RealClearHealth: Burgess and Gingrich: Protecting the Investment of a Kidney

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Washington, August 9, 2020 | comments
Protecting the Investment of a Kidney
August 9, 2020
By: Congressman Michael C. Burgess and former Speaker Newt Gingrich

Picture welcoming your newborn baby boy into the world – then not having the opportunity to bond with your child because he is immediately taken away upon showing signs of lung distress. The next thing you are hearing is that your son is in renal failure. Instead of holding him, you’re watching as he is being prepped to go into surgery and equipped with his first dialysis catheter. This was the reality for Mike and Stephanie Luhm as they welcomed their first child, Wiley.

Every day, the Luhms fought for their son’s life by hooking him up to his dialysis machine, trying to help him gain weight, taking his vitals and giving him lifesaving medication. Every day, they prayed that their son would not become one of the 13 patients who die each day waiting for their turns to experience the promise and hope that a new kidney could provide. Every day, the Luhms, like many other families, hoped that their child would make it to the age where he could receive a donor kidney.

Fortunately, that day did come for Wiley. In 2017, he was finally healthy enough to start the transplant process. By the middle of the year, he was able to receive a new kidney donated to him by his mother.

Just like many other patients and their families, Mike and Stephanie realized that a kidney transplant is a lifesaving investment into their son’s future. As with any investment, it should be made with a goal of long-term success in mind.

A crucial component of any kidney transplant is the delivery and maintenance of a consistent immunosuppressive medication regimen. Without these medications, the patient will likely reject the gift of the transplanted organ and be forced to return to dialysis—a time-intensive and expensive treatment.

Because of the astronomical expense of treating end-stage renal disease (ESRD) with dialysis, in 1972, Congress made it possible for individuals living with ERSD to become eligible for Medicare, regardless of their age or disability status.

Patients with ESRD constitute roughly 7 percent of Medicare fee-for-service spending but only make up 1 percent of total enrollment for Medicare. These patients are incredibly ill and often have other costly chronic conditions. At the start of dialysis, 93 percent of patients between 18 and 54 years of age are classified as disabled, and more than 100,000 Americans begin dialysis each year due to kidney failure.

Under Medicare’s ESRD benefit program, patients like Wiley are eligible for coverage during their dialysis treatments and when they receive their transplant. However, their immunosuppressive medications are only covered for the first 36 months of their treatments. Kidney recipients require these drugs for the rest of their lives, or they risk their bodies rejecting the transplants. So, after they’ve gone through the harrowing experience and trauma of undergoing dialysis and an organ transplant, patients who can’t find other health insurance must then face down a life-long, crippling expense. If they can’t afford the immunosuppressive drugs, the patient’s body will reject the kidney and they are back on dialysis.

Further, from the taxpayer’s perspective, only covering these medications for 36 months is like throwing money down the drain—or in this case not just money but the precious gift of a kidney. If patients’ kidneys are rejected, Medicare pays for dialysis treatments again, costing taxpayers approximately $90,000 per patient every year. Immunosuppressant drug coverage costs Medicare an average of $2,303 per patient per year. Patients who can afford the drugs can go on to live active, productive lives. That means 45 patients could be treated with immunosuppressant drugs for one person getting dialysis. Yet the government pays for the vastly more expensive therapy and limits payment for the radically less expensive treatment. For both ethical and financial reasons, it is clear this policy must change.

The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, H.R. 5534, directly addresses this problem by extending Medicare coverage of immunosuppressive drugs past 36 months for kidney transplant patients who do not obtain other health care coverage. This is a policy that has the support of everyone from patients to transplant surgeons. It also is something that the kidney community has coalesced behind for an upwards of 15 years and has even received recent support from the Trump Administration.

In July, President Trump launched the "Advancing American Kidney Health,” an initiative which aims to improve care and foster innovation to benefit kidney patients across the country.

H.R. 5534 aligns with the goals of the Administration. In fact, both the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary and the US Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation have published reports on the benefits of extending Medicare coverage of immunosuppressive drugs. The reports include financial savings for the Medicare program totaling approximately $300 million over 10 years.

There is momentum to make a difference in the lives of kidney patients, and H.R. 5534 is a critical component of this effort. If it becomes law, this bill will improve patient adherence to immunosuppressive drugs and help to ensure that patients can maintain their transplants to hopefully avoid future kidney-related health care complications.

A kidney transplant is an investment. An investment that can make the difference between living and dying. Passing H.R. 5534 is a step towards ensuring that we protect this investment, honor the gift of kidney donation, and improve the lives of millions of Americans.
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