Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1641_3314.pdf
Page Number: 10

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

1 

KAGAN, J., dissenting in part 

SUPREME COURT OF THE UNITED STATES 

_________________ 

No. 20–1641 
_________________ 

MARIETTA MEMORIAL HOSPITAL EMPLOYEE 
HEALTH BENEFIT PLAN, ET AL., PETITIONERS 
v. DAVITA INC., ET AL. 

ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF 
APPEALS FOR THE SIXTH CIRCUIT 

[June 21, 2022] 

JUSTICE KAGAN,  with  whom  JUSTICE SOTOMAYOR  joins,

dissenting in part. 

Today the Court crafts for the Medicare Secondary Payer
Act (MSPA) a massive and inexplicable workaround.  The 
MSPA instructs that a group health plan “may not differ-
entiate in the benefits it provides between individuals hav-
ing end stage renal disease and other individuals covered 
by such plan on the basis of the existence of end stage renal 
disease,  the  need  for  renal  dialysis,  or  in  any  other  man-
ner.”  42  U. S. C.  §1395y(b)(1)(C)(ii).    The  majority  holds
that  the  plan  here  does  not  so  “differentiate”  because  it 
draws  distinctions  only  between  dialysis  and  other  treat-
ments—not between individuals with end stage renal dis-
ease and individuals without it.  See ante, at 6, n. 2.  That 
conclusion flies in the face of both common sense and the 
statutory text.*

One fact is key to understanding this case: Outpatient di-
alysis is an almost perfect proxy for end stage renal disease. 
Virtually  everyone  with  end  stage  renal  disease—and 

—————— 

*Like the majority, I am unpersuaded by DaVita’s arguments concern-
ing  disparate-impact  liability  and  the  MSPA’s  separate  take-into-ac-
count clause.  See ante, at 5, 7.  But I part ways with the majority as to 
DaVita’s “proxy” theory (which the majority relegates to a footnote).  See 
ante, at 6, n. 2.