By Dianne Anderson

If SB 1156 passes, local kidney transplant recipient Philip Silva fears that patients like himself, suffering kidney disease and over a decade on dialysis, risk getting pushed off their insurance or losing their homes in the process.

On the surface, he said SB 1156 (Connie Leyva, D-Chino) almost sounds good.

“But it has implications that nobody is aware of,” he said. “The attacking the kidney [disabled], they’re using us as pawns.”

Being under 65 years old, the only reason he qualified for Medicare was that he was an end-stage renal patient, but it wasn’t enough to cover his costs.

In the past, he received Medicare statements for his home-based peritoneal dialysis, with costs of $2,166.20 for one post-transplant drug, of which Medicare only picked up $187.52. His supplemental insurance also picked up only 20 percent.

His second job disqualified him from taking Medi-Cal, which is typical for end-stage renal patients to receive, but Medi-Cal came with strings attached.

He received Medi-Cal notices stating they would take his house if he died, and that his wife wouldn’t be able to get the house.

Silva, on dialysis, had lost his job, and unable to carry premiums not covered by Medicare. Through his social worker, he accessed a Medigap Plan in Tennessee, and he received his kidney last December.

Because he was unable to work consistently, the nonprofit American Kidney Fund picked up his Medicare and Medigap premium for eight years.

“I would’ve been completely broke without American Kidney Fund,” he said. “Especially when you get the transplant, it’s [costs are] outrageous.”

Silva, an adult education teacher, said through the ordeal, both he and his wife survived off his wife’s part-time income as a teacher, and AKF charitable donations.

It’s been rough.

Now he is looking for full-time work. He expects to return part-time as an adult education teacher in the coming weeks.

Opponents say the 90 day wait period to determine if the insurer will accept a charitable payment puts the patient at risk getting thrown off coverage without recourse.

Holly Bode, vice president of government relations at AKF, said they oppose the bill because it puts patients in the middle of SEIU’s efforts to organize dialysis clinics and the insurers’ battle with providers over reimbursement rates.

If longer waiting periods are established to receive financial help, she said that would harm patients and cause them to lose their coverage.

“What’s important to us is that patients have the ability to choose the insurance plan that is best for their individual and family situations, even if they need charitable help to pay their premiums, without undue administrative burdens or delays,” she said.

For patients like Silva who are under 65 years old, Medicare is often not the best choice. In California, patients can not access Medigap plans to cover the 20% co-insurance on all medical treatments. Medicare only covers 80 percent.

Mr. Silva is a good example of why options are important to dialysis and transplant patients, she said.

“AKF pays premiums for the full plan year and in many cases, like Mr. Silva’s, for many years. We are not a dialysis provider and we are not a financially interested third party. We are a nearly 50-year-old charitable organization that has received the highest ratings from charity watchdog groups like Charity Navigator,” she said.

Earlier this year, Sen. Leyva released a statement that requiring financially interested third parties to pay entire year premiums ensures that patients do not lose health coverage mid-year. She said the measure would require provider-funded organizations to follow disclosure requirements, and certify that consumers do not have better available options open to them.

“These providers have a right to make a profit, but not when those financial interests can hurt patients or even keep them from receiving the care they need,” she said.

She said the commonsense safeguard prevents patients from getting caught up in schemes where they may lose their health insurance, which could ultimately raise premiums for other Californians.

Under SB 1156, Sen. Leyva said that low-income patients that are eligible for Medi-Cal will continue to have their treatment covered by Medi-Cal, and that SB 1156 does not change any patient’s eligibility for any particular insurance or program.

“If an organization decides to stop paying the premiums of Medi-Cal eligible patients, those patients would be able to have their treatment covered promptly by Medi-Cal so that they would be able to continue to receive care. A financially interested third party would be able to continue making payments, but would receive the lower of the contracted rate or the Medicare rate,” Sen. Leyva said in an email.