American Kidney Fund Calls on President-elect Biden to Prioritize Policies that Address Health Disparities and Enhance Access to Health Coverage for Kidney Patients

ROCKVILLE, Md. (January 7, 2021) — The American Kidney Fund (AKF) is calling on President-elect Joseph R. Biden, Jr. to prioritize our country's kidney disease epidemic by focusing on policies that address health disparities, and protect and expand access to affordable, high-quality health coverage.

Kidney disease and kidney failure, also known as end-stage renal disease (ESRD), have a disproportionate impact on racial and ethnic minorities. Compared to white Americans, Black Americans are 3.4 times more likely to develop kidney failure, Native Americans are 1.9 times more likely and Asian Americans are 1.3 times more likely. Additionally, people of Hispanic ethnicity are 1.5 times more likely to develop kidney failure than non-Hispanics. These statistics — and more importantly the people they represent — have come into sharper focus as COVID-19 continues to spread across the country, with those same communities facing higher rates of hospitalizations and mortality during the pandemic. People with underlying kidney disease and ESRD are at higher risk for COVID-19 and death related to the disease. Additionally, COVID-19 itself can cause kidney damage.

Affordable and high-quality health insurance is crucial for the American public to gain access to primary care physicians, specialists and medications. The COVID-19 pandemic has resulted in millions of Americans losing their jobs, and with it, their employer-sponsored insurance. AKF urges the Biden administration to take steps needed to ensure that Americans have the health care they need.

"Today we are calling on President-elect Biden to prioritize the prevention and treatment of kidney disease, which includes addressing health disparities and ensuring insurance coverage for all Americans," said LaVarne A. Burton, AKF president and CEO. "Black and Brown Americans with kidney disease and its two leading causes — diabetes and hypertension — have long faced health inequities, and today they are suffering a double pandemic because of it. People's lives are on the line, and the Biden administration must act accordingly."

In a letter to President-elect Biden, AKF requested the following actions:

Addressing health disparities

• Minimize the impact of social determinants of health (SDOH) — the social, economic and environmental conditions that affect health and wellbeing — that are significant contributors to health disparities. SDOH include: income level; access to education; job opportunities; access to housing and utility services; workplace safety; gender inequity; racial segregation; food insecurity; early childhood experiences; and exposure to violence and pollution.
• Improve the health care delivery system to make it more equitable, accessible and inclusive, and ensure high quality care across demographics and geographic regions, including rural areas.
• Invest in kidney-related research, particularly research on kidney disease in people of color.
• Improve the public health surveillance infrastructure to modernize reporting on COVID-19 and other diseases and conditions, including improving the collection and reporting of race and ethnicity data.
• Mandate that insurers must accept health insurance premiums from charities, as these programs help communities of color that are disproportionately impacted by diseases like kidney disease.
• Ensure equitable access to affordable and comprehensive health insurance coverage.

Protect access to health insurance for all people

Affordable Care Act (ACA):

• Support proposals that would help strengthen the ACA Marketplace, such as funding reinsurance programs, cost-sharing reduction payments and ACA enrollment outreach and education activities.
• Support proposals that would expand eligibility for cost-sharing reduction subsidies and advanced premium tax credits beyond the current income thresholds of 250% and 400% of the federal poverty level, respectively.

Through COBRA, assist people who have lost their health insurance:

• COBRA allows people who have recently lost their jobs to keep their employer health insurance for 18 months by paying the entire health insurance premium. During the financial crisis of 2009, a 65% COBRA subsidy was created to help people retain their insurance, which lasted until May 31, 2010.
• Implement an expanded version of this policy so people can keep their doctors and have continuity of care, especially when remaining insured is so important during a pandemic.

Protect and expand Medicaid:

• Rescind policies that undermine Medicaid's core objective, such as changes to: Medicaid eligibility and benefits that would impose work or service requirements; lifetime coverage limits; lock-out penalties; elimination of retroactive eligibility; and elimination of non-emergency medical transportation.
• Support AKF-backed proposals that would automatically increase federal support to state Medicaid programs during economic downturns and link Federal Medical Assistance Percentage (FMAP) adjustments to state unemployment levels. Federal support during an economic crisis would be more responsive, timely and effective.

Charitable premium assistance:

• Charitable premium assistance is a means by which nonprofit organizations can help make coverage affordable and ensure that low-income patients have reliable access to necessary care. Without this assistance, patients forego needed care and suffer from poor health outcomes. AKF's Health Insurance Premium Program (HIPP) pays health insurance premiums for low-income ESRD and recent transplant patients. The population we help is disproportionately minority compared to the U.S. population; over 60% of our grant recipients are people of color. When insurers reject AKF HIPP payments, low-income people of color are disproportionately affected.
• Require health insurers to accept direct payments from charities for health insurance.