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House panel approves renal care cost-shift


WASHINGTON--Hundreds of millions of dollars in health care bills incurred by individuals with kidney disease would be shifted to employer-sponsored plans from Medicare--if Congress passes a cost-shifting provision tucked into a massive children's health insurance bill approved by a House panel last week.

The provision approved by the Ways and Means Committee as part of the broader bill, H.R. 3162, would increase to 42 months from 30 months the period of time that employers--not Medicare--are the primary payers of medical bills for those with end-stage renal disease, which affects the kidneys and requires costly medical treatment.

In 1972, Congress expanded the Medicare program to provide coverage for ESRD for people younger than 65, the standard eligibility age for Medicare. Legislation later was passed so that employer health care plans become the primary payer of ESRD medical bills for an 18-month period; in 1997, the law was revamped to extend that period to 30 months.

While a revenue estimate was not available on the latest change, a 2006 Bush administration proposal to make employer plans the primary payer for 60 months would have saved Medicare about $1 billion between 2007 and 2011 and boosted employer costs by at least that much, the administration estimated at the time. However, Congress did not act on the proposal.