National Kidney Foundation Statement on Senate Graham-Cassidy Healthcare Proposal

The National Kidney Foundation opposes the Senate Graham-Cassidy proposal which will reduce access to vital, preventive and life-saving care for people with kidney disease. 
Despite promises that people with pre-existing conditions could still purchase insurance in the Marketplaces, this bill allows states to eliminate the essential health benefits currently provided under the Affordable Care Act, and permits insurers to discriminate against people with pre-existing conditions by not covering vital medications and treatments they need to manage their conditions. For kidney patients, this could include treatments such dialysis, transplantation, or medications.
In addition, National Kidney Foundation is concerned about the significant changes to Medicaid and cuts to funding for many states.  These cuts could leave many low-income people without access to health insurance and health care services, including preventive care necessary for slowing the progression of chronic kidney disease. Nearly one-third of people with kidney failure are enrolled in Medicaid (most being dually enrolled in Medicare and Medicaid).  As state Medicaid budgets are tightened across the nation, states may look to reduce the populations they cover and eliminate expensive, but critical, benefits like dialysis treatments. Once kidneys fail, dialysis or a kidney transplant are needed just to stay alive.
We are also concerned about the repeal of subsidies and tax credits designed to assist low-income and elderly patients afford health plans, and those to assist employers who offer healthcare coverage. 
NKF acknowledges that improvements in access to, and affordability of, healthcare are needed to address the many challenges kidney patients face today.  We urge Congress and the Administration to address the following challenges in their plans to improve access to affordable healthcare:
  • Access to healthcare is critical to earlier detection and management of chronic kidney disease (CKD). Earlier detection and management can often delay or prevent progression of chronic kidney disease and the need for dialysis treatment, improve outcomes for patients and lower healthcare expenditures.  NKF urges Congress to enact policies that maintain or increase the number of insured patients, which will enable earlier detection of CKD.
  • People with end stage renal disease (ESRD) require either a kidney transplant or dialysis to survive.  As such, insurers should be required to cover these treatments and be prohibited from limiting coverage to people with ESRD who choose not to enroll in Medicare.
  • Over 200,000 ESRD patients have received a life-saving kidney transplant and must take immunosuppressive drugs for the life of the transplant
    • The insurance practice of placing immunosuppressive medications, including generics, on high cost sharing tiers requiring coinsurance amounts of greater than 20% and up to 50%, while also excluding generic immunosuppressive medications from fixed copayment amounts, severely jeopardizes the long-term success of the transplant.  
    • Cutting back on, or skipping doses of, immunosuppressive medications can be detrimental to the transplant and the patient.
    • Each year Medicare spends $87,000 per dialysis patient; opposed to $32,500 for a transplant patient.  Transplantation is far more cost effective and is associated with better outcomes than a lifetime of dialysis. 
  • In addition, as a member of the National Health Council (NHC), NKF supports its domains and values for health care reform as these are essential to ensuring that people with chronic conditions can obtain, and afford, insurance. 
 Kidney Disease Facts
30 million American adults are estimated to have chronic kidney disease—and most aren’t aware of it.  1 in 3 American adults are at risk for chronic kidney disease.  Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history of kidney failure.  People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end stage renal disease (kidney failure). 
The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease.  For more information about NKF visit