American Kidney Fund Statement on Rep. Katie Porter's Report

Rep. Katie Porter's report portrays the American Kidney Fund's Health Insurance Premium Program in an inflammatory manner that is disconnected from reality.

The report acknowledges the disproportionate impact of kidney failure on people of color, and it points out the terrible impact of the COVID-19 pandemic on kidney patients — but it fails to make the connection between these disparities and the positive impact our program is having on them. While the nation is finally having a long-overdue conversation about health equity, Rep. Porter's report ignores the fact that our program is what makes health care possible for low-income, predominantly minority individuals who are fighting kidney failure. We are incredibly proud of the successes of this program and the ethical standards with which we have operated it for the past 24 years.

Our exclusive focus is on protecting low-income kidney patients' access to health coverage and the care it provides. Our program is a national model for provider-funded assistance, and our compliance policy is on our website and routinely shared with government officials and policymakers. Over the years, we have carefully examined and strengthened every aspect of this program to ensure strictest adherence to federal laws and regulations.

Patients come to AKF for assistance after they have selected their insurance plan and dialysis provider. We enforce rigorous standards of compliance and conflict of interest policies for our staff and board of trustees.  Our firewalls ensure that dialysis providers have no say in whether AKF will assist any patient. We, alone, determine patient eligibility, based solely on the patient's financial need, regardless of where the patient is treated and what kind of insurance they have. In keeping with the Office of the Inspector General Advisory Opinion 97-1, we do not in any way favor dialysis providers that donate to this program. In fact, more than half the providers with patients receiving our grants do not contribute to our program at all, and the program is frequently in a deficit because we do not have adequate funding to meet the ever-growing patient demand.

We help those in greatest need. We help the vast majority of our grant recipients with premiums for Medicare, Medigap, and employer or COBRA plans; contrary to the report's implications, ACA plans make up only a small fraction of our grants.

The report ignores the reality that to afford the treatment for kidney failure and its comorbidities, and to have a transplant, patients must have both primary, such as Medicare, and secondary insurance coverage. Often one of these plans is a private plan because of the law Congress enacted decades ago to ensure coordination of coverage between public and private payers. AKF makes this comprehensive coverage possible; for example, helping a patient with a Medicare primary and a COBRA secondary plan they could otherwise not afford.

Rep. Porter and the opponents of our program — the health insurance industry and labor unions — continue to boldly and falsely claim that AKF is preventing patients from having transplants. In fact, the opposite is true. One out of every 14 kidney transplants performed in the U.S. last year occurred because AKF was supporting the patient financially. This is one of our proudest successes.

Facts matter. Rep. Porter's report gets many wrong. In reality:

• AKF provided premium assistance to nearly 75,000 patients in 2020.
• More than two-thirds of our grant recipients are people of color.
• The average household income of the people we help is under $25,000.
• Two-thirds of our premium grants in 2020 were for Medicare Part B, Medigap, Medicare Advantage and Medicaid (in states that have Medicaid premiums).
• A small fraction – only about 2,600 patients — received our help with individual market (ACA) plans. Often, these were people who had the ACA plans before they became ill and needed to continue them.
• 1,615 patients had kidney transplants with our help in 2020. This represents 7% of all kidney transplants performed in the U.S. last year. We help transplant patients for the full year. Each month, we are helping more than 100 people get off dialysis and live better lives through kidney transplant.
• We make transplantation more equitable. The people who have transplants with assistance from AKF are more likely to be on Medicare and more likely to have a low income than the overall transplant population. They also are more likely to be people of color.

AKF continues to dedicate our time, energy and focus on patients, operating a program of the highest standards and practices.  It is time for these patently false claims to stop, and for all stakeholders to come together and focus on what is important — ensuring every person with kidney failure has access to affordable and comprehensive care, no matter their racial and ethnic identity, income level or employment status.