By John A. Schall

With the new 110th Congress only a few months old, already a dozen or so bills have been introduced that would help kidney patients – and even more bills are on the way.

We will have to wait and see which of these pieces of legislation actually makes it all the way through the legislative process this year and next, but here is a snapshot of the ideas currently being considered on Capitol Hill.

A Congressional Medal

How about a Congressional Medal for those who donate an organ and save a life? Rep. Pete Stark (D-CA) has been proposing this idea for the last 15 years. HR 1764, the William H. Frist Gift of Life Congressional Medal Act, would award a Congressional Medal to organ donors. It’s a good idea that provides much-deserved recognition to organ donors and their families. Now Rep. Stark is Chairman of the House Ways and Means Health Subcommittee, so his bill has a real chance of being passed. The prospects for passage of the Gift of Life Congressional Medal Act are further enhanced by strong bipartisan support: Stark introduced the bill with Rep. Dave Camp (R-MI), and the bill is named in honor of former Senate Majority Leader Bill Frist (R-TN), a transplant surgeon who retired from the Senate last year.

There is also strong support for the idea of a Gift of Life Congressional Medal in the Senate, where Senators Dick Durbin (D-IL) and Chuck Grassley (R-IA) have introduced the bill (S.1062).

That said, because the bill would create a new "Congressional Medal," it needs a lot of cosponsors in order to be reported out of committee and make it to a final vote. If you think a Gift of Life Congressional Medal is a good idea, contact your Congressman or Senator and ask them to support HR 1764 and S. 1062.

Tax Credits

Because of the chronic shortage of available organs, there are long waiting lists for transplants. Well over 90,000 Americans are in need of a transplant, with 70,000 waiting for a kidney.

Rep. Joe Wilson (R-SC) thinks a tax credit to cover some of the costs of organ donations may increase the supply of available organs. Wilson introduced HR 1035, the Living Organ Donor Tax Credit Act of 2007.

The Living Organ Donor Tax Credit Act would amend the Internal Revenue Code to allow a nonrefundable tax credit for a donation of a qualified life-saving organ for transplantation by a living individual into another individual.

The bill defines "qualified lifesaving organ" as a kidney, liver, lung, pancreas, intestine, bone marrow or any part thereof. It would provide a tax credit of up to $5,000 for the un-reimbursed costs and lost wages incurred by an organ donor in connection with an organ transplant.

Education

Medicare currently does not cover education about kidney disease. Many in Congress think this policy is selfdefeating: it would make much better sense to educate people about kidney disease in order to save Medicare money in the long run. Rep. Jim McDermott (D-WA) introduced HR 1245, the Kidney Disease Educational Benefits Act of 2007, to provide for Medicare coverage of kidney disease education services.

A companion bill, S. 432, has been introduced in the Senate by Senators Blanche Lincoln (D-AR), Susan Collins (R-ME), Norm Coleman (R-MN), Dick Durbin (R-IL) and Mark Pryor (D-AR).

Help for Providers

A much more comprehensive bill is being pushed in Congress by dialysis providers. Called the Kidney Care Quality and Education Act of 2007, HR 1193 has numerous provisions but is built around increasing the Medicare reimbursement rate to dialysis providers. The Kidney Care Quality and Education Act would, among other things, authorize demonstration projects to: (1) increase public awareness about the factors that lead to chronic kidney disease (CKD), how to prevent it, how to treat it, and how to avoid kidney failure, as well as enhance surveillance systems and expand research to better assess the prevalence and incidence of kidney disease; and (2) enable individuals with end-stage renal disease (ESRD) to develop self-management skills. It would also provide for Medicare coverage of kidney disease patient education services.

It would also direct the Secretary to: (1) establish blood flow monitoring demonstration projects; and (2) arrange with the Institute of Medicine of the National Academy of Sciences to evaluate the barriers to increasing the number of individuals with ESRD who elect to receive home dialysis services or other treatment modalities under Medicare. It also sets forth required training for patient care dialysis technicians.

Those are all worthy aims deserving of strong support. The more expensive and somewhat controversial part of the bill addresses the annual update framework for the Medicare ESRD composite rate. It would create a three-year continuous quality improvement initiative under which quality incentive payments are provided to renal dialysis facilities, providers of services, and physicians that meet quality benchmarks and demonstrate quality improvements. Rep. John Lewis (D-GA) is the sponsor of the bill in the House and Senator Kent Conrad (DND) introduced the companion bill in the Senate, S. 691.

Home Dialysis

A small number of patients prefer to receive home dialysis. AAKP has always believed that medical treatment decisions should be made by the patient and the doctor. Unfortunately, Medicare pays for only three dialysis sessions per week, which limits the options for some patients.

A Medicare demonstration program extending coverage to home dialysis could document the better clinical outcomes that often result from home dialysis and from more frequent dialysis. Home dialysis should be an available option for those patients who want it.

Legislation in the last Congress did not get passed but did result in Congress calling on the Government Accountability Office to do a study on the costs and benefits of home dialysis over the next two years. Rep. Jim McDermott (D-WA) will likely introduce a bill again this year to extend Medicare coverage for home dialysis.

Immunosuppressive Drug Coverage

For kidney transplant recipients under age 65, Medicare only covers immunosuppressive drugs for about three years. Too many low-income people cannot afford to continue taking these critical life-saving drugs after Medicare coverage runs out. Without immunosuppressive drugs to keep kidney transplants from being rejected, many patients find themselves right back where they started: in need of a kidney.

This circular cycle of care is costing taxpayers a lot of money and putting thousands of lives on the line. It’s time to provide lifetime coverage for immunosuppressive drugs through Medicare. Doing so will reduce the number of graft failures and reduce the need for dialysis and kidney re-transplants. In the long run, both money and lives will be saved.

AAKP has long been pushing hard for legislation to eliminate the 36-month cap on immunosuppressive drug coverage for those eligible for the ESRD program. We expect Rep. Dave Camp (R-MI) to once again emerge as a strong champion for this cause and soon reintroduce legislation to provide lifetime coverage for these life-saving drugs.

John A. Schall, MPP, is the vice president at Jefferson Government Relations.