Medicare Policy a National Disgrace

Lack of dependable access to long-term immunosuppression is the Achilles’ Heel of American kidney transplantation. A legal remnant of now-disproven assumptions, the federal policy of discontinuing Medicare eligibility three years after a kidney transplant places thousands of recipients at risk each year, and is a major cause of graft failure. This policy also prevents countless potential recipients from even considering a transplant due to fears of financial ruin.

While AST and other groups have advocated for a rational end to this policy for years, an article published online this week by two Canadians in the New England Journal of Medicine (Gill and Tonelli, N Engl J Med, which you can read here) puts the impact of this failed US policy into perspective. These investigators document that Americans insured by Medicare have compromised long term outcomes compared to privately-insured patients, and beyond the 3-year-limit, risk of graft failure increases an additional 40-70%. Among Americans, long-term outcomes are dramatically worse than recipients in Australia, Canada, or the UK. This is an incredible waste of resources (to pay the $100K or so for a transplant and not cover the $10K or so required to make it work) and disrespects the sacrifice of those individuals and families who donate organs in this country.

This is no longer a policy “quirk,” but a national disgrace. As Congressman Michael Burgess (R-TX, a physician and primary cosponsor of H.R. 2969: The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011) related to me, if Medicare policy cannot address a simple issue like this effectively, how can one expect relevant agencies to cope with the complexity of something like the Affordable Care Act of 2010?

With H.R. 2969 (and its Senate equivalent), the current Congress can remedy this outrage that most of us have lived with our entire careers. We do our patients a disservice by remaining passively on the sidelines.

Contact your Senators and Representatives; inform State officials of the issue; let HHS, HRSA, CMS, et al know that lifetime support for dialysis while withdrawing immuno coverage after three years is not only poor policy, but also disgraceful, unethical, and immoral.

Now is the time for action!

Robert S. Gaston