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: Sen. Menendez, Robert [D-NJ]
Target Audience
Population: Individuals with end-stage renal disease
Estimated Size: 750000
- End-stage renal disease (ESRD) affects a significant number of individuals worldwide and requires dialysis treatment for survival.
- According to the US CDC, more than 750,000 people in the US have ESRD.
- Globally, it is estimated that over 2 million people receive treatment for kidney failure, including dialysis.
- The bill focuses on private health insurance coverage policies for dialysis treatment, which could lead to broader access to necessary treatments and potentially better health outcomes for those affected.
- Improvements in dialysis treatment coverage can significantly impact the quality of life and financial aspects for individuals living with ESRD.
Reasoning
- The target population for this policy includes over 750,000 individuals in the United States who require dialysis due to end-stage renal disease (ESRD). Dialysis is a life-sustaining treatment that can be financially burdensome for patients, and this policy aims to reduce that burden by preventing private insurers from imposing more restrictive benefits on dialysis services compared to other medical treatments.
- Given the significant population affected and the financial budget constraint, this policy is likely to have varying levels of impact on individuals depending on their insurance status, state legislation, and personal financial situation.
- Some individuals already on Medicare may have less direct impact as Medicare covers ESRD patients regardless. However, those on private insurance who might face higher costs could benefit more prominently.
- Simulating individuals across different demographics (age, occupation, insurance status) can provide a broad spectrum of expected outcomes and opinions.
Simulated Interviews
retired (California)
Age: 65 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I don’t worry too much about my current dialysis costs because Medicare has covered most of it.
- I think the policy will help more people who might be struggling with private insurance.
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 |
teacher (Texas)
Age: 48 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I'm really stressed about the cost of dialysis with my current insurance.
- If this policy passes, I believe it will be a significant relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
software engineer (New York)
Age: 35 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- Balancing the costs of my treatment and daily living expenses is daunting.
- The policy would mean fewer out-of-pocket expenses, which is positive.
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 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 4 |
part-time librarian (Ohio)
Age: 59 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- I have Medicare now, but insurance coordination is still tricky.
- Clarity from this policy would lessen my paperwork and stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
retired engineer (Florida)
Age: 73 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- Medicare takes care of me well; I don't expect much to change for myself.
- It's a beneficial policy for those still facing hurdles with insurance.
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 |
graphic designer (Illinois)
Age: 27 | Gender: female
Wellbeing Before Policy: 2
Duration of Impact: 15.0 years
Commonness: 4/20
Statement of Opinion:
- I'm scared about growing costs once I'm not on my parents' insurance.
- This policy gives me hope for more manageable healthcare expenses.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 2 |
| Year 2 | 6 | 2 |
| Year 3 | 6 | 2 |
| Year 5 | 7 | 2 |
| Year 10 | 8 | 2 |
| Year 20 | 8 | 2 |
accountant (Georgia)
Age: 52 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Navigating my medical coverage is burdensome, and any policy easing this would help.
- Economic relief from this policy would improve my quality of life.
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 | 6 | 4 |
| Year 20 | 6 | 4 |
unemployed (Oregon)
Age: 64 | Gender: female
Wellbeing Before Policy: 1
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- I'm in a precarious situation due to my lack of insurance and require urgent help.
- Any policy that reduces barriers to treatment is life-saving for people like me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 1 |
| Year 2 | 5 | 1 |
| Year 3 | 6 | 1 |
| Year 5 | 7 | 1 |
| Year 10 | 7 | 1 |
| Year 20 | 7 | 1 |
stay-at-home parent (Arizona)
Age: 41 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Between kids and my health, the financial strain of dialysis is tough.
- I expect this policy to give some breathing room financially.
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 | 6 | 3 |
| Year 20 | 6 | 3 |
construction worker (New Jersey)
Age: 56 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- It's been difficult keeping up with the copayments despite having insurance.
- Knowing this policy might lessen personal expenses makes me hopeful.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 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: $1700000000 (Low: $1200000000, High: $2200000000)
Year 10: $1800000000 (Low: $1300000000, High: $2400000000)
Year 100: $3000000000 (Low: $2000000000, High: $4000000000)
Key Considerations
- Administrative costs for both insurers and providers may change the net cost dynamics over time.
- The impact on private health insurance premiums could spill over into employer-sponsored insurance policies, affecting a broader range of insured individuals beyond ESRD patients.
- The policy might create small shifts in the dialysis industry in response to changes in demand patterns.