Jesse
Grady|Posted: Jul 09, 2020 10:41 AM The opinions expressed by columnists are their
own and do not necessarily represent the views of Townhall.com.
This year has posed a variety of dangerous new challenges
for Americans. Many have lost their jobs as states grapple with the economic
fallout of the COVID-19 pandemic, and with worries about stable employment
often come worries about healthcare. We are at a moment where we can ill afford
to limit Americans’ access to critical care services. Unfortunately, when it
comes to patients with end-stage renal disease (ESRD) and those who need
regular dialysis treatments, we are coming up short.
That’s because in May, the Centers for Medicare and Medicaid
Services (CMS) announced changes to network adequacy requirements – rules which
determine how networks can provide reasonable access to care – for dialysis
clinics included in Medicare Advantage plans. This could limit the number of
facilities available to ESRD patients and make it harder for them to receive
necessary care. Given that those with ESRD are at a higher risk for serious
problems resulting from COVID-19, we simply cannot allow that to happen.
This change would make it so that dialysis facilities
covered within Medicare Advantage plan networks are not subject to time and
distance limits, which outline how far patients can be required to travel to
receive certain types of care. Instead, those limits will be replaced by a
standard based on broader health care patterns in a particular community. This
standard, which is usually reserved only for types of care that don’t require
frequent travel, makes it possible for the private insurance companies who
issue Medicare Advantage plans to cut costs by including fewer dialysis
facilities and doctors within the plan’s network.
Given the critical nature of dialysis and the care dialysis
centers provide, this could be incredibly detrimental to ESRD patients. Many
have to travel to clinics three or more times a week for treatments that can
last several hours. Requiring them to travel even farther for these treatments
would make an already time-consuming and draining experience even more
difficult. Beyond this, even those ESRD patients who do in-home dialysis still
need to be able to access a clinic in case something goes wrong, or for the
check-ins that they are required to have with their doctors.
This change will ultimately disincentivize ESRD patients
from pursuing Medicare Advantage plans at all, and in the process take away
options for care that they pushed hard to receive.
In 2016, thanks in great part to the efforts of ESRD
patients across the U.S., a bipartisan group of members of Congress passed the
21st Century Cures Act, which opened Medicare Advantage enrollment to thousands
of dialysis patients who previously did not qualify for those plans. The first
period for them to enroll is set to take place in October for plans beginning
in 2021. Unfortunately, less than six months before that, the Administration
has essentially taken this opportunity away, compromising the level of care
available to ESRD patients.
With Medicare Advantage plans – which are offered through
private health insurers – patients are able to shop for the plan most suited to
their needs, often with more benefits and at a lower cost out-of-pocket than is
available through standard Medicare. For many, this will not be an option, as
Medicare Advantage networks will be less likely to include their doctors thanks
to this move from CMS.
Understandably, ESRD patients are
pushing back. After all, this is another in a long line of regulatory decisions
that fail to address their needs and leave them behind. Dialysis Patient
Citizens, which is a group that advocates for ESRD patients, has filed a lawsuit
against CMS and Administrator Seema Verma to draw attention to how this change
will hurt dialysis patients and, hopefully, see this new regulation
overturned.
We are at a critical point for health care in the U.S., and
we simply cannot afford to treat some patients better than others. Sadly, this
CMS decision does just that, and will only make it harder for ESRD patients to
readily access the care they rely on. The right move now is to show ESRD
patients that we are just as dedicated to their health as we are any other
patients and overturn this decision.
Jesse Grady is a former staff member of President
Donald Trump’s 2016 campaign and is a former Regional Director for the
Republican Party of Texas.
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