Will transplantation be considered an Essential Health Benefit?

Most of us involved clinically are living with some degree of uncertainty regarding the implications of health care reform (ACA of 2010, Obamacare) on transplantation. Certainly, the exact impact remains unknown, with some positive and some negative effects likely. I would refer you to the excellent articles by Axelrod, Millman, and Abecassis (AJT 10: 2197-2207, 2010) for a flavor of what might be coming.

Thus far, in reviews of what should comprise the “essential health benefit” (EHB) to be included in all standard coverage, transplantation fares very well. Most, if not all, benchmark policies include transplantation as a covered service. In December, 2011, however, HHS sent the issue of defining benchmark coverage back to the States to define. And, if you remember the Arizona turmoil of 2010-11, you may recall only kidney transplantation as unequivocally covered in that State’s Medicaid revision. The vigilant attention of local programs, coupled with pressure from AST, ASTS, and others, along with updated data confirming cost-efficacy of the non-covered allografts resulted in policy overhaul. With the recent HHS decision, AST and ASTS are in the early stages of enlisting members in each State to monitor developments in their home locale.

Please be aware that this process is underway, and let us know if you become aware of threats to transplant coverage in your State. Are there other related concerns or nuances we should be addressing?

Robert S. Gaston

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