Medicare pays plans to prevent kidney disease—but only if they don't avoid sick patients
H.R. 9891 — PREVENT ESRD Act · Filed by Joe Wilson (R-SC) · Introduced Jul 22, 2026 · Referred to committee
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What it does
This bill creates a 10-year Medicare demonstration program (starting January 2027) that pays health plans a share of the savings Medicare achieves when those plans successfully prevent kidney disease patients from progressing to end-stage renal disease (ESRD). Plans that participate must cover kidney disease screening, preventive drugs, nutrition services, and disease management at low or no cost to patients; if their kidney disease progression rates fall below a benchmark, they receive 25% of the Medicare savings they generate. The program is funded with $5 million annually for administration and uses Medicare trust funds for shared savings payments.
Why we flagged it
The bill's core mechanism is a shared-savings demonstration that rewards health plans for preventing kidney disease progression. It is structured as a public health intervention with financial incentives, not a subsidy or carve-out.
What the text implies
- Plans may face pressure to enroll sicker kidney disease patients to maximize savings potential, creating adverse selection dynamics if benchmarks are not carefully calibrated.
- The 25% shared-savings split means Medicare retains 75% of savings, but plans' ability to recoup advance investment payments from shared savings creates a clawback mechanism that could discourage upfront investment.
The full analysis lists 5 implications of this text.
Who stands to gain
Health insurance plans (group, individual, Medicaid managed care, Medicare Advantage); Pharmaceutical manufacturers (drugs with kidney-function indications); Dialysis providers (indirectly benefit from reduced ESRD progression, lowering their patient volume)