Trump Advances American Kidney Health
President Nixon signed into law the Medicare End Stage Renal Disease benefit in 1972. Since that time, we have had distorted incentives in this space in ways few could have predicted, resulting in high costs and poor patient outcomes. Taxpayers spend $114 billion on Medicare beneficiaries with kidney disease, more than on the National Institutes of Health ($39 billion), the Department of Homeland Security ($47.5 billion), and NASA ($21.5 billion) combined.
The human cost is even greater: Over 726,000 Americans require dialysis treatment or live with a kidney transplant, and minorities are disproportionately impacted. Dialysis prevalence is 3.7 times greater in the African American population than the population as a whole, and African Americans and Hispanic Americans also receive fewer transplants. President Trump recognized that the United States needed to rethink how we approach kidney care and decided it was time for presidential action.
This week, he delivered a message of hope to the approximately 30 million Americans suffering with kidney disease. The president signed an executive order signaling that the administration will propose updates to the way kidneys are provided for transplants in America and advance American kidney health more broadly. He was moved to act by the stories of people like Nancy Scott.
Nancy is a retired nurse and an ordained minister who suffered with kidney disease for nearly a decade. Inspired by the good fortune that struck her in 2011 when she received a kidney transplant, Nancy began to advocate for patients and point out that she is healthy today due to the work of a nonprofit organization in Delaware that provides organs, known as an Organ Procurement Organization or OPO.
But Nancy’s fortune isn’t shared by all who need organs. OPO performance varies tremendously by region, and there is little transparency regarding how the figures reported to the federal government are formulated. The Bridgespan Group estimates that OPO reform would lead to 17,000 more kidneys and 11,000 more hearts, lungs and livers available for transplantation. Each one of those organs represents hope to an American on a waiting list praying for a match.
In addition to bringing new transparency to OPOs, the president has directed the Department of Health and Human Services to take action to provide additional support for living organ donors. Those giving a kidney, or a portion of a liver, lung, or intestine to someone in need, should not face financial burdens due to their decision to donate life-giving organs. Currently Americans who give up a piece of themselves take a hit to their wallet if they have to take time off work or hire someone to care for their children or an elderly relative while they recover. It is shocking that so many donors, who give of themselves to save others, are left without support.
The president’s effort goes beyond encouraging transplantation. It aims to change the entire care paradigm for kidney disease by preventing progression and increasing patient choice. We know there is something wrong in how we do things when 56% of patients in Guatemala receive their dialysis at home and but only 12% of Medicare beneficiaries receive home dialysis, even though it is associated with increased patient satisfaction and improved health outcomes. The Center for Medicare & Medicaid Innovation has introduced five models to adjust Medicare payments to delay or prevent the onset of kidney failure and encourage greater use of home dialysis and kidney transplants. We believe providers will respond to these financial incentives, the same way actors respond to incentives in other markets.
The cumulative impact of these changes will be astounding. All Americans with loved ones suffering from kidney disease or waiting for an organ transplant can potentially benefit from this effort.
Over the next year, you will see action building on the president’s vision to advance American kidney health. Similar to how the president’s October 2017 health care executive order laid out a series of actions that are expected to enable millions of Americans to access affordable health care, expect to see a transformative impact here.