SB 1156: A boon for insurers, a disaster for patients

LaVarne A. Burton, president and CEO of the American Kidney Fund

The Senate Health Committee recently advanced a bill threatening low-income dialysis and kidney transplant patients while boosting health insurers’ profits. SB 1156, backed by financially interested insurers and labor unions, would give insurers unlimited power to decide whether low-income patients can receive charitable assistance from the nonprofit American Kidney Fund (AKF) to pay their premiums. It’s a backdoor way for insurers to dump expensive patients off their plans.

Bill author Sen. Connie Leyva says the bill won’t stop nonprofits from paying premiums. But it creates bureaucratic hurdles so great, and places so much decision-making power in the hands of insurers, that it will become almost impossible for a patient to receive this help.

For example, among its many unworkable provisions, the bill requires AKF to notify an insurer 60 days in advance of making a payment. The insurer then gets 30 more days to approve the payment. Our grant recipients are coping with a life-threatening disease that often strikes without warning. Most have lost their jobs. They need help now—not three months from now—because they face insurance termination due to non-payment. A 90-day review will cause them to lose coverage.

The result? A father who lost his job after starting dialysis won’t be able to use our help to afford the COBRA plan he and his family need. Insurers know that. That’s their end game—getting chronically ill patients off their plans in relentless pursuit of even higher profits. This bill finally gives insurers the “out” they’ve been seeking.

All the national charity watchdog organizations recognize AKF as one of the nation’s best nonprofits, with the highest possible standards of transparency and stewardship. For decades, our federally approved program has been helping California patients hold on to their Medicare Part B, Medigap, COBRA, employer and commercial coverage. We help patients for the full plan year, including post-transplant. We don’t advocate for any type of insurance plan, nor does it matter to us where a patient receives treatment.

The bill’s supporters claim they want to prevent steering of patients into inappropriate health plans. We are adamant that neither health care providers nor insurers should be permitted to engage in steering. That’s why we have put in place strong provisions, including a provider code of conduct, that prevent dialysis companies from taking advantage of our program. But SB 1156 gives insurers authority to steer patients into coverage that may not provide the care they need and could result in their families having no coverage at all.

Legislators should insist the decision-making power remains with the patient. SB 1156 should be amended to ensure patients can receive charitable financial assistance and use it to afford the coverage that best meets their medical and financial needs. It’s a simple directive, but one that will assure low-income patients of access to the financial safety net they need.