HHS announced Oct. 20 a national plan to improve kidney disease care as part of Make America Health Again’s focus on chronic disease. Approximately 37 million American adults have kidney disease, but many lack a diagnosis.
The plan, unveiled by HHS Secretary Robert F. Kennedy Jr., targets what the agency calls “structural deficiencies” across three areas: the dialysis market, the organ transplant system, and prevention and innovation. An estimated 87% of adults with chronic kidney disease do not know they have it, according to HHS.
Much of the document‘s argument rests on a lack of market competition, contending that “in many cases, government should do less” and that decades of overregulation have weakened kidney care. It singles out dialysis market concentration — two chains, DaVita and Fresenius Medical Care, control roughly 74% of the market, up from about 59% in 2006 — and argues dominant players use their market power to command higher prices. The two companies are under Federal Trade Commission scrutiny.
Private insurance and Medicare Advantage plans pay up to 500% and 25% more for dialysis, respectively, than original Medicare, the plan said.
To spur competition, HHS said it would consider streamlining certification requirements that raise upfront costs for new dialysis suppliers and investigating anti-competitive tactics by the largest firms.
On transplantation, the plan builds on recent moves to hold organ procurement organizations accountable, including the first-ever decertification of an OPO for performance in September 2025.
Organ donations rose 21% and transplants 24% between 2019 and 2023, yet the plan presses for stronger OPO oversight, a shift to a multi-vendor transplant network and an expansion of living kidney donation, which has stayed largely flat since 2000. Roughly 90,000 Americans remain on the kidney transplant waiting list, many waiting three to five years for a donor organ.
For prevention, the plan frames the federal government’s role as the dominant payer for end-stage renal disease as a disincentive for private insurers to invest in earlier detection. ESRD patients make up less than 1% of the population but accounted for $24.4 billion in original Medicare spending in 2023. The plan suggests the CMS Innovation Center develop a payment model rewarding better diagnosis and treatment of early-stage disease, pointing to its recently announced ACCESS Model as a template.
The plan marks the next step in a reform agenda that began with the 2019 executive order Advancing American Kidney Health, now folded into Mr. Kennedy’s broader chronic disease push.
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