The Department of Health and Human Services (HHS) on Oct. 20 released a Kidney Care National Plan, a department-wide strategy organized around three priorities: preventing kidney failure, restoring competition and patient choice in dialysis, and reforming the organ transplant system. HHS said agencies will use it to shape policy, payment, research and regulatory actions, but the document lists steps the department “will consider” rather than setting numeric targets, deadlines or new spending.
An estimated 37 million American adults have chronic kidney disease (CKD), and about 87% of them do not know it, according to an HHS fact sheet. Kidney disease was the eighth leading cause of death in the US in 2024. Roughly 831,000 Americans were living with kidney failure in 2023, and about 90,000 are on the kidney transplant waiting list, many for three to five years. Fewer than half of patients who start dialysis are alive five years later, the fact sheet says.
The cost falls largely on Medicare, which has covered patients with end-stage renal disease (ESRD) regardless of age since 1972. According to the 17-page plan, published by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), ESRD patients accounted for about $24.4 billion in Original Medicare spending in 2023, roughly 4.7% of fee-for-service spending, plus $27.7 billion in Medicare Advantage spending, a record total. Original Medicare spent a further $141.1 billion in 2023 on beneficiaries with CKD that had not yet progressed to kidney failure.
On prevention, HHS says it will consider commissioning a systematic evidence review of kidney disease screening in at-risk groups, including people with diabetes, hypertension, cardiovascular disease or a family history of kidney failure; designing payment models that prioritize prevention; working with researchers to identify validated surrogate endpoints that could support earlier Food and Drug Administration (FDA) approvals; and establishing research pathways for new diagnostics and precision-medicine therapies.
On dialysis, the plan describes a market in which the two largest chains hold roughly 74% of facilities, up from about 59% in 2006, and in which, as of 2019, roughly one-third of the US population lived in areas where the only dialysis provider was one of the two dominant firms. HHS says it will examine streamlining Medicare conditions for coverage for dialysis facilities, update certification requirements to ease home-based care, evaluate alternative treatment settings, and investigate “potential anticompetitive payment and legal strategies used by the largest firms.” Home dialysis use rose from 10.5% of patients in 2017 to 16% in 2023, the highest level in more than a decade.
On transplantation, HHS plans to continue competitive, multi-vendor contracting for the Organ Procurement and Transplantation Network, with a focus on its IT system; tighten accountability for organ procurement organizations (OPOs) and fast-track certification of new ones; establish an Organ Donation Corruption and Safety Task Force; and strengthen living donation through a National Transplant Expansion Strategy and a public awareness initiative. Kidney transplants rose 24% between 2019 and 2023, HHS says, and an ASPE analysis released with the plan associates the 2019 executive order on kidney health with roughly 2,000 additional transplants a year.
“Our goal is simple: preserve kidney health, give patients more choices, and help more Americans avoid kidney failure and live longer, healthier lives,” HHS Secretary Robert F. Kennedy Jr. said in the release. Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said the plan “puts prevention first and challenges policies that limit competition, innovation, and patient choice.”
Why it matters
Kidney groups broadly welcomed the direction. The National Kidney Foundation said it supports HHS’s focus on finding kidney disease earlier, slowing its progression, expanding patient choice, increasing transplantation and accelerating innovation. “For too long, America has invested far more in treating kidney failure than in preventing it,” said Dr. Jesse Roach, the foundation’s senior vice president for government relations.
Others pointed to the limits of what HHS can do alone. Colin Roskey, executive director of Kidney Care Partners, said the core problem is the payment system, which only Congress can change, and urged lawmakers to pass the Kidney Care Access Protection Act and the Restore Protections for Dialysis Patients Act, Healio reported. Dialysis provider DaVita said the plan reflects many of its priorities but added: “Where we differ is the suggestion that kidney care has lacked innovation.”
What to watch
The fact sheet describes the listed actions as “representative” and says the full plan sets out the complete set of recommendations, so the test will be which items become rules, payment models and enforcement. HHS said it has already moved to decertify OPOs that failed federal safety and performance standards, is investing up to $4.67 million in a KidneyX prize competition with the American Society of Nephrology on earlier identification of cardiovascular-kidney-metabolic risk, and has implemented the HOLD Act, passed in February 2026, to reduce financial barriers to living donation.
The caveats
The plan is a statement of federal direction, not a rule or an appropriation; it contains no funding commitments, numeric targets or timelines. The market-concentration figures and the projection that transplant growth since 2019 could yield up to $200 billion in economic benefits through 2040 come from HHS’s own analysis. DaVita has a direct commercial stake in the dialysis reforms the plan describes.
This article is for general information and does not replace advice from a qualified clinician. Corrections: email the editor using the address on the Contact page.
