaboration between primary care physicians and specialists treating the same patients improves outcomes and reduces the cost of care. Coordinated care is especially important for kidney patients, many of whom are living with multiple chronic conditions and have to juggle numerous health care providers and health care settings. To spur the creation of a workable coordinated care program for dialysis patients, HR 1130 would establish a voluntary program to incentivize kidney doctors and dialysis facilities to better align treatment.

While many seniors—particularly those with multiple co-morbidities—rely on Medicare Advantage plans to coordinate their care, Medicare beneficiaries who develop ESRD are prohibited from enrolling in this kind of plan. If we want health care delivery to be more efficient through care coordination, this prohibition is an outdated relic. HR 1130 would lift this restriction and allow people with kidney failure the option to choose a Medicare Advantage plan.

Our bill expands options for patients to dialyze at home by facilitating home dialysis treatment options through telemedicine, especially in rural and underserved regions. The legislation would also help improve access to care for patients in rural and medically underserved areas by helping ensure that there are enough kidney doctors and other kidney specialists practicing in these regions. Every American deserves ready access to highly trained medical professionals, and HR 1130 aims to make this a reality for kidney patients nationwide.

To join ASN in supporting this legislation, please visit ASN’s Legislative Action Center to send a pre-composed message to your Congressional delegation at