Bill Overview
Title: Restore Protections for Dialysis Patients Act
Description: This bill specifies that private health insurers may not limit, restrict, or condition benefits for renal dialysis services for individuals with end-stage renal disease as compared to other types of benefits for other medical conditions under Medicare secondary payer rules.
Sponsors: Rep. Clarke, Yvette D. [D-NY-9]
Target Audience
Population: People with End-Stage Renal Disease requiring dialysis
Estimated Size: 500000
- End-stage renal disease (ESRD) patients typically require dialysis treatments to survive, and their care is often covered by health insurance, including plans governed by Medicare rules.
- There are approximately 3 million ESRD patients globally who require dialysis.
- The bill protects dialysis patients from discriminatory insurance practices in relation to non-ESRD-related services, meaning it focuses on a specific insurance gap.
- Restoring protections ensures that dialysis patients have equal access to their insurance benefits without incurring different terms or conditions.
Reasoning
- The target population for this policy includes approximately 500,000 US dialysis patients, all of whom have end-stage renal disease (ESRD).
- Dialysis treatment is essential and can be financially burdensome, often requiring comprehensive insurance coverage for sustainable care.
- Policy aims to ensure dialysis patients do not face discriminatory insurance practices, which could significantly affect their overall wellbeing by reducing stress and financial burden associated with healthcare costs.
- Consideration of the policy budget must ensure that it covers increased insurance payouts without bankrupting existing systems, balancing patient benefits with sustainability.
Simulated Interviews
retired (Seattle, WA)
Age: 65 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- This policy will relieve a lot of stress regarding coverage.
- I won't have to worry about higher costs anymore.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
store manager (Houston, TX)
Age: 48 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Anything that keeps costs down is a huge relief.
- I need stable, predictable insurance terms.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
software developer (Chicago, IL)
Age: 31 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- Young and facing high medical expenses.
- The policy helps me plan my future better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 7 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 3 |
teacher (Miami, FL)
Age: 57 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- The policy will make my insurance situation easier.
- Fewer things to worry about during treatments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
retired engineer (Boston, MA)
Age: 72 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- I've seen insurance changes over the years; stabilizing them is great.
- This policy could help improve my quality of life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 5 | 5 |
freelancer (Los Angeles, CA)
Age: 42 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Private insurance has been a nightmare financially.
- The policy might help me stabilize costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
graphic designer (Denver, CO)
Age: 50 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 4/20
Statement of Opinion:
- Managing care for my family and myself is tough.
- Ease of insurance terms will significantly benefit us.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
retired from construction (Phoenix, AZ)
Age: 60 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Medical costs keep climbing; this policy promises relief.
- Ensures protective measures for someone in my situation.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
chef (New York, NY)
Age: 55 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- Private insurance has been inconsistent; this is reassuring.
- I can focus more on my job with less stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
mechanic (Charlotte, NC)
Age: 39 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- Financial strain is a constant worry; this policy could be life-changing.
- I'm hopeful about the policy but cautious.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 7 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 6 | 3 |
Cost Estimates
Year 1: $1500000000 (Low: $1000000000, High: $2000000000)
Year 2: $1550000000 (Low: $1050000000, High: $2050000000)
Year 3: $1600000000 (Low: $1100000000, High: $2100000000)
Year 5: $1750000000 (Low: $1250000000, High: $2250000000)
Year 10: $2000000000 (Low: $1500000000, High: $2500000000)
Year 100: $2500000000 (Low: $2000000000, High: $3000000000)
Key Considerations
- The policy impacts heavily depend on the response of private health insurers to the newly imposed requirements.
- Potential shifts in the insurance market could occur due to changes in pricing models to accommodate dialysis care coverage.
- The bill could face legal challenges from insurance providers regarding the establishment of non-discriminatory benefits.