In the past legislative session, the Georgia General Assembly passed – and Gov. Brain Kemp signed – a bill I authored called the Giving the Gift of Life Act. This bill was inspired by my son Will, who desperately needed a kidney transplant after suffering from kidney failure. I was fortunate to be a donor match and jumped at the opportunity to give my son a new lease on life by giving him one of my kidneys.
But in this process, I learned the decision isn’t so simple for many families in Georgia who have experienced the difficult decision to either donate potentially life-saving organs or risk losing their insurance coverage. No one should have to make that choice, which is why I authored the Giving the Gift of Life Act to prohibit insurers from canceling or refusing coverage under any life insurance policy due to that individual serving as a living organ donor.
State Sen. John Albers
Hopefully, we’ve now solved at least one of the issues that disincentivizes organ donation. Millions of people still suffering from End-Stage Renal Disease (ESRD), however, will not find a donor. That means they will require life-saving dialysis treatments for the rest of their lives. Sadly, though, a recent Supreme Court decision could make coverage for those treatments harder to get.
In its decision earlier this summer in Marietta Memorial Hospital v. Davita, the Supreme Court ruled that insurers could offer lower rates for dialysis treatments despite rules that prevent discrimination against patients suffering from ESRD who rely on dialysis treatments to live.
Right now, the law allows ESRD patients to remain on employer-sponsored health insurance for 30 months after their initial diagnosis before Medicare becomes their primary plan. Under this new decision, however, it could be possible for insurers to essentially force patients onto Medicare before reaching that point by offering rates that are simply too low for patients and their families to make use of.
Beyond taking away a patient’s ability to choose the best plan for their needs, forcing them to switch to Medicare early also carries other serious risks. Medicare brings severe limitations that could hurt a patient’s ability to receive quality, comprehensive care. For example, Medicare doesn’t offer access to dental coverage for ESRD patients. Proper dental care is essential for patients hoping to receive a kidney transplant, and losing that coverage is a serious blow.
Medicare also doesn’t always cover the full cost of dialysis on its own. Instead, it only covers up to 80 percent of the cost of the treatments for ESRD patients under 65 while the patient covers the rest. If those patients don’t have access to affordable Medigap plans (which many don’t depending on what state they live in), that cost will come out of their pocket. Other things patients may need – like wheelchairs – also are not entirely covered by Medicare. This decision carries enormous weight for ESRD patients and their families who stand to lose so much without their employer-sponsored coverage.
Just as Georgia’s lawmakers took steps to protect access to coverage for donors, though, our representatives in Congress are working to do the same for ESRD patients across the country. Georgia Representatives Buddy Carter and Drew Ferguson have signed onto H.R. 8594 along with Representatives Yvette Clarke, Jodey Arrington, and Danny Davis. The bill would prevent insurers from discriminating against ESRD patients by offering lower rates for dialysis treatments. The bill is also gaining traction in the Senate with Senators Bill Cassidy and Bob Menendez.
This bill is needed to guarantee that patients can’t be forced off their employer-sponsored plan thanks to this new decision, and patients throughout the U.S. are counting on Congress to pass it right away. They need this protection to ensure that they have the choice to remain on their private plans for that 30-month period and retain access to some essential benefits they might otherwise lose.
I’m proud that our state is helping to lead the way on this issue. Dialysis patients already go through so much, and this decision could make things so much more difficult. This bill is absolutely vital, and I’m hoping Congress can get this done.
State Sen. John Albers represents District 56 which includes portions of Fulton, Cobb and Cherokee counties.
