WASHINGTON, DC – The Partnership for Employer-Sponsored Coverage (P4ESC) applauds Congress for raising the concerns of patients struggling with end-stage renal disease (ESRD) and opposes policies that would increase costs for these patients and the employers who provide their dialysis coverage such as the Restore Protections for Dialysis Patients Act.
“Employers have long provided robust coverage and access to dialysis services for patients suffering from chronic kidney disease. But, unfortunately, the highly consolidated dialysis industry is seeking to limit employers’ ability to negotiate dialysis prices, and vulnerable ESRD patients will bear the costs,” said Taylor Hittle, Executive Director of P4ESC. “Commercial plans already reimburse dialysis providers at rates more than six times higher than Medicare, far exceeding the cost of care and reflecting the limited competition in this market. What would these rates be if employers were not empowered to negotiate costs on behalf of patients? Policies that create new mandates on employer-sponsored plans risk strengthening for-profit dialysis chains’ leverage and will increase costs for working families and taxpayers.”
In 2022, the Supreme Court in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., confirmed that employers can apply standard coverage rules to dialysis, preserving their ability to negotiate, use reference-based pricing, and contain costs in a market dominated by two legacy providers with little incentive to lower prices or improve quality. Patients remain protected by antidiscrimination law and continue to have access to dialysis coverage under employer-sponsored plans, and a recent ruling by the U.S. Southern District Court of Ohio Eastern Division makes clear that the Marietta case is about forcing higher commercial reimbursement and network structure, not whether patients have affordable access to dialysis services. Since the ruling, employers have proudly continued to cover dialysis for beneficiaries, rather than shifting patients to Medicare; in fact, recent data indicate that commercial coverage of dialysis has increased since the decision.
P4ESC is a coalition of employment-based organizations and trade associations representing businesses of all sizes and sectors, and the millions of Americans and their families who rely on employer-sponsored coverage every day. Employer-sponsored coverage has been the backbone of our nation’s health care system for nearly eight decades and is the single largest source of coverage. https://www.p4esc.org