HHS Unveils Kidney Care National Plan, Aims at Dialysis Market Dominated by DaVita and Fresenius

The Department of Health and Human Services launched its Kidney Care National Plan today, Oct. 20, calling it a department-wide strategy for American kidney care under the Make America Healthy Again banner.

The plan rests on three priorities: preventing kidney failure, improving dialysis care and expanding patient choice, and reforming transplantation.

The market HHS wants to open up

The dialysis side is the most pointed. The plan calls for more competition in a market dominated by DaVita and Fresenius Medical Care, which together hold roughly 74 percent of it, according to The Hill.

Bloomberg Law reports the proposals include cutting the requirements to open a dialysis center. HHS describes the goal as promoting competition and reducing barriers to entry for new providers.

The stakes are large. HHS estimates more than 830,000 Americans live with end-stage renal disease. Bloomberg Law describes the federal government as facing a growing cost crisis over kidney care.

Less government, by HHS's own account

The plan's language leans hard toward limited government. "In many cases, government should do less, focusing its efforts on promoting accountability, competition, and innovation," it says. It adds that a federal role is warranted "in the narrow circumstances where a specific, identifiable market failure prevents private actors from serving the public interest."

HHS also points at Washington itself. The department indicated that the federal government's role in paying for end-stage renal disease care is a primary barrier to better prevention.

That is a notable admission. Medicare is the dominant payer for kidney failure, and the plan names the payment structure as part of the problem.

Catching the disease earlier

An estimated 37 million American adults have kidney disease, and most do not know it. Treatment too often starts after significant damage has occurred, leaving patients dependent on lifelong dialysis or a transplant.

The plan aims to detect disease sooner, intervene earlier and advance treatments that slow or stop progression. HHS Secretary Robert F. Kennedy Jr. said the goal is to "preserve kidney health, give patients more choices, and help more Americans avoid kidney failure and live longer, healthier lives."

Transplants and a fight over "monopoly"

Roughly 90,000 Americans are on the kidney transplant waiting list, and many wait three to five years for a donor kidney.

HHS said it will advance a National Transplant Expansion Strategy building on President Trump's 2019 executive order, Advancing American Kidney Health. The strategy aims to make living donation easier and more accessible.

At an announcement event at JPS Health Network in Fort Worth, Texas, Kennedy said a monopoly over the organ transplant program had corrupted the system over time. HRSA Administrator Tom Engels, who appeared with him, said the plan aims to ensure no corruption exists in dialysis and transplant systems and to stop monopolies within them.

DaVita pushes back on one point

DaVita issued a statement today saying it "shares the Administration's urgency" and that the plan "reflects many of DaVita's priorities." It endorsed earlier detection, slowing progression and expanding patient choice.

The company drew a line at one claim. "Where we differ is the suggestion that kidney care has lacked innovation or that scale stands in its way," DaVita said. It argued that scale lets it fund investments in technology and clinical advances and spread them to patients faster. DaVita said it is in the middle of rolling out a major clinical innovation across its centers.

DaVita also cited a different figure from HHS's on awareness, saying 87 percent of adults with chronic kidney disease do not know they have it. It cautioned that preventing disease must not be "conflated" with delivering lifesaving care to people already in kidney failure.

The model DaVita holds up

DaVita pointed to the Kidney Care Choices model run by the Center for Medicare and Medicaid Innovation as proof that value-based kidney care works. The model, which CMS began in 2022, encourages providers to care for patients with advanced chronic kidney disease before dialysis starts.

CMS's own documents show a mixed record. The agency reported gains on some quality measures, including a higher rate of home dialysis. Its evaluation also found the model did not reach its savings goal. CMS has changed the payment mechanics and participant financial responsibility starting in 2026.

Only about 12 percent of American dialysis patients receive treatment at home, according to NPR. The 2019 initiative had set a goal of getting 80 percent of new end-stage renal disease patients onto home dialysis or a transplant by 2025.

Whether lowering entry barriers brings new dialysis operators into a market two companies hold roughly three-quarters of is the open question. So is whether the payment models HHS and DaVita both point to can deliver the savings the Kidney Care Choices evaluation did not find.