Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1641_3314.pdf
Page Number: 12.0

Cite as:  596 U. S. ____ (2022) 

3 

KAGAN, J., dissenting in part 

relationship between end stage renal disease and dialysis—
and the text it wrote reflects that knowledge.  The statute 
proscribes not just differentiation “on the basis of the exist-
ence of end stage renal disease,” but also “on the basis of . . . 
the  need  for  renal  dialysis,  or  in  any  other  manner.” 
§1395y(b)(1)(C)(ii).  The back half of that provision prevents 
exactly  the  circumvention  the  majority  today  allows.    It 
bars  plans  from  differentiating  between  people  with  and
without end stage renal disease even when that differenti-
ation is accomplished indirectly—by targeting their treat-
ment, or by relying on some other proxy for the condition. 
So contra the majority, the statutory text does indeed pro-
hibit differentiation as to services—and not only as to indi-
viduals.  See ante, at 6, n. 2. 

That reading also fits with the statute’s purpose.  As the 
majority  recognizes,  the  MSPA’s  renal  disease  provisions 
were designed to prevent plans from foisting the cost of di-
alysis  onto  Medicare.    See  ante,  at  2.  Yet  the  Court  now 
tells plans they can do just that, so long as they target dial-
ysis, rather than the patients who rely on it, for disfavored 
coverage.  Congress would not—and did not—craft a statute 
permitting such a maneuver.  Now Congress will have to fix 
a statute this Court has broken.  I respectfully dissent.