Future Care for Uninsured Dialysis Patients in Question

While the agreement eased concerns for those patients, most of them illegal immigrants, it does not address the dilemma of the future: What happens to the next wave of uninsured patients facing kidney failure?

Grady closed its outpatient dialysis unit in October to help it balance its books. The hospital said the unit was losing $4 million a year serving about 100 patients.

Most Americans with end-stage renal disease are covered by Medicare. Illegal immigrants, and some legal immigrants new to the country, are not eligible for the program.

Grady does not screen patients based on immigration status, and it treats uninsured patients, whether they are U.S. citizens or illegal residents. Immigration status has figured into the dialysis issue because illegal immigrants make up the bulk of those who need dialysis and do not qualify for Medicare coverage.

Uninsured patients can get emergency dialysis treatments at Grady or other hospitals. But with the Grady safety net gone for outpatient dialysis, those needing regular treatments to survive have few options. They can try to persuade a private clinic to offer charity care, which experts say will be difficult, or they can resort to irregular care in emergency rooms when their life is threatened.

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Many Americans oppose taxpayer-funded care for illegal immigrants, arguing that the care is an expensive drain on already limited public health resources.

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Grady offered last year to pay travel expenses of displaced patients who wanted to return to their home countries, and 13 patients accepted. Grady also agreed to pay for care at local dialysis clinics, which most patients accepted. The contract with the private company that provided the care was to expire this week.

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It’s unclear how firm the agreement is. DaVita Inc., one of the nation’s largest dialysis providers, is working with community leaders to resolve the issue, said company spokesman James N. “Skip” Thurman.

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Dr. Leslie Spry, a kidney specialist from Nebraska who is a spokesman for the National Kidney Foundation, said the problem is a national one.

In states with heavy immigration, Spry said, “they’re being inundated with these kind of folks, and they just turn the people away.”

Spry said that even in Nebraska, it’s becoming a common dilemma. He said the nonprofit dialysis clinic where he works offers charity care to some illegal immigrants without coverage, but only to those with community support and the willingness to pay what they can.

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As more uninsured Americans gain coverage through the implementation of the nation’s health care overhaul, illegal immigrants, who are not eligible for the program, are expected to make up a growing share of the remaining uninsured.

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