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Annie and Robert Maldonaldo-Escalera volunteer in Lemoore with their son, Robert Austin Maldonaldo-Escalera. 

LEMOORE — Annie and Robert Maldonaldo-Escalera commit 12 hours every week to dialysis, a treatment that keeps them alive.

The Lemoore couple, diagnosed with end-stage renal disease, used to worry about receiving new kidneys.

But now they worry if they will be able to afford dialysis.

In January, California Assemblymember Jim Wood introduced AB 290, a bill that limits the amount of payment for medical services for dialysis providers to the Medicare rate, according to his website. This only impacts patients that have premiums paid by third-party payers, such as the American Kidney Fund.

When dialysis companies, through a third party, “steer patients away from Medicare or Medi-Cal by indirectly paying a patient’s premiums, for the company’s own financial benefit”, health care premiums increase for everyone, according to Wood’s website.

The bill discriminates against low-income dialysis patients, said Kathy Fairbanks, the spokesperson for the Dialysis is Life Support coalition. The organization includes doctors, medical societies, businesses and dialysis patients opposed to AB 290.

If the bill is passed, the American Kidney Fund will have to leave California, Fairbanks said. The nonprofit organization helps pay low-income dialysis patients’ health care premiums through grants.

The bill has to be heard by the Senate Health Committee by July 12, Fairbanks said.

The American Kidney Fund would have to leave the state because AB 290 conflicts with U.S. Department of Health and Human Services Advisory Opinion 97-1, said the fund’s Senior Director of Communications Alice Andors. 

“Our program is structured under the opinion, which creates a firewall between contributors (to the fund) and our grants,” Andors said. “The reason for the firewall is so patients can choose whatever health provider they want and not be influenced to choose one that donates to us.”

The bill would make the American Kidney Fund identify patient information, which conflicts with the federal guideline, Andors said. After talking with legal and outside councils, the organization decided that if the bill passed, they would have to cease operations in California.

AB 290 ultimately means Annie Maldonaldo-Escalera’s death, Annie said.

The American Kidney Fund pays almost $400 a month towards the couple’s insurance premiums, Robert Maldonaldo-Escalera said.

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“Without that money, we have to figure out if we are going to put gas in the car, buy food or pay the electricity,” he said.

The couple isn’t able to work because of dialysis and other routine medical appointments. They also have a 23-year-old son with high-functioning autism who they need to care for.

Over 80 percent of dialysis patients can’t work, Andors said.

But undergoing dialysis is a full-time job, she said.

In 2018, more than 3,700 low-income dialysis and transplant patients in California relied on grant assistance from the American Kidney Fund, according to a fund press release.

“We made it clear to legislators if this becomes law, we cannot provide assistance to people in California,” Andors said.

A few of the effects of AB 290 on low-income patients, according to the American Kidney Fund, will be:

  • Some patients will be unable to afford even their Part B premiums, threatening their Medicare coverage.

  • Those who cannot afford their Medigap premiums will be forced to pay for Medicare’s 20 percent coinsurance, which can average to $7,000 a year, Fairbanks said.

  • Some patients will have no choice but to go without health coverage altogether and use emergency rooms for treatment.

“We disagree with the American Kidney Fund’s interpretation of the Health and Human Services advisory opinion and have asked for a legal opinion, which is in process,” Wood said in an email. “This bill does not stop the American Kidney Fund from continuing to help patients pay for their premiums, and it doesn’t stop the dialysis companies from making contributions (to the fund). It just stops these large dialysis companies from leveraging their donations into higher reimbursement rates...I don’t author health care legislation unless it puts patients first and this bill is no exception.”

Senator Melissa Hurtado is part of the Senate Health Committee, who will hear the bill in the coming weeks, Fairbanks said. Hurtado could not be reached for comment.

Annie Maldonaldo-Escalera was a nurse for 20 years, she said. She has served students, inmates and low-income patients. She and her husband are regular volunteers for the community.

“It's troubling that doing over 20 years of service, the government is going to turn its back on me,” she said. “(The bill) worries me, but not only because of me. I’m more worried about how it would affect my son.”

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