A coalition of insurance groups, employers and unions issued a joint letter to HHS Secretary Alex Azar requesting that he close a loophole they say allows organizations to inappropriately steer patients with end-stage renal disease toward commercial policies that reimburse at a higher rate than Medicare and Medicaid.
The letter’s signatories include America’s Health Insurance Plans, Blue Cross Blue Shield Association, and the Service Employees International Union (SEIU). The organizations argue the guaranteed issue provision of the Affordable Care Act allows dialysis providers to "generate significant profits" by engaging in a scheme to shift patients to commercial plans.
The letter accuses dialysis providers of using the American Kidney Fund (AKF) to steer patients away from Medicaid and Medicare by offering to help pay their premiums on commercial exchanges.
Since the commercial insurance plans offer more generous reimbursements than federal programs, the letter suggests dialysis companies can reap higher overall returns. The letter cites a J.P. Morgan report published in 2017, which “estimated that the return on ‘charitable’ donations by dialysis providers to the American Kidney Fund likely exceeds 500%.”
A separate analysis from 2016 suggested the premium assistance program drove approximately $1.7 billion in adverse selection.
The AKF issued a lengthy rebuttal (PDF) on Tuesday suggesting the groups behind the letter are engaged in inappropriate steering of their own, from employer-provided insurance plans onto government-run plans. Only a quarter of the group’s grants go to employer-provided health plans, according to the charity, which insists it has run its premium support program transparently.
“Our donors do not, and cannot, influence individual patient grant decisions,” AKF's letter to Azar states. The AKF goes on to say it works actively to defend patients from being steered onto or off of their current healthcare coverage.
The rebuttal also accuses the SEIU of working with insurers to target the dialysis industry as part of a broader campaign “to organize and unionize dialysis facilities in California and other states.”
"It is extremely concerning that real people who are living with kidney failure have been caught in the middle of this battle and are now being used as political pawns by these groups, who are working together in an indefensible attempt to discourage and outright reject their health coverage," the group wrote.