S.1173 - Restore Protections for Dialysis Patients Act (119th Congress)
Summary
S.1173, the "Restore Protections for Dialysis Patients Act," aims to amend Title XVIII of the Social Security Act to reinforce protections under the Medicare Secondary Payer Act for individuals with end-stage renal disease (ESRD). The bill seeks to prevent private health plans from discriminating against dialysis patients or treating dialysis unfavorably compared to other medical services. It clarifies that health insurance plans should not shift the primary responsibility for covering healthcare costs for ESRD patients to Medicare.
Expected Effects
The bill's enactment would likely result in private health insurance plans being prohibited from limiting benefits or coverage in ways that disproportionately affect individuals with ESRD. This would ensure that dialysis patients receive equitable treatment in terms of healthcare coverage. The legislation also clarifies that plans can still choose their provider networks, but cannot use this to discriminate against ESRD patients.
Potential Benefits
- Ensures equitable healthcare coverage for individuals with end-stage renal disease.
- Prevents private health plans from discriminating against dialysis patients.
- Protects Medicare from becoming the primary payer when private insurance should be responsible.
- Affirms congressional intent to prevent disfavored treatment of dialysis services.
- Clarifies the scope of permissible network limitations for dialysis providers.
Potential Disadvantages
- May increase costs for private health insurance plans, potentially leading to higher premiums for all enrollees.
- Could create complexities in interpreting and enforcing the non-discrimination provisions.
- Might lead to litigation if the definition of "disparately affect" is contested.
- Potential for unintended consequences if provider networks are overly restricted in response.
- Possible administrative burden for the Secretary to enforce the provisions.
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution, as it aims to improve healthcare access and affordability for a vulnerable population. Specifically, the bill amends Title XVIII of the Social Security Act, which falls under Congress's power to provide for the general welfare as outlined in Article I, Section 8. The bill does not appear to infringe upon any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).