Why It Matters
The Kidney Care Council is lobbying on the Kidney Care Access Protection Act, which would extend supplemental payments for innovative dialysis drugs and refine labor cost calculations in the ESRD payment system. This is a more favorable pathway than CMS’s proposed incremental annual adjustments. At the same time, the council must manage reputational risk: Sen. Richard Blumenthal has pressed the FTC to investigate what he calls "predatory, monopolistic potential practices" by the two companies controlling roughly 75 percent of U.S. dialysis clinics.
By the Numbers
The Kidney Care Council reported $85,000 in in-house lobbying expenditures for first quarter 2026, part of a nearly two-decade advocacy presence totaling approximately $15.06 million across 73 disclosure reports since 2007. No external firms were retained this quarter—a shift from the council’s historical strategy of supplementing internal capacity with outside counsel.
The KCC’s most active external partners have included Lester Health Law PLLC (49 filings, 2014–2026), Alston & Bird LLP (43 filings, 2004–2017), Squire Patton Boggs (32 filings, 2003–2014), and Avenue Solutions (17 filings, 2015–2019). Historically, the council’s lobbying has concentrated on Medicare/Medicaid issues (66 filings) and broader healthcare matters (59 filings).
The Agenda
The Kidney Care Council is focused on Medicare reimbursement, payment stability, and patient access.
The Kidney Care Access Protection Act would stabilize Medicare payments for new dialysis drugs and adjust workforce cost calculations. The Restore Protections for Dialysis Patients Act would prevent private insurers from discriminating against ESRD patients. The New Era of Preventing End-Stage Kidney Disease Act targets prevention and research—consistent with the KCC’s broader healthcare advocacy.
Broader Context
The KCC’s lobbying unfolds against significant headwinds. Approximately 45 percent of dialysis patients rely on Medicaid, and one state slashed kidney dialysis Medicaid reimbursement by 30 percent in 2025. CMS terminated the ESRD Treatment Choices Model two years early after it failed to boost home dialysis and transplantation, deepening payment uncertainty.
The council competes for influence alongside the Renal Healthcare Association, the Alliance for Home Dialysis, and Dialysis Patient Citizens in a crowded advocacy ecosystem.
Between The Lines
The Kidney Care Access Protection Act has bipartisan, bicameral backing from Reps. Carol Miller (R-WV) and Terri Sewell (D-AL) and Sens. Bill Cassidy (R-LA), Cory Booker (D-NJ), Kevin Cramer (R-ND), and Martin Heinrich (D-NM). The End Kidney Deaths Act, championed by Reps. Nicole Malliotakis (R-NY) and Josh Harder (D-CA), addresses the transplant shortage through tax credits for living donors.
But scrutiny is mounting. Sen. Blumenthal has questioned a federal investigation into alleged predatory practices by major dialysis companies, and Rep. Emanuel Cleaver (D-MO) has raised concerns about Medicaid cuts affecting nearly half of all ESRD patients. CMS’s early termination of its ESRD payment experiment further underscores why Congress is pursuing legislative alternatives.
Competitive Landscape
The KCC faces a fragmented but largely aligned advocacy ecosystem. The Renal Healthcare Association fields 22 lobbyists and spent $70,000 per quarter in 2025. The Alliance for Home Dialysis spent $50,000–$100,000 per quarter focused on Medicare home dialysis coverage. Dialysis Patient Citizens lobbies on similar legislative priorities from the patient perspective. While these groups broadly align on core reimbursement and insurance protection bills, they diverge by focus area—forcing the KCC to compete for congressional attention while coordinating on shared priorities.
The Bottom Line
The Kidney Care Council spent $85,000 on in-house lobbying in the first quarter of 2026, pursuing a focused strategy: advance the Kidney Care Access Protection Act while managing intensifying scrutiny over market consolidation and industry practices. Bipartisan momentum exists—but so does congressional skepticism. The council’s ability to shape federal kidney care policy will depend on how effectively it navigates both.
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