Bipartisan bills provide Medicare coverage, prohibit raise in insurance ratesDeWine, Durbin offer legislation to ensure organ transplants



WASHINGTON, DC U.S. Senators Mike DeWine (R-OH) and Dick Durbin (D-IL) recently offered two bills targeted at organ donorsa proposal aimed at helping organ transplant patients maintain access to the life-saving drugs necessary to prevent their immune systems from rejecting new organs and another proposal that would bar insurance companies from imposing additional premiums or pre-existing condition exclusions on living organ donors.

Every year, approximately 6,000 people die waiting for an organ transplant. Currently, more than 80,000 Americans are waiting for a donor organ. Those individuals who receive an organ transplant must take immunosuppressive drugs every day to help ensure the transplant is not rejected by their immune system. However, Medicare policy denies certain transplant patients coverage of these vital medicines.

Medicare treats transplant patients differently than other patients, Dubin said. The Medicare rules actually discriminate against transplant patients. For example, Medicare only pays for anti-rejection drugs for transplants performed in a Medicare-approved transplant facility. Most people are completely unaware of this fact and how it can jeopardize their future coverage of immunosuppressive drugs. To receive an organ transplant, a person must be very ill, and many are far too sick at the time of transplantation to research the intricate nuances of Medicare coverage policy.

DeWine said, Donor organs are extremely scarce, and yet current federal law compromises the success of organ transplants. In 2000, Sen. Durbin and I worked to pass legislation that would extend Medicare coverage of anti-rejection drugs. Although the legislation became law, it included loopholes to the coverage that would finally be closed by the bill were offering today.

Medicare coverage for immunosuppressive drugs currently includes the following gaps:

l Medicare does not pay for anti-rejection drugs for those patients who received their transplants prior to becoming a Medicare beneficiary. For instance, if a person receives an organ transplant at age 64 through her health insurance plan, she loses immunosuppressive drug coverage when she retires and enrolls in Medicare for health coverage.


l End Stage Renal Disease patients qualify for Medicare on the basis of their needing dialysis. If ESRD patients receive a kidney transplant, they only qualify for Medicare coverage for three years after their transplant.

The new Medicare policy would remove these limitations and would extend coverage to all Medicare beneficiaries who have had a transplant and who need immunosuppressive drugs to prevent rejection of the transplant. The coverage would be available for as long as the anti-rejection drugs are needed.

DeWine and Durbin have also introduced a bill that would ensure that individuals who choose to be living organ donors are not discriminated against in the insurance marketplace. The proposal builds on the protections provided by the Health Insurance Portability and Accountability Act, so that living organ donors are not denied insurance nor are they applied discriminatory insurance premiums because of their living organ donor status.

DeWine said, Quite simply, a brother who donates a part of his kidney to his sister should not be denied health insurance. But tragically, that is what oftentimes happens. Frequently, individuals who are living organ donors are denied health insurance or restricted from the insurance market. Instead, we should celebrate living organ donors and remove obstacles and barriers for the successful donation of organs. Insurance shouldnt undermine someones decision to be a living organ donor.

Durbin pointed out that both bills he and DeWine are offering would have a real impact on peoples everyday lives.

Dubin said, Take our immunosuppressive drug billI had a constituent from Illinois named Anita Milton who was no longer able to work and was forced onto disability. The following year, her lungs gave out, and she had to have a bilateral lung transplant. But because of current Medicare rules, she was not eligible for Medicare when she had the transplant and received no Medicare coverage for the anti-rejection drugs she needed to live.

To afford her medications, she was forced to sell her home and move into her sons basement, and she began to scale back on her immunosuppressive drugs, Durbin added. This caused her body to nearly reject the transplant; she lost a third of her lung capacity permanently and became sicker and sicker. Eventually, two years ago, she died.

DeWine said, We have the medical know-how to save lives, but we lack the organs. We lack organs because most Americans simply are unaware of the life-giving difference they can make by choosing to become organ donors. It is time for Congress to take a few sensible steps in support of a persons decision to be an organ donor.

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