Bill Overview
Title: John W. Walsh Alpha-1 Home Infusion Act of 2022
Description: This bill provides for Medicare coverage of treatment for alpha-1 antitrypsin (AAT) deficiency (a protein deficiency that raises the risk of lung and other diseases). Specifically, the bill provides for coverage of at-home augmentation therapy for beneficiaries with emphysema as a result of severe hereditary AAT deficiency. Treatment must be provided through qualified home infusion therapy suppliers; beneficiaries must be under the care of a physician, nurse practitioner, or physician assistant.
Sponsors: Rep. Salazar, Maria Elvira [R-FL-27]
Target Audience
Population: People with alpha-1 antitrypsin deficiency
Estimated Size: 100000
- The primary population affected by this bill are individuals with alpha-1 antitrypsin (AAT) deficiency, especially those who develop emphysema as a result.
- Alpha-1 antitrypsin deficiency is a genetic condition, affecting populations worldwide, with higher prevalence in individuals of European descent.
- Estimates suggest about 1 in 2,500 individuals globally may be affected by AAT deficiency, meaning several million could potentially be impacted.
- Not all individuals with AAT deficiency will develop emphysema or require augmentation therapy, so the target group is smaller than the total number of those with the deficiency.
Reasoning
- The policy primarily targets a niche group - those with alpha-1 antitrypsin (AAT) deficiency who have developed emphysema, which requires Medicare coverage for at-home therapy.
- AAT deficiency, while globally prevalent, has a smaller population segment in the U.S. That said, only a subset of these individuals will require the specific therapy covered by the policy.
- Cost constraints and projected budget allocations make it vital to simulate a range of individuals, from those who benefit greatly to those almost unaffected by the changes.
- Interviews consider varying impacts, from those heavily reliant on costly treatment (high impact) to those with mild symptoms or different support systems (low or no impact).
- Rural locations, age distribution (Medicare beneficiaries), and overall health status factor into these scenarios, acknowledging limited reach within a potentially higher-need group.
Simulated Interviews
retired school teacher (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- Finally, I can receive treatment at home without exhausting travel.
- This policy relieves both financial and physical burdens significantly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 2 |
| Year 5 | 6 | 2 |
| Year 10 | 6 | 1 |
| Year 20 | 5 | 1 |
retired engineer (Ohio)
Age: 68 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 0.0 years
Commonness: 5/20
Statement of Opinion:
- I'm grateful for others, although I'm not directly impacted.
- Access is important, especially for rural residents like myself.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 5 |
retired librarian (California)
Age: 77 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- This is a huge help for my husband and our financial stress.
- It helps me focus less on logistics and more on caregiving at home.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 2 |
| Year 20 | 4 | 1 |
construction worker (Texas)
Age: 45 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 6/20
Statement of Opinion:
- I see the importance but remain unaffected.
- Hoping for long-term benefits if I ever require such treatment later.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
software developer (New York)
Age: 35 | Gender: other
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 4/20
Statement of Opinion:
- While the Medicare coverage is good, I rely on private insurance.
- This provides more comprehensive options for myself currently.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
retired nurse (Illinois)
Age: 65 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 3/20
Statement of Opinion:
- Knowing it's covered at home is a huge relief.
- I do worry about potential budget limits lowering care quality.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
retired farmer (Mississippi)
Age: 82 | Gender: male
Wellbeing Before Policy: 2
Duration of Impact: 10.0 years
Commonness: 2/20
Statement of Opinion:
- The support is essential, but navigating Medicare still daunting.
- Hoping this ensures consistent care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 3 | 2 |
| Year 2 | 4 | 2 |
| Year 3 | 5 | 2 |
| Year 5 | 5 | 2 |
| Year 10 | 4 | 1 |
| Year 20 | 3 | 1 |
stay-at-home parent (Missouri)
Age: 51 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- While not immediately beneficial, this provides future security.
- Affects planning for my later life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
retired military officer (Washington)
Age: 66 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 0.0 years
Commonness: 7/20
Statement of Opinion:
- The act respectfully addresses civilian concerns, less military.
- Post-transplant needs may not align with coverage, but still important.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 5 |
HR Manager (Arizona)
Age: 59 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- Affordable care is crucial, but I feel sufficiently supported already.
- Coverage is more beneficial for those experiencing severe issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Cost Estimates
Year 1: $500000000 (Low: $300000000, High: $750000000)
Year 2: $510000000 (Low: $306000000, High: $765000000)
Year 3: $520200000 (Low: $312120000, High: $780300000)
Year 5: $540808000 (Low: $324484800, High: $811212000)
Year 10: $582137856 (Low: $349282714, High: $873206784)
Year 100: $1133165855 (Low: $679899513, High: $1699748782)
Key Considerations
- The precise target group is critical for accuracy in cost estimation.
- Potential for prevention of complications could save healthcare costs in the long run.
- Long-term budget costs will depend on adoption rates and alternative treatments.