Pro­tect kid­ney, other pa­tients from re­jec­tion by in­surer

Honolulu Star-Advertiser - - VIEWS & VOICES - By Scott Bruun ——— Scott Bruun is ex­ec­u­tive di­rec­tor of the Chronic Dis­ease Coali­tion, based in Port­land, Ore.

Imag­ine bat­tling a chronic dis­ease that re­quires a ma­chine to fil­ter your blood mul­ti­ple days ev­ery week just so you can sur­vive. For pa­tients with end-stage re­nal dis­ease (ESRD), or kid­ney fail­ure, this is their re­al­ity. The last thing they should have to worry about is whether a health in­sur­ance com­pany is go­ing to drop their cov­er­age when they’ve been pay­ing their bills on time.

And yet Hawaii has joined a num­ber of states where in­sur­ers are be­ing al­lowed to dis­crim­i­nate against kid­ney fail­ure pa­tients — re­ject­ing their pre­mium pay­ments so they are forced to switch to Medi­care or Med­i­caid in­stead.

As the Star-Ad­ver­tiser re­ported (“Dial­y­sis pa­tients worry over HMSA pol­icy change”), more than 115 ESRD pa­tients in Hawaii re­cently re­ceived let­ters from the Hawaii Med­i­cal Ser­vices As­so­ci­a­tion (HMSA) — part of Blue Cross Blue Shield — say­ing their pre­mium pay­ments will no longer be ac­cepted start­ing Feb. 1.

How does HMSA jus­tify harm­ing sick and vul­ner­a­ble Hawaii res­i­dents this way? Blue Cross and HMSA say it’s be­cause these pa­tients rely on fi­nan­cial sup­port from char­i­ta­ble or­ga­ni­za­tions to pay some of their bills.

In­sur­ers’ ef­forts to dump ex­pen­sive pa­tients onto Medi­care or Med­i­caid are not new. Pa­tients with kid­ney fail­ure re­quire reg­u­lar dial­y­sis treat­ments for their en­tire lives un­less they re­ceive a kid­ney trans­plant. Dial­y­sis treat­ments are costly.

These tac­tics aren’t sur­pris­ing, given news that the coun­try’s largest in­sur­ers are buy­ing up and reap­ing mas­sive prof­its off Medi­care and Med­i­caid plans na­tion­wide. This is a clear con­flict of in­ter­est on the part of in­sur­ers, who are mak­ing mil­lions at pa­tients’ ex­pense.

There is a life-or-death dif­fer­ence be­tween com­mer­cial in­sur­ance and Medi­care for many peo­ple. Pa­tients on pub­lic pro­grams have less ac­cess to anti-re­jec­tion med­i­ca­tion fol­low­ing a trans­plant. In ad­di­tion, a 2013 Na­tional In­sti­tutes of Health re­port found that ac­cess to kid­ney trans­plants — the only real cure for ESRD — is three times higher for peo­ple on com­mer­cial in­sur­ance than for those on Medi­care.

The same re­port noted African-Amer­i­cans with com­mer­cial in­sur­ance are 14 times more likely to re­ceive a trans­plant than those on Medi­care. This is es­pe­cially trou­bling con­sid­er­ing that African-Amer­i­cans, who make up less than 13 per­cent of the U.S. pop­u­la­tion, rep­re­sent nearly one-third of end-stage re­nal dis­ease pa­tients.

Kid­ney fail­ure dis­pro­por­tion­ately af­fects res­i­dents of Guam and Hawaii as well, ac­cord­ing to a study pub­lished in the In­dian Jour­nal of Nephrol­ogy. This means that in­sur­ers forc­ing kid­ney pa­tients onto Med­i­caid cre­ates a dis­pro­por­tional neg­a­tive im­pact on black and brown peo­ple. In­sur­ance dis­crim­i­na­tion, in this case, is racial dis­crim­i­na­tion as well.

As a so­lu­tion, or­ga­ni­za­tions across the coun­try are call­ing for pol­i­cy­mak­ers to sup­port bi­par­ti­san fed­eral leg­is­la­tion called the Ac­cess to Mar­ket­place In­sur­ance Act, or H.R. 3976. H.R. 3976 would pro­tect low-in­come pa­tients — not only kid­ney pa­tients, but those with di­a­betes, mul­ti­ple sclero­sis, arthri­tis and other chronic con­di­tions — from be­ing dis­crim­i­nated against by in­sur­ance com­pa­nies. The bill pro­tects Amer­i­cans’ right to choose a health plan that meets their needs and en­sures that no one bat­tling a chronic dis­ease has to choose be­tween pay­ing for es­sen­tial med­i­cal care and buy­ing food or cover­ing rent.

Hawaii Con­gress­woman Colleen Hanabusa is among the bill’s 100-plus co-spon­sors, and we ap­plaud her for pro­tect­ing pa­tients’ rights. We hope Con­gress­woman Tulsi Gab­bard will do the same.

But more can be and must be done. While HMSA is tar­get­ing kid­ney pa­tients to start, there’s no telling which chronic dis­eases would be cut next. We must come to­gether in de­fense of our friends, neigh­bors and fam­i­lies. Hawaii law­mak­ers must stop HMSA from vi­o­lat­ing res­i­dents’ rights and putting their health in dan­ger.

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