California Democrats must really hate dialysis victims, what to do next?

[rleong@rocketmail.com]

Why do I say this?  Here's some background. 

https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200AB290,
AB290, the SEIU takeover of dialysis clinics.  Originally introduced last year in the Legislature, it was vetoed by Governor Brown and then beaten at the ballot box as Prop 8 in 2018. 

In 2019, new governor and legislature.  Asm. Jim Wood (D-Santa Rosa) introduces a rehash of Prop 8, adding a part for the insurance companies.  If a patient receives a grant from a third party, such as the American Kidney Fund, they can be dumped.  They are in the bill by name.  The SEIU who authored this bill and the insurance industry lobby hard for this.  It passes both Assembly and Senate on a party line vote; all Democrats vote YES and all Republicans vote NO.  Governor Newsom signs the bill on the last day he's allowed to, the Sunday before Columbus Day. 

This means that every dialysis victim who receives a grant to pay their medical premiums, including the secondary insurance we NEED to have in order to be considered for transplant, is now cut off by AKF who refuses to continue grants for existing receipients despite having a carve out in the final version of the bill.  On a personal note, I will now have to find $1250/month to pay Blue Shield as of January. 

Gavin Newsom's Individual Mandate, imposed after President Trump ended it on the federal level, includes a subsidy that can be applied for.  EXCEPT for those already on Medicare.  So that means no subsidy for dialysis victims since Medicare is our primary, thanks to the insurance companies.   And speaking of insurance companies..

No Insurance coverage outside California.  Last year, the Continuation of Coverage policy was to get preapproval for any care relating to chronic or transplant.  This year, there is NO coverage out of state for any care, period.  Sooo...if you don't want to be a dialysis victim for the rest of your productive life or to deal with the 13+ year wait at UCSF, you can always get listed out of state with a much shorter (2 years) wait.  Except now we will have to pay the 20% out of pocket.  Any sort of insurance policy change MUST be approved by the state of California.  So since the unions now control the dialysis clinics, is this planned to keep people on dialysis as long as possible, to squeeze as much money out of them before they die?    Maybe this isn't something we the dialysis victims aren't supposed to know. 

So what kind of options are there for the lost AKF grant AND the now useless outside of California secondary insurance?

[Simon Dog]

If a patient receives a grant from a third party, such as the American Kidney Fund, they can be dumped.

If properly implemented, this makes sense from a public policy perspective.

What was happening is that dialysis clinics were arranging to pay for the premiums of medicaid eligible patients they had to accept, so they would get the higher private insurance reimbursement rate rather than the lower Medicaid rate.    The insurance companies were then forced to accept patients who were known economic losses - the equivalent of being forced to write a fire policy on a burning building.

Medicaid for insurance is income based, so these grants were often going to people who were "Medicaid Eligible".   A law that prevents providers (directly or via intermediaries) from moving a patient from Medicaid to a more lucrative private policy makes sense.   The trick is doing it without unintended consequences, like barring patients from receiving financial aid who are not otherwise Medicaid eligible.   

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From the text of the bill:

(a) There has been a rapid increase in the practice of certain health care providers and provider-funded groups paying health insurance premiums in California’s individual and group health insurance markets on behalf of consumers with very high-cost conditions such as end stage renal disease and addiction to alcohol or drugs.
(b) These third-party payment arrangements have proliferated in recent years as a result of health care providers that have demonstrated a willingness to exploit the Affordable Care Act’s guaranteed issue rules for their own financial benefit.
(c) Encouraging patients to enroll in commercial insurance coverage for the financial benefit of the provider may result in an unjust enrichment of the financially interested provider at the expense of consumers purchasing health insurance. This practice can also expose patients to direct harm.

Note item "c".  These grants are for the financial interest of the provider, not to assist the patient.   Everything makes sense except the last claim about "direct harm".
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Why is the SEIU concerned about keeping dialysis reimbursements low (which is what this law is about).  You'd think they would want more $$ flowing into the clinics so they would be fighting for a slice of a bigger pie.
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The full text of the bill is worth a read.  It's about preventing dialysis companies from paying for insurance for patients so they can get a higher reimbursement rate.    Its a byproduct of health insurance being the only type of policy that is required to issue policies that are known to be money losers at the time they are sold.

[rleong@rocketmail.com]

First off, SEIU has been trying to unionize Fresnius and Davita for years.  Their lobbyist was caught on a hot mic a few years ago saying, “if they won’t join, we’ll just change the law”.

Second, if you read the beginning of the bill, dialysis victims are not being “enticed” by AKF grants to shun public insurance and get private plans instead.  As you know, in order to be considered for transplant, you need Medicare and a secondary insurance policy, in that order.  Medicare is the assigned primary for anything renal related, thanks to the insurance companies and it’s considered a success to move responsibility to Medicare. My secondary insurance doesn’t pay jack for the 20% that Medicare doesn’t cover.  So I don’t get the “poor insurance companies” angle or the “Encouraging patients to enroll in commercial insurance coverage” part.  It really reads like something the insurance companies would say.  I guarantee you that you ask AKF grant recipients, none of them were “encouraged” to enroll with private insurance while shunning Medicare.  AKF did grants for both here. 

Third, I can speak as a middle class dialysis victim, one who is ineligible for Medicaid or disability (because self employment is not considered “work” even though it’s hella taxed) but has some savings that will be depleted due to having to pay $17,500 a year for coverage only in California. 

SEIU wants to strangle the dialysis clinics until they give in and unionize.  Then all of a sudden, they will be concerned about what patients they have left.  Of course, since CA private insurance no longer covers care outside of California, they now have a captive audience that can no longer go out of state for a much shorter wait to get a kidney and to get off dialysis.  That’s a lot of sweet sweet federal money that dialysis victims serve as conduit for.  Fresnius and Davita got all that money for itself, instead of giving it all to the union. Now the union has changed the rules so they control the money that the dialysis clinics make .  California and SEIU has a vested interest in keeping all dialysis victims in California in order to milk them dry.  I will say that AB290 does NOT make sense from a public policy stand-point unless the goal is to enrich the union and the Democrats that support them.  It doesn’t make public policy sense to hurt dialysis victims every further, but since when did California care about the non union, tax paying citizens?

[rleong@rocketmail.com]

I have read this bill ad nauseum since this started.  I found the carve out for current grant recipients not having to do the reporting that AKF is using as an excuse to cut off everyone in California. These recipients will not be subject to the reporting that AB290 requires.  In English, they get to continue under the pre AB290 rules.  AKF could continue to help these dialysis victims while their court case winds its way through the system.  But they’re not.  And they don’t acknowledge the carve out either.  But that’s a different rant for another time.