NO MEDICINE FOR WHITES: Biden administration proposes prioritizing minority patients for kidney transplants to address ‘racial inequities’

The Biden administration has announced a new initiative aimed at prioritizing low-income patients for kidney transplants, a move intended to address racial inequities in the transplant process, according to Health and Human Services Secretary Xavier Becerra.

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The proposal, announced by Becerra’s agency on May 8, will place 90 of the nation’s 257 transplant hospitals into a pilot program. This program employs an annual point system to grade hospitals, where a successful kidney transplant counts as one point, but a transplant provided to a low-income patient counts as 1.2 points due to a “health equity performance adjustment.” This adjustment is designed to incentivize hospitals to prioritize low-income patients.

“These changes are aimed at removing racial bias from the transplant process,” Becerra said. “Black Americans disproportionately struggle with life-threatening kidney disease yet receive a smaller percentage of kidney transplants. The Biden-Harris administration is taking concrete steps to address these disparities.”

The proposal, while using income rather than race as a categorizing factor, is intended to address racial concerns. The scoring system aims to rectify what Becerra describes as inherent biases within the organ transplant industry.

Pilot Program Details

The Centers for Medicare and Medicaid Services released the proposed model, which determines a hospital’s annual score based on three factors: the number of transplants performed, organ acceptance rates, and post-transplant outcomes. The number of transplants accounts for the majority of the score, with a 20 percent bonus applied to transplants performed on low-income patients.

“Hospitals that meet their transplant target can receive up to $8,000 per transplant, while those that don’t meet the target could face penalties of up to $2,000 per transplant,” according to the HHS announcement.

The program aims to address potential concerns that it might incentivize shifting kidney transplants from one type of patient to another. The proposal contends that the health equity performance adjustment is meant to promote activities increasing access for all patients, while recognizing that low-income patients may face greater barriers to care.

Reactions and Concerns

Dr. Stanley Goldfarb, a kidney specialist and former associate dean at the University of Pennsylvania School of Medicine, argues that the proposal is a workaround to avoid legal issues that would arise from explicitly prioritizing patients based on race. “These are ways around it to do what they’re trying to accomplish,” he said.

Goldfarb expressed skepticism about the effectiveness of the proposed incentives. He highlighted research indicating that relatives of Black patients are less likely to donate kidneys, often due to non-financial issues like preexisting conditions. He also noted that Medicare already covers end-stage kidney failure for Americans of all ages.

“I’m in favor of outreach to patients who have trouble accessing the health care system, but I’m not sure this is the case with kidney transplants. It’s much more a case of patient unwillingness to pursue this and families’ unwillingness to donate kidneys,” Goldfarb stated.

Broader Implications

The Biden administration’s focus on equity is part of a broader agenda, outlined in a January 2021 executive order, which directs federal agencies to address inequities in their policies and programs. The HHS proposal directly cites this executive order.

The pilot program, which could start as early as January 2025, will involve 90 of the nation’s transplant hospitals. It could significantly impact how kidney transplants are allocated and prioritized in the United States.

Despite the initiative’s potential benefits, it has faced criticism for its approach to incentivizing hospitals. Other medical institutions have also faced backlash for their “health equity” initiatives, raising concerns about the implementation and outcomes of such programs.

The Biden administration remains committed to its equity agenda, seeking to address long-standing disparities in healthcare access and outcomes. However, the effectiveness and fairness of these measures will likely continue to be a topic of debate and scrutiny.

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