The year I was born, 1972, President Richard Nixon and Congress launched an ambitious program to provide comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure, regardless of age or income.

Prior to that, there was a committee that decided which patients would receive the life-saving treatments of dialysis, rationing medical care and limiting access to those who met certain criteria such as their profession, their contributions to the community and if they had children.

This panel really did make life and death decisions. But with the advent of universal coverage for kidney failure, this was no longer necessary and everyone was given access.

Rep. John Mizuno, standing, joined unhappy dialysis patients at St. Elizabeth Church in Kalihi for a Jan. 10 press conference regarding HMSA’s policy change on dialysis costs.

Anthony Quintano/Civil Beat

To this day, people diagnosed with kidney failure are automatically eligible for Medicare coverage, and if an employer plan is still in place, coverage can begin as early as the fourth month of dialysis treatments. The rationale is that their treatments should be covered regardless of their working status, and coverage for dialysis services continues for the rest of their lives.

These days, transplants can also result in discontinuation of dialysis, which does change the benefits and coverage. But for those on dialysis, working, disabled or otherwise, coverage is guaranteed.

When the Hawaii Medical Services Association recently notified its members that premiums paid by a third party, such as the American Kidney Fund, would no longer be accepted, patients protested that they would be stuck paying more for their dialysis treatments.

But would they? Is it fair that a for-profit dialysis center should be partnering with an organization to pay the insurance premiums of dialysis patients in order to ensure higher payments for each session of dialysis? How might such a system create higher costs for everyone else?

It all comes down to the government-approved amount for reimbursement of dialysis sessions. Medicare sets rates for dialysis, and for the medications used during a session, and that’s all it pays. Private insurance often pay a percentage higher than Medicare, and in doing so, creates an imbalance that keeps profits up, while not changing the potential inadequacy of the Medicare fees.

It seems only fair that if dialysis patients have an insurance alternative, in this case Medicare, then that should be the primary coverage for their dialysis.

Without consolidation in the dialysis industry, there would be no way to provide the services needed for the money Medicare is paying. But rather than changing the Medicare rates, dialysis centers are boosted by the additional amount paid by private insurance. That’s why the centers would prefer to have private payers like HMSA still responsible for the payment of their services.

But how does HMSA, UHA, HMA or any of our local insurers have the money to pay for their medical care costs? From premiums, which affect all of us.

If higher numbers of dialysis patients are enrolled in the insurance plan, then the costs for their care will be paid by the increases in premiums that everyone in the plan faces annually. So everyone else in the plan has to pay more to cover for the dialysis of only a few, and these very members have alternative health care coverage, guaranteed through the Medicare system.

With such a system in place, it seems only fair that if dialysis patients have an insurance alternative, in this case Medicare, then that should be the primary coverage for their dialysis. If the rates are not adequate, then efforts need to be made to increase the Medicare payments, not rely on private insurance to make up the difference.

This is not to suggest that working dialysis patients can’t have private insurance, but only that the dialysis portion of their care should be covered by the very program that was built to pay for it — the now 45-year-old Medicare plan benefit. This will force dialysis centers and Medicare to come up with a more reasonable reimbursement rate, and also protect other private insurance subscribers from rising rates due to higher medical costs of the few members who have coverage elsewhere.

This doesn’t restrict access to dialysis at all, because the centers are still going to be paid for their services. But it does force the greater cooperation of the Centers for Medicare and Medicaid Services to pay what’s necessary for the dialysis centers to provide care, and also limit the exposure of private insurance companies, with premiums paid by employers and employees from added costs.

HMSA made a bold move to stop the potential conflict of interest of payments of premiums from the American Kidney Fund, due to concerns that the fund was diverting patients to the dialysis centers that helped support the fund as some type of kickback payment scheme.

Whether or not that is the case, the fact that patients who should be covered primarily by Medicare and/or Medicaid for their dialysis treatments are not needs to be addressed. Federal funds are specifically allocated to support those programs, and therefore should be used by those who need to cover their dialysis treatments.

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