This legislation threatens the health and safety of dialysis patients

By LaVarne Burton, Special to CalMatters

To survive, people with kidney failure need ongoing health care not only to rid their bodies of deadly toxins and excess fluids, but also to treat their cardiovascular disease, their diabetes, their anemia, their bone disease, and to help them get transplants.

In short, to manage all the serious conditions that go hand-in-hand with kidney failure.

For 22 years, the neediest patients in California have turned to the American Kidney Fund for help staying insured. We help only low-income patients. Most of our grant recipients are minorities. We don’t select their insurance. We help them hang on to existing coverage. This includes people on government health insurance programs.

But Assembly Bill 290 by Assemblyman Jim Wood, Santa Rosa Democrat, is on Gov. Gavin Newsom’s desk. If signed, this bill, which is backed by the billion-dollar health insurance industry, will force us to end our program for the 3,700 dialysis and transplant patients we help in California and all those who might need our assistance in the future.

Make no mistake: Without the American Kidney Fund’s support, people will lose their health coverage and have no choice but to dialyze in emergency rooms. Many people will lose their place on the transplant list. Others will be forced into bankruptcy and lose their homes because of high medical bills.

The arrangement proposed by AB 290 is unlawful. We cannot run a program that violates federal law. But that’s not all. AB 290 also would strip away two fundamental rights guaranteed in our healthcare system: patient privacy and freedom of choice.

The version of the bill that narrowly passed the Legislature removed basic protections baked into the dozens of provider-funded health care assistance programs, including ours, that are approved by the U.S. Department of Health and Human Services Office of Inspector General. 

AB 290’s requirement that we disclose to insurers the names of certain patients we assist would trigger a series of events resulting in these patients knowing that their dialysis providers made financial contributions to our program. 

The Office of Inspector General approved our program in large part because it is a blind donation system. If that were to  end, and patients come to learn this information, they may be improperly influenced to use a particular provider, a violation of federal fraud and abuse laws.

The inspector general also requires American Kidney Fund to treat every patient the same, regardless of their provider or insurance plan. 

This safeguard ensures that people who rely on us for help don’t need to worry that receiving assistance will limit their choice of plans or providers.

But AB 290 would turn that model upside down. It would single out the neediest patients, locking current grant recipients into health plans for the long term even if their circumstances change. And it would require us to treat patients differently depending on where they go for dialysis. 

This conflicts with the inspector general requirement for uniform treatment of grant recipients, and with privacy safeguards the inspector general requires.

AB 290 contains a provision that the American Kidney Fund could go to the Office of Inspector General for an opinion on whether the bill’s requirements are acceptable under federal law. The inspector general’s own guidelines do not allow organizations to ask general questions. 

We would be forced to propose a new arrangement where AB 290 would become the basis for our program nationwide. We cannot and will not go to the federal government with a disingenuous request to operate a new program that would be, on its face, unlawful and that would have devastating consequences for patients.

Our program has been helping Californians avoid financial destitution and survive kidney failure for 22 years. That will end if Gov. Newsom signs this bill. We are strongly urging him to veto AB 290 to avoid creating a completely avoidable crisis for thousands of current and future kidney patients in California.  

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LaVarne Burton is president and chief executive officer of the American Kidney Fund, [email protected]. She wrote this commentary for CalMatters.

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