Kidney Failure Patients Drive Up Individual Market Spending

When the Affordable Care Act banned individual market insurers from denying coverage to people with pre-existing conditions or charging them higher rates, it created a new option for patients with end-stage renal disease (ESRD), who previously could not access affordable plans in that market. But the ACA’s reforms also opened the door to a practice that has stirred up controversy in the health care sector: dialysis facilities steering patients to higher-reimbursing private plans by indirectly subsidizing their premiums. While attempts to ban such behavior have failed so far, a new study offers reasons why policymakers may want to take another shot at addressing the issue.

The study, published in JAMA Internal Medicine, examined 2016 data from ACA-compliant on- and off-exchange health plans, finding that patients with ESRD comprised just 0.10% of individual market member months but 3.3% of spending. For such patients, average monthly spending on dialysis and other services was 33 times that of patients without ESRD, “underscoring the incentive for [dialysis] facilities to encourage individual market enrollment,” the study stated.

© 2021 MMIT

Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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