New bill to make kidney patients pay more for aid

An article Sunday about proposed changes in Maryland's Kidney Disease Program misstated the proportion of a single person's income that would be protected from a 5 percent fee the health department wants to charge people receiving benefits. Under the proposal, the first $9,420 would be protected.

Six weeks after backing off from plans to kill Maryland's generous benefits program for victims of kidney disease, the Schaefer administration has raised a new storm with legislation that would require many recipients to pay stiffer premiums for the coverage they get.


Acting Health Secretary Nelson J. Sabatini said the bill, filed last week, simply would make the program more equitable by requiring higher-income people to pay a fair share for benefits.

But many kidney patients and families, who breathed a collective sigh of relief Christmas Eve when the governor rescued the program from its scheduled demise, are viewing the bill as a way to whittle away benefits until the program disappears.


Patients say they are concerned about the new fees but insist they are more frightened about another aspect of the bill. That one would give Mr. Sabatini's department the authority to regulate such things as eligibility for benefits, taking that power away from an independent commission that has regulated the program since its inception two decades ago.

"Our belief is that they have a hidden agenda -- that this makes it easier for them to get rid of the program," said Joseph Morton, a Woodlawn accountant whose wife, Dagmar Maszun, was a kidney dialysis patient before she died Dec. 30.

"The real issue is regulatory control. It seems strange for the department to come in with this now, when their intent was to eliminate the program. This doesn't smack of good intentions," he said.

When told of the widespread distrust, Mr. Sabatini countered, "That's nonsense.

"We didn't say we were going to eliminate the program because we didn't like it."

Mr. Sabatini said the department simply was trying to control mushrooming Medicaid expenses. "The fact of the matter is that this legislation clearly establishes that there is a Kidney Disease Program and that the intent of the program is to keep people from having to end up in poverty."

The Kidney Disease Program pays for the lifesaving drugs needed by kidney dialysis and transplant patients. It also picks up the 20 percent co-payment that patients must pay toward their Medicare coverage, which picks up 80 percent of the cost of dialysis itself.

The benefits vary, depending on the severity of the illness and whether patients have other sources of insurance.


The program pays as much as $10,000 for some patients, far less for others. All told, about 4,200 patients are enrolled.

Due in part to the skyrocketing cost of drugs and medical services, the program's cost jumped from $4.7 million in 1988 to an estimated $5.8 million this year.

Mr. Sabatini estimated the program will cost more than $7 million in fiscal 1992 unless serious changes are made.

For the first time in 20 years, the department last year exercised its right to treat the program as an insurance policy, charging patients a premium equal to 5 percent of their adjusted gross income. The fee has always been on the books, but the department ignored it until recently.

With the new bill, Mr. Sabatini is proposing to reach a little deeper into the pockets of recipients who have moderate and ample means.

It would disqualify people who have savings that exceed the total amount a poverty-level family earns every year -- for example, more than $6,280 for a single person and $12,700 for a four-person household. This means, in effect, that people would have to exhaust much of their life savings before qualifying for the program.


Mr. Sabatini admits that for some people, it won't make sense to spend money saved for a child's college education just to derive a comparatively small benefit. Those people, he said, may simply opt out of the program.

The plan is harsher in another way as well. The 5 percent fee would be charged on gross income; the state, for instance, no longer would deduct from income the amount some recipients pay for private insurance.

In another respect, however, the program is kinder. It protects from the 5 percent tax a chunk of income equal to 150 percent of poverty-level income -- the first $13,920 for a single person and $19,000 for a family of four.

All told, Mr. Sabatini says, the proposal is kindest to the poor and harshest to the wealthy, a fair balance in times of shrinking resources.

"I don't think people with kidney disease should have to spend themselves into impoverishment," he said. "I think it's reasonable to expect people who have income and assets, liquid assets, to contribute tothe cost of their medical care."

Advocates for the patients insist that few have large savings. The majority, they say, are poor and middle-income people who are struggling to sock away a few dollars.


Kidney patients, who have been circulating petitions opposing the bill, say they have no doubt what will happen if the health department wrests regulatory control from the Maryland Commission on Kidney Disease, a group made up of doctors, nurses, insurance-industry representatives and lay people whom they have come to regard as their advocates.

"If Mr. Sabatini is in charge, quite naturally he will be able to cut it at his own discretion," said Truxon Sykes, 47, a patient who has been on kidney dialysis since April.

Mr. Sabatini insisted he has no intention of gutting the program. But he said it makes no sense for the health department to administer a multimillion-dollar program when it cannot regulate such things as the application procedures and the fine nuances of eligibility.

The proposal may face tough sailing in the legislature, however. Sen. Barbara A. Hoffman, D-Baltimore, plans to offer legislation of her own that would preserve the commission's authority.

"When Nelson [Sabatini] says he doesn't want to do away with the program, nobody believes him," she said. "He tried to do away with it, and that's what you have to go by."

For the record