PRICED
Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc.
596 U.S. 880 (2022) · 2022
A plan may cover dialysis badly for everyone — and because it fails everyone equally, it discriminates against no one.
“If a plan does not differentiate in the benefits provided to individuals with and without end-stage renal disease, then a plan has not violated that statutory provision, and the differentiation inquiry ends there.”
The Ruling
A group health plan that limits outpatient dialysis coverage uniformly for all participants does not "differentiate" against individuals with end-stage renal disease under the Medicare Secondary Payer statute, however severely the limit falls on them.
The Personhood Argument Not Made
Uniformity is doing the work here. Almost everyone on outpatient dialysis has end-stage renal disease, so a rule that names only the treatment reaches only those patients — while remaining, on its face, a rule about a service rather than about people. The statute is built to detect differentiation between persons. A limit written about a procedure is invisible to it. The class is targeted precisely by never being mentioned.
The Execution Gap Created
The protection against being singled out survives fully intact. It simply does not detect a rule that singles you out without naming you. Formal equality is preserved and the cost lands on one group, which is what makes this a pricing mechanism rather than an exclusion.
Primary sources & research
Related cases
Part of The Personhood Prism, the companion to The Execution Gap by Thomas William Hornig. See all personhood cases →