As America continues to reckon with racial injustice, we cannot let the opportunity to advance equity slip through our fingers.
For Americans of color, healthcare disparities are a constant burden: as evidenced by prevalence and morbidity in areas as diverse as Covid-19, cardiovascular disease, diabetes, asthma, and maternal health, among others.
Stemming from a legacy of slavery and structural racism, these problems will not disappear overnight. But by continuing the ongoing conversation about equity – and backing it up with real, structural change — America can right these historic wrongs by expanding access to care and improving patient outcomes.
When it comes to chronic kidney disease (CKD), an issue I am particularly interested in given its major impact in my community, the statistics are stark. Over 37 million Americans live with kidney disease today—representing roughly 15% of all adults in the country. Black and African Americans are nearly 4 times more likely to suffer from the chronic condition, which occurs when a patient’s kidneys cannot effectively filter out toxins from the body, resulting in a series of increasingly dire complications including the need for dialysis and even death.
Moreover, research shows that Black and African Americans face significantly higher rates of obesity, high blood pressure, and diabetes than white Americans – all risk factors for CKD. Throw in physiological predispositions, social determinants of health, food insecurity, transportation challenges, lack of education, a dearth of access to affordable health coverage and it is little wonder why non-Hispanic Black adults show the highest proportion of patients living with CKD.
A significant number of CKD patients suffer from a complication called iron deficiency anemia (IDA). By preventing the body from effectively absorbing the iron it needs to properly carry oxygen throughout the bloodstream, IDA can cause fatigue, weakness, and advanced progression of kidney disease. Yet, convenient care is frustratingly out of reach for many, particularly in the Black community, due to the same structural barriers that plague our health system more broadly.
For example, the only Medicare-covered treatment for non-dialysis dependent patients with IDA involves going to hospitals or infusion centers, where patients are hooked up to a machine that delivers the necessary drug drip by drip intravenously. Even before the pandemic, this approach was frustrating, inconvenient, uncomfortable for patients, and carried the risk of site infection and venous damage. Many patients and their families had difficulty making the appointments fit into their work schedule, while others had difficulty securing or paying for rides to the hospital or infusion center. Once the Covid-19 pandemic hit, the Black community faced some of the nation’s highest risks of infection and death—creating major anxiety for IDA patients forced to leave their homes to get care and risk exposure in clinical settings.
While Medicare only pays for infusion therapy, there is an effective oral treatment that patients could take safely at home. Unfortunately, this scientifically validated, FDA-approved treatment, called ferric citrate, has been out of reach for many patients since Medicare became the only major payer (public or private) to refuse to cover it. Imagine how all of the ride bargaining, schedule juggling, and weekly disruptions would vanish if patients could just take a simple pill. Now imagine what groups are worst impacted by the decision not to cover it, and you start to understand the structural inequity behind this “colorblind policy.”
As the nation continues to reckon with disparities in health, we have a real opportunity to remove barriers to proper kidney care. Fortunately, in a rare but refreshing act of bipartisanship, lawmakers from both sides of the aisle recently re-introduced the Renal Anemia Innovation Support and Expansion (RAISE) Act (H.R. 2934) in order to start removing the barriers to oral treatments for IDA. The bill – which was also introduced during the last Congress– is sponsored by Reps. Tom O’Halleran (D-AZ), Larry Bucshon (R-IN), Markwayne Mullin (R-OK), and G.K. Butterfield (D-NC). If passed, the legislation would direct the Medicare program to reinstate coverage for ferric citrate so thousands of high-risk kidney patients can take the oral treatment in the comfort and safety of their own homes.”
To be clear, aside from this legislation being a “no-brainer” that benefits all Medicare patients grappling with CKD, passing the RAISE Act is only one small piece of the nation’s equity puzzle. Going forward, it will be critical for Congress and the Administration rally behind commonsense solutions to tackle disparities in healthcare. As leaders on Capitol Hill consider additional legislation to address structural racism, I urge them to pass the RAISE Act so that Black and African Americans can better access the care they need to prevent kidney disease progression and death.
Photo: Justin Sullivan, Getty Images