The Honorable Max Baucus Chairman Committee on Finance United States Senate 219 Dirksen Senate Building Washington, DC 20510 The Honorable Charles Grassley Ranking Member Committee on Finance United States Senate 219 Dirksen Senate Building Washington, DC 20510 Dear Senators: On behalf of Kidney Care Partners, a coalition of patient advocates, dialysis professionals, care providers, and suppliers dedicated to working together to improve quality of care for individuals with kidney disease, I wish to thank you for your ongoing attention to the Medicare End Stage Renal Disease (ESRD) program. As you know, the program serves 400,000 Americans living with irreversible kidney failure. Our coalition has been working on behalf of these patients since its creation to advocate for needed reform to a 35-year-old program that has not kept pace with patient and provider needs. As you know, the House of Representatives addressed ESRD issues in the Childrens Health and Medicare Protection (CHAMP) Act of 2007. One critical provision in the CHAMP Act has recently come under attack from a misinformed group of large corporations. Section 703 of the Act would extend Medicare Secondary Payer (MSP) in the ESRD by 12 months for large group health plans with more than 100 enrollees. Extending MSP to 42 months strikes the right balance between the current 30 months and the 60-month period that some, including the President, advocate. This moderate extensions is a central component of the Kidney Care Quality and Education Act of 2007, introduced by Senator Kent Conrad and cosponsored by six other members of the Committee, including Senators Jeff Bingaman, Blanche Lincoln, Debbie Stabenow, Maria Cantwell, Trent Lott, and Gordon Smith. Extending Medicares secondary-payer status for ESRD patient is a sound policy. An additional year of responsibility for beneficiaries would encourage private payers to adopt protocols that address patient wellness, prevent hospitalizations, and make dialysis safer and more efficient. By contrast, the current policy establishes perverse incentives for employers not to offer wellness services to dialysis patients, since private payers benefit if the beneficiary drops coverage early and goes into Medicare. There is a positive impact on patient care when private payers are incentivized to keep beneficiaries healthy. While universal coverage for ESRD services is critical to ensure that patients retain access to life-saving care, it is unique to Medicare. The ESRD program is the only are of Medicare that allows private insurers to limit coverage for a chronic condition. ESRD patients are eligible to drop private coverage and enroll in Medicare at any point after the third month of treatment, however many patients prefer their coverage and would like the option to remain in private coverage beyond 30 months. As a result of the policy, kidney patients face coverage disruption, higher out-of-pocket costs, loss of integrated family coverage, and greater complexity. Dialysis patients should be afforded the same rights as others to choose how their care is financed. Experts estimate that the extension would have negligible to no impact on health insurance premiums. If MSP were extended as proposed, most employers would not cover dialysis patients for the full 42-month period. About 70% of dialysis patients that begin dialysis with private coverage are no longer ensured by the end of the current 30-month period due to a variety of reasons. It is estimated that between 5,000 and 10,000 of the nearly 4000,000 ESRD beneficiaries would remain privately insured from month 31 to month 42 if MSP were extended and would be spread across hundreds of insurance plans. According to the most recent Census data, approximately 200 million people are covered by private health insurance in the United States. Therefore, a 12-month extension of MSP would result in a 0.005% increase in the total population of privately-insured Americans. It is clear that the policy would have an insignificant impact, if any at all, on health insurance costs to employers. In a pay-as-you-go environment, a modest extension of MSP raises necessary revenue for critical reforms within the program. It is only designed to generate modest savings. Though relatively small, these savings can be used to offset the costs of other critical reforms, while also providing choice to patients. As advocates of the entire kidney care community, we feel it is important to set the record straight with regarding to extending MSP by 12 months. We are always available to provide information to the Committees members and staff, as you consider this important issue. Sincerely, Edward R. Jones, MD Chairman Kidney Care Partners: Abbott Laboratories AMAG Pharmaceuticals American Kidney Fund American Nephrology Nurses Association American Regent, Inc. American Renal Associates, Inc. American Society of Nephrology American Society of Pediatric Nephrology Amgen Baxter Healthcare Corporation Board of Nephrology Examiners Nursing and Technicians California Dialysis Council Centers for Dialysis Care DaVita, Inc. DaVita Patient Citizens Diversified Specialty Institutes Fresenius Medical Care North America Fresenius Medical Care Products and Hospital Group Genzyme Kidney Care Council National Association of Nephrology Technicians and Technologists National Kidney Foundation National Renal Administrators Association National Renal Alliance, LLC Northwest Kidney Centers Renal Advantage, Inc. Renal Physicians Association Renal Support Network Renal Ventures Management, LLC Roche Laboratories Satellite Health Care U.S. Renal Care Watson Pharma, Inc.