It’s been said that serious illness is a great equalizer. No matter our socioeconomic status or skin color, everyone is susceptible to disease. Serious illness does not discriminate, but our country’s healthcare policies do, especially when it comes to kidney care.
The sad truth is the impact of chronic disease is not felt equally across demographics. We cannot continue to stand by as our country’s healthcare system perpetuates this reality. Here in the United States, communities of color are more likely to suffer from conditions like high blood pressure and diabetes, a reflection of serious structural factors in our society that have resulted in racial minorities experiencing a disproportionate chronic disease burden. Heartbreakingly, greater numbers of Black, Hispanic, and Native Americans develop chronic kidney disease (CKD) and end-stage kidney disease (ESKD)—requiring routine dialysis or a kidney transplant to survive.
Nationwide, our healthcare system too often fails communities of color. Even in 2022, this sad truth is not just an ideological issue, it has real, quantifiable repercussions for these underrepresented groups.
Thirty-seven million Americans have kidney disease yet Black Americans are 3.4 times more likely to develop ESKD than white Americans. Native Americans and Hispanic Americans also fare worse—individuals from these communities are 1.9 and 1.5 times more likely to develop ESKD, respectively.
Education, awareness, and early diagnosis are key to slowing or stopping disease progression. The statistics are daunting. In 2019 alone, 135,000 Americans were newly diagnosed with ESKD, and approximately 40% of people who, prior to starting on dialysis, did not even know they had kidney disease. Almost half (47%) of new ESKD cases are attributable to diabetes and nearly a third (29%) are caused by high blood pressure—two conditions disproportionately commonplace among our communities of color.
These disparities are glaring, but they are far from new. For years, policymakers and healthcare providers have understood that kidney disease is more prevalent in Black, Hispanic and Native American communities.
Since the 1980s, the Medicare Secondary Payer (MSP) Act has allowed people living with ESKD to remain on their employer-sponsored private insurance for up to 30 months—which often includes their families if they are the primary plan holder—with Medicare as secondary insurance. Then, after 30 months, they have the option to make Medicare their primary insurance, and private insurance becomes secondary.
This policy was enacted over 40 years ago, protected our vulnerable populations and ensured they were able to access private insurance coverage. However, a recent U.S. Supreme Court decision involving MSP highlighted an unintended weakness in the statute and the Court held that the statute does not explicitly protect individuals with kidney disease from discrimination by health plans. This interpretation could permit insurance companies to limit dialysis benefits and effectively push these patients onto Medicare immediately or prior to the required 30 months.
Naturally, the Court’s decision is a boon to private insurance companies who see major financial benefits from dropping dialysis coverage following diagnosis, putting the responsibility and a heavier burden on the Medicare system, patients and taxpayers. Disturbingly, these changes to MSP also eliminate any incentive for insurance companies to do their part to care for people with failing kidney function before they are diagnosed with ESKD.
Failure to fight discriminatory policies as we are seeing with this loophole means patients face less choice, less control and even greater inequity in receiving coverage for life-saving care.
Fortunately, there is still a bipartisan, bicameral spirit of cooperation in important areas to protect vulnerable Americans and take a unified stand against discriminatory policies advocated by the insurance lobby. One of the most important things we can do to reverse this dangerous course is to pass The Restore Protections for Dialysis Patients Act, co-sponsored in the Senate by Senators Bill Cassidy, R-La., and Bob Menendez, D-N.J., and in the House by Representatives Yvette Clarke, D-N.Y., Danny Davis, D-Ill., Buddy Carter, R-Ga., and Jodey Arrington, R-Texas. This legislation would amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act.
Translation: the legislation would restore these vital protections intended by Congress and ensure individuals living with ESKD cannot be discriminated against based on their need for dialysis care.
Try as we may, healthcare providers can never eliminate the risk of illness—for anyone. But we can encourage lawmakers to do better when it comes to policies our most at-risk Americans depend upon for their care.
Sarrah Johnson is the chief diversity & inclusion officer and SVP for operations at US Renal Care.