Dialysis Patient Citizens Releases Health Management Associates Report:

Minimal Cost to Enacting Jack Reynolds Memorial Medigap Expansion Act

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Sep 22, 2021, 09:22 ET

WASHINGTON, Sept. 22, 2021 /PRNewswire/ -- Today Dialysis Patient Citizens (DPC) released a report by Health Management Associates (HMA) detailing the costs associated with the passage of the Jack Reynolds Memorial Medigap Expansion Act (H.R. 1676), which would require insurers to make Medigap plans available to End-Stage Renal Disease (ESRD) patients under the age of 65.

Under current federal law, insurers are not required to offer Medicare Supplemental Insurance (also called Medigap) plans to patients under 65 years of age. While Medicare pays for 80 percent of an individual's healthcare costs, patients are required to cover the remaining 20 percent out-of-pocket. As a result, Medicare beneficiaries who live in states without added patient protections for individuals under the age of 65 often struggle to cover their health care costs. The lack of supplemental insurance also remains a significant barrier for many dialysis patients trying to secure a kidney transplant, as they are often required to demonstrate they possess the remaining funds to cover a potentially life-saving transplant surgery in order to remain "active" on the transplant waiting list.

Health policy experts often criticize Medigap's relief from cost sharing as adding to Medicare expenditures. However, using Medicare cost data from 2017-2019, HMA estimated that extending Medigap coverage to all ESRD patients under the age of 65 would only add about $50 million in federal expenditures over the next 10 years. HMA actuaries compared the utilization of services by dual eligible dialysis patients vs. Medicare-only dialysis beneficiaries, and found that the one relevant increase in cost was in drug spend. HMA suspects that by expanding access to Medigap coverage, more dialysis patients will have the money to pay for all of their prescribed medications, as their supplemental insurance would now cover their other health care related expenses. Therefore, HMA projected a de minimis cost increase to Medicare due to increased utilization under Part D following the expansion of Medigap access to patients under 65 years of age. At the same time, the potential increase in medication adherence could lead to better health outcomes and reduced complications. The full report by HMA is available at: https://www.dialysispatients.org/wp-content/uploads/2021/09/DPC-Est-Impact-Jack-Reynolds-Memory-Medigap-Exp-Act.pdf.

"For states that don't have protections for ESRD patients under 65, like my home state of Alabama, many patients don't have anywhere to turn," said DPC Board President Andrew Conkling. "In many cases where insurers do offer Medigap coverage for ESRD patients under 65, the plans are still not affordable. Without that coverage, the costs can be overwhelming, and it can be more difficult to receive a kidney transplant."

DPC is calling on Congress to enact the Jack Reynolds Memorial Medigap Expansion Act, which was introduced earlier this year by Representatives Cindy Axne (D-IA) and Jaime Herrera Beutler (R-WA), to help provide ESRD patients with the supplemental insurance they need to remain financially secure. DPC recently released an interactive State Report Card on Medigap Access and Affordability for ESRD patients under 65 available at: www.DialysisPatients.org/Medigap

"Currently, it's up to each state to determine whether Medigap plans are sold to people younger than 65 years old who could qualify because of their kidney illnesses," Rep. Axne said. "The issue that bothered Jack Reynolds – for whom this bill is named – and what bothers me is that these Medigap plans have an unnecessary age cap despite only being open to those with serious illnesses. Kidney issues can happen at any age. For Jack, he was only four years old when he was injured, and 22 when his kidneys began to fail. The bipartisan legislation I'm leading with Congresswoman Herrera Beutler would make this commonsense fix to enable patients of all ages to get the coverage and care they need."

"Folks living with end stage renal disease should have access to life-saving medications, dialysis, and kidney transplants needed to treat their illness," Rep. Herrera Beutler said. "Unfortunately, thousands of Americans under the age of 65 living with ESRD are barred from obtaining a Medigap plan that could help cover the cost of these treatments. I'm proud to partner with my colleague, Congresswoman Axne, on this important legislation to put Medigap plans within reach and thereby ensure patients – regardless of their age – can access the care they need."

ABOUT DPC:

With more than 30,000 patient members, Dialysis Patient Citizens (DPC) is a patient-led, non-profit organization working to improve the quality of life for all dialysis patients through education and advocacy. Learn more here: https://www.dialysispatients.org/

CONTACT: Hannah Bracamonte, [email protected]

SOURCE Dialysis Patient Citizens