American Society of Nephrology (ASN) President Eleanor D. Lederer, MD, FASN, wrote to Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Charles E. Schumer (D-NY) today expressing ASN’s strong objections to the Graham-Cassidy health care proposal under consideration in the US Senate this week.
The proposal is the latest, and most assuredly the last, bill designed to repeal the Affordable Care Act (ACA) for September 2017. The Senate has been trying all year to repeal the ACA under 2017 budget reconciliation instructions – those expire on September 30 as does the government’s 2017 fiscal year. Those instructions have been key to Republican-led repeal efforts in the Senate, because under the instructions the bill only needs a simple majority to pass and cannot be filibustered.
More than 40 million Americans have kidney diseases and nearly 680,000 have complete kidney failure, a condition that disproportionately affects minority communities. In support of its mission to prevent, treat, and cure kidney diseases, ASN developed a set of guiding principles for health care reform (see appendix). These principles focus on the belief that people with kidney diseases deserve access to a high-quality, patient-centered health care system, regardless of socioeconomic status, geographic location, or demographic characteristics.
ASN’s letter maintains that the Graham-Cassidy proposal does not achieve the goals embodied in ASN’s guiding principles. Dr. Lederer wrote “ASN believes the bill’s passage would negatively impact millions of patients, particularly those with kidney failure, advanced kidney diseases, and other chronic illnesses. We strongly believe the Graham-Cassidy proposal would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.”
The proposed cuts to the Medicaid program could reach as high as $172 billion. Today, Medicaid covers one in five Americans, ensuring access to care for the most vulnerable citizens in our society. The proposed Medicaid cuts are particularly concerning to ASN given that Medicaid beneficiaries experience disproportionately higher rates of kidney diseases. Moreover, nearly one-half of Medicare beneficiaries with kidney failure rely on Medicaid for coverage.
ASN also expressed its concern that Americans with pre-existing conditions would experience significant barriers in accessing affordable, high-quality care. If so, they could be forced to delay treatment, only accessing health care services in high-cost settings, such as emergency departments, when treatment deferral is no longer possible. For people with advanced kidney diseases or who have received a kidney transplant or donated a kidney as a living donor, such barriers could be life-threatening.
Appendix: ASN Guiding Principles for Health Care Reform
1)Provide access to affordable care for all Americans Patients with kidney diseases are some of the most vulnerable members of society with a high likelihood of co-morbidities and limited access to care.
2) Protect the integrity of the patient-physician relationship Patients should have the freedom to choose their physician; ensuring that patients have choices among health insurance providers is, for many patients, an important aspect of that goal, and it is an important aspect patient-centered care.
3) Emphasize access to evidence-based screening, detection, and preventive care Early detection and treatment is cost-effective. These services lead to saving and improving the lives of millions of Americans at risk for kidney failure and, ultimately, save Medicare billions of dollars in costly dialysis.
4) Guarantee access to care for Americans with pre-existing conditions Nephrology health professionals have committed their lives to keeping patients healthy and to restoring them to health when they become ill; insurers should not be permitted to limit care only to the healthiest Americans.
5) Encourage development of innovative, cost-efficient, physician-driven care delivery models Support physician-led efforts to test models that promote collaboration and provide comprehensive patient-centered care, especially for patients with costly chronic conditions like advanced kidney disease.
6) Ensure predictable, continuous access to immunosuppressant drugs for transplant recipients Guarantee that every transplant patient will have uninterrupted lifelong access to the medications critical to preserving function of their transplanted kidney.
7) Support policies to facilitate kidney transplantation and organ donation Kidney transplantation is the optimal and most cost-effective therapy for many kidney failure patients; use all measures to promote organ donation and transplantation; protect living donors must be from discrimination by insurers; and allow patients under 26 years of age to remain on their parents’ insurance.