Insurers keep going after dialysis patients
April 2, 2019
The relief California’s 66,000 kidney dialysis patients felt last fall after two serious threats to their survival were beaten back has turned out to be short-lived.
Not only are labor unions contemplating a second attempt to pass something like last year’s failed Proposition 8, but there’s also an attempt to revive a legislative proposal that could throw thousands of patients who require dialysis to stay alive off the expensive treatment.
Because labor interests like the Service Employees International Union, which sponsored Proposition 8, lost by a solid 62-38 percent margin last year, that possible revival looks like the less threatening of this dangerous pair.
Proposition 8 aimed to put more union workers in hundreds of dialysis clinics, where patients with end-stage kidney disease sit for at least three hours, three times a week while their blood runs through filtering machines that cleanse it of toxins normally removed by healthy kidneys. It would have forced closure of an unknown number of clinics by demanding they withhold payment from key workers and officials.
(Full disclosure: The writer underwent six months of dialysis before receiving a kidney transplant.)
The other threat last year came from a legislative bill carried by Democratic state Sen. Connie Leyva of San Bernardino County. Her measure could have thrown dialysis patients off their health insurance plans if they accept third-party aid in paying premiums.
For some dialysis patients, such aid is critically important. Many are so exhausted and weakened by the constant blood interchanges they endure that they cannot work, living on fixed disability payments and other forms of welfare. Premium assistance can be the means for staying alive.
But Leyva’s bill, known as SB1156, quickly moved through several legislative committees, eventually passing handily in part due to support from unions that saw it as somewhat similar in impact to their ballot initiative, which eventually failed. Fortunately for dialysis patients, then-Gov. Jerry Brown vetoed that bill.
But it is back, a near clone sponsored this time by Democratic Assemblyman Jim Wood of Healdsburg, whose district includes much of the state’s North Coast. It would require organizations providing charitable financial aid to dialysis patients to disclose their identities to insurance companies. This bill is part of a national effort by insurers to force such patients off their books and onto public coverage like Medi-Cal. Essentially, the insurance companies seek to transfer their expense to taxpayers.
Dialysis does cost a lot, often running more than $6,000 per month and sometimes above $50,000. So the new measure can have two major effects: Limiting some people’s ability to get dialysis and increasing insurance company profits.
No one yet knows how Wood’s new bill, known this time as AB 290, will eventually fare. But there are few new faces in the Legislature, and there’s little new about the identity of their financial backers. Which will likely place the fate of thousands of dialysis patients in the hands of Gov. Gavin Newsom, who has said nothing about this bill.
There are ironies here. One comes in the brief bio posted on Woods’ official website, where the longtime dentist brags that he’s “been successful in passing legislation to protect and expand (access to) medical, dental and mental health care…”
His new bill would have the opposite effect. Because it allows insurance companies to reimburse dialysis clinics at rates below the cost of providing care, some clinics might close or refuse care to patients with premium assistance.
Many of those patients are helped now by the American Kidney Fund (AKF), financed in part by large dialysis companies that run the majority of California clinics. The AKF gives premium help to about 74,000 dialysis patients in all 50 states, including almost 4,000 in California.
It called last year’s SB 1156 “a thinly veiled attempt by insurers to prevent kidney patients from being able to choose their own insurance plan, if they accept charitable premium assistance.”
The AKF claimed that bill aimed to let insurance companies rid themselves of “sicker and more costly patients.”
So at least some dialysis patients are once again back on notice that their needed care might not last long. That’s not a good thing for folks whose health is already seriously compromised.
Email Thomas Elias at firstname.lastname@example.org. His book, “The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It,” is now available in a soft cover fourth edition. For more Elias columns, visit www.californiafocus.net