October 7, 2022

“Providers and patient groups in this area have consistently pushed for a resolution in light of the ruling,” a Republican Senate official told anonymity to speak about the advocacy, POLITICO told. Lobbying began around December, when the Biden administration submitted a briefing in support of the group’s health plan, the aide said, but after the June 21 decision, “scaling up a ton.”

DaVita has flexed its political muscles to close what it calls a “loophole” created by the advice — stating that the current law, while banning plans to provide various benefits to beneficiaries with kidney disease in the end stage, it is not explicit that plans are needed to cover dialysis services.

Three weeks after the Supreme Court loss to DaVita, Kathleen Waters, the company’s chief legal officer, and Kelly Philson, one of its key lobbyists, drafted proposed legislative language that would be in addition to the Medicare statute at issue in the case, according to metadata in a Word document obtained by POLITICO. The proposal would create coverage parity for dialysis services “compared to other covered medical services” provided by the plan. There is no outward indication that the text is from DaVita.

While pushing for changes, lawyers tried to assure lawmakers they weren’t trying to expand coverage, according to a summary document also obtained by POLITICS. While the broad wording could be “played with by a plan” to create a “‘lean’ plan that doesn’t cover benefits for chronic conditions,” the executive summary reads, “it highlights our intent not to create a mandate.”

On July 29, a bipartisan group of 17 members of the House submitted a bill That largely mirrored the proposal, and Sens. Bob Menendez (DN.J.) and Bill Cassidy (R-La.) followed by a fellow senate on August 3. Instead of creating an equality between dialysis treatments and other services in general, it would ban a group health plan posting “limits, restrictions or conditions” on dialysis benefits compared to services needed to treat other chronic conditions covered by the plan.

“After the Supreme Court decision in June created a loophole, members of Congress, concerned about the potential harm to their voters in this vulnerable patient population, began work to restore protections under the Medicare Secondary Payer Act,” a DaVita spokesperson said in a statement. an email statement in response to an inquiry from POLITICO regarding the company’s involvement in the proposal and its lobbying and campaigning activities.

See also  Scientists say a One Health approach to plant health is vital to achieving sustainable global food security

In addition to spending about $4 million a year on lobbying efforts, DaVita has a prolific political action committee.

Each of the House bill’s 17 co-sponsors has received campaign funds from DaVita’s PAC since January 2021, totaling $67,000, according to OpenSecrets, which tracks political spending. Five co-sponsors also received contributions to their leadership PACs, Federal Election Commission data shows.

Industries often contribute to legislators working on their problems, so it’s not uncommon for DaVita to have spent thousands of dollars in recent election cycles for most of those members — nearly all of whom sit on committees responsible for health policy.

But in May, Rep. Yvette Clarke (DN.Y.), the bill’s primary sponsor and vice chair of the House Energy and Commerce Committee, received $14,500 in contributions from 10 DaVita executives and employees — a departure from the relatively modest checks her campaign has typically received from the PAC during the year.

The donations include $2,500 from Waters — the attorney who drafted the bill — and $2,000 from its CEO, Javier Rodriguez, according to FEC data. Records show that none of them, or any DaVita employee, have contributed to her before. The company did not comment on the contributions.

The issue is of “particular concern” to the congresswoman because of the prevalence of kidney failure among her constituents, Clarke’s office said in a statement.

“During the legislative process, we always ask for input from stakeholders: patient groups, healthcare providers, lawyers and our constituents. We welcome suggestions from these stakeholders to ensure we get the best information to make sound public policy decisions,” the statement said.

Cassidy and Menendez have not received campaign contributions from DaVita’s PAC since early last year, but it has contributed $10,000 and $5,000 respectively to their leadership PACs.

“Because kidney disease disproportionately impacts minority communities, and the Supreme Court ruling could negatively impact access to care, I led the introduction of this common sense law to ensure health plans do not discriminate against kidney disease patients as part of of my longstanding commitment to reducing inequality in our health care system,” Menendez said in an emailed statement.

See also  Mike ‘Boogie’ Malin has a warrant issued for his arrest after failing to appear in court

A spokesperson for Menendez said the office has not had any contact with DaVita or any of its lobbyists “recently about this bill or other issues,” but noted that it had received feedback from patient groups.

Cassidy’s office declined to comment.

In a statement, DaVita said, “Our teammates have been involved in the community for decades and will continue to advocate for this patient population going forward. This includes support for members of Congress, both Democrats and Republicans, who have prioritized better renal care policies for patients.” .”

While the Supreme Court decision was a blow to dialysis companies like DaVita and a source of fear for patients who feared plans would go down within the network, it provided a roadmap for amending the law.

“If Congress wanted group health plans to provide certain benefits, or to require group health plans to guarantee equality between different types of benefits, Congress knew how to write such a law,” Judge Brett Kavanaugh wrote in the court’s decision. “That has not happened under this statute.

Medicare, known for providing insurance to older Americans, also provides coverage for people with end-stage kidney disease, regardless of age.

If a person with advanced renal failure receives health insurance through their employer, Medicare acts as a “secondary payer” and temporarily takes up a portion of the tab. After that, Medicare becomes primary and the group health plan becomes secondary.

Medicare spends $51 billion on beneficiaries with end-stage kidney disease, according to United States Renal Data System annual report. People with advanced kidney failure need a kidney transplant or regular and expensive dialysis treatments to survive.

The Medicare Secondary Payer Act prohibits private plans from considering this eligibility when designing their benefit programs. The law says a collective health plan cannot terminate coverage, charge higher premiums, and “must not differentiate the benefits it provides … based on the existence of end-stage renal disease, the need for renal dialysis or by any other means.”

DaVita argued in his lawsuit that, by taking dialysis care out of the network — and forcing the patient to pay more for these services — the plan inadmissibly gave patients with end-stage renal disease worse coverage than other beneficiaries and deliberately pushed individuals into Medicare, which reimburses at a much lower rate.

See also  Why ‘political will’ isn’t the magic bullet that can fix South Africa’s energy crisis

Kavanaugh disagreed, saying the plan provided the same level of coverage for dialysis services regardless of the patient’s rate of progression of kidney disease.

But dialysis is “a near-perfect proxy for end-stage kidney disease,” Judge Elena Kagan wrote in the dissent, as nearly all patients with kidney failure receive the treatment. The decision, she added, created a “huge and inexplicable solution” to employer-based plans. The recently introduced legislation aims to strengthen the “shall not differentiate” part of the law.

Cameron Lynch, the senior vice president of government relations for another dialysis giant, Fresenius Medical Care, noted the court’s decision and the disagreement “referred to the need for legislative action to resolve this issue.”

“While the vast majority of those in the health industry are interested in patient well-being, we are pleased to see Congress introduce this important legislation to protect people newly diagnosed with kidney failure from potentially discriminatory behavior,” Lynch said in a statement. e-mail. pronunciation. The company did not answer questions about lobbying the bill.

Dialysis companies, providers and patient groups claim the decision paved the way for more plans to limit dialysis coverage to cut costs. For patients, that could mean paying for both their employer-sponsored coverage — for things like vision and dentistry — and Medicare for their kidney care or switching to Medicare entirely and foregoing additional benefits.

Payers, meanwhile, argue that the legislative effort is a cash grab by industry seeking to ensure they are reimbursed by the higher network rates private plans offer.

By creating a parity between kidney failure and all other chronic conditions, employers claim, it effectively enforces nearly comprehensive coverage and — because DaVita and Fresenius dominate 80 percent of the dialysis market — they have the leverage to raise prices.

The bill “would require employers’ health plans to pay kidney dialysis monopolies regardless of the amounts those companies demand,” said a lobbyist who advocates group health plans that grant anonymity to speak freely about the legislation. “Ultimately, this means higher health care costs for anyone who has health insurance through an employer.”