(Picture credit Matt Johnson)
OMAHA — On Thursday afternoon, U.S. Rep. Mike Flood toured DaVita Cornhusker Dialysis in Bellevue and talked with staff about the financial pressure on dialysis centers, especially in rural Nebraska.
The Bellevue site is a smaller in-center clinic. Patients typically sit in treatment chairs three to four hours, three days a week, while machines circulate their blood through a dialyzer that does the work their kidneys no longer can. Staff also train patients who can manage home hemodialysis or overnight peritoneal dialysis.
Staff told Flood that dialysis service has disappeared in Columbus and Chadron. The key driver, they said, was not a recent federal “cut” or the One Big Beautiful Bill. It was a change in payer mix after a 2022 U.S. Supreme Court decision.
Most dialysis patients become eligible for Medicare after 90 days of treatment, regardless of age. Group Facility Administrator Stacy Roberts said commercial coverage is what keeps a clinic open. One commercial payer, she said, “pays what 10 Medicare patients would pay.”
That mix got harder after the Court’s June 2022 decision in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc. For decades, the Medicare Secondary Payer Act let people with end-stage renal disease keep employer or other group coverage as primary insurance for up to 30 months. The Court held that a plan does not violate that law if it limits outpatient dialysis benefits, so long as the same limited benefits apply to everyone. Plans and administrators have used that opening to carve out dialysis or steer patients onto Medicare.
Flood compared it to rural nursing homes, where Medicare and Medicaid alone are not enough if private pay disappears.
“I have not gotten the best explanation until today, because I understand the payer mix. We’ve had a lot of our nursing homes close through rural areas,” Flood said. “It’s not that the nursing homes are raising their prices. It’s that if you don’t have that private pay individual that pays $10,000 a month — that private pay probably is 10 times the amount of the Medicare.”
Flood, who lives in northeast Nebraska, said missing a session is not optional.
“If there’s a snowstorm coming, somebody in Creighton, Nebraska is going to come down, get a hotel room in Norfolk, because they can’t miss their dialysis the next day, because it’s life-threatening,” he said. “The fact that one is not in Columbus is a problem.”
DaVita asked Flood to back H.R. 2199, the Restore Protections for Dialysis Patients Act. The bill would restore those 30-month commercial-primary protections and bar insurers from limiting dialysis benefits in a way that treats ESRD patients differently from other chronic conditions.
On the way out, Flood thanked staff for front-line work and said the 2022 ruling and the payer mix explain the closures.
“I’m going to look into this legislation that would seem to make sense because they’re trying to make it work,” Flood said. “And so I’m going to go take this information back to Washington and see what we can do.”
— Matt Johnson is a freelance reporter with The Plains Sentinel.