HR 9891: PREVENT ESRD Act

HR 9891 in plain English: The PREVENT ESRD Act aims to reduce the progression of kidney disease to end-stage renal disease (ESRD). The bill addresses a condition that accounts for $126 billion in annual direct health care spending, including more than $50 billion per year Medicare spends on ESRD treatment, and would allocate $5 million per year from fiscal years 2026 through 2038 for related efforts.

Stated purpose

The bill directs the federal government to run a 10-year demonstration program that shares Medicare savings with private health insurance plans that invest in preventing or delaying kidney disease from progressing to end-stage renal disease (ESRD). It also requires a listening session to improve screening, diagnosis, and treatment of kidney disease at earlier stages.

Key points

• Targets prevention of kidney disease progression to end-stage renal disease (ESRD)
• Kidney disease currently accounts for $126 billion in direct health care spending each year
• Medicare spends more than $50 billion per year on ESRD-related treatment
• Provides $5 million per year for fiscal years 2026 through 2038 for program funding

Arguments supporters make

• Kidney disease costs Medicare over $50 billion a year, and early intervention could reduce that burden while keeping patients healthier longer
• Nine out of ten people with kidney disease don't know they have it, so this program creates financial incentives for insurers to find and treat patients earlier
• Allowing private plans to share in Medicare savings aligns business interests with better patient outcomes, encouraging investment in prevention without mandating it

Arguments opponents make

• A 10-year government demonstration program adds administrative complexity and cost, and there is no guarantee that projected savings will actually materialize
• Private insurers sharing in Medicare savings could benefit financially even if their efforts had little direct effect on slowing kidney disease, making it hard to confirm the program is working
• The bill does not address why nearly 90% of kidney disease patients are currently undiagnosed, so incentivizing insurers alone may not reach the most vulnerable or underserved populations

Tradeoffs

The program spends public funds upfront and shares future Medicare savings with private insurers on the bet that prevention now will cost less than ESRD treatment later, but if savings fall short or are hard to measure, the government bears the financial risk while insurers collect a portion of the benefit.

Current status in Congress: In committee.

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