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7
Access Problems of ESRD Patients

The high costs of dialysis and transplantation severely limited the access of most Americans to care for ESRD before 1973. Section 2991 of the Social Security Amendments of 1972 effectively resolved access problems stemming from financial considerations. That statute defined eligibility for ESRD beneficiaries in the following language:

(e) Notwithstanding the foregoing provisions of this section, every individual who—

  1. has not attained the age of 65;

  2. (A) is fully or currently insured (as terms are defined in section 214 of this Act), or (B) is entitled to monthly insurance benefits under title II of this Act, or (C) is the spouse or dependent child (as defined in regulations) of an individual who is fully or currently insured, or (D) is the spouse or dependent child (as defined in regulations) of an individual entitled to monthly insurance benefits under title II of this Act; and

  3. is medically determined to have chronic renal disease and who requires hemodialysis or renal transplantation for such disease; shall be deemed to be disabled for purposes of coverage under parts A and B of Medicare subject to the deductible, premium, and co-payment provisions of title XVIII.1

The 1972 amendment created a ''near-universal'' entitlement to Medicare coverage of ESRD treatment for most Americans. It did not, however, create an entitlement for all.2 Consequently, one question that Congress asked in its OBRA 1987 charge dealt with access problems of ESRD patients who are not eligible for Medicare coverage. The congressional charge also asked that the study consider access problems of Medicare-covered ESRD beneficiaries. Both are considered below, with a focus on dialysis patients. (Chapter 8 deals with access problems of kidney transplant pa-



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