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4  MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH 

BENEFIT PLAN v. DAVITA INC. 
Opinion of the Court 

Inc., 598 F. Supp. 2d 1344 (ND Ga. 2009).  Moreover, sev-
eral weeks after the Sixth Circuit’s decision, the Ninth Cir-
cuit  agreed  with  Judge  Murphy’s  dissent  and  largely  re-
jected the Sixth Circuit’s analysis.  See DaVita Inc. v. Amy’s 
Kitchen, Inc., 981 F. 3d 664 (2020).

This Court granted certiorari to resolve the disagreement

between the Courts of Appeals.  595 U. S. ___ (2021). 

II 
A 
We first consider DaVita’s differentiation argument.  To 
reiterate,  the  relevant  statutory  provision  states:    A  plan
“may  not  differentiate  in  the  benefits  it  provides  between 
individuals having end stage renal disease and other indi-
viduals covered by such plan on the basis of the existence of 
end  stage  renal  disease,  the  need  for  renal  dialysis,  or  in
any other manner.”  42 U. S. C. §1395y(b)(1)(C)(ii).

That statutory language prohibits a plan from differenti-
ating in benefits between individuals with and without end-
stage renal disease.  For example, a group health plan may 
not  single  out  plan  participants  with  end-stage  renal  dis-
ease by imposing higher deductibles on them, or by covering
fewer services for them.  See 42 CFR §§411.161(b)(2)(i)–(iv). 
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 dif-
ferentiation inquiry ends there.1 

—————— 

1 If and only if a plan differentiates in benefits between those with and
those  without  end-stage  renal  disease,  the  next  question  would  be
whether the plan differentiates “on the basis of ” (i) the existence of the
disease, (ii) the need for renal dialysis, or (iii) in any other manner.  42 
U. S. C. §1395y(b)(1)(C)(ii).    Those  three  circumstances,  especially  the 
somewhat ungrammatically phrased catchall “in any other manner,” ap-
pear to cover the waterfront of possible bases on which a plan might dif-
ferentiate in the benefits provided to those with end-stage renal disease.
In other words, if there is differentiation, the differentiation is likely on
an impermissible basis.  Therefore, the only meaningful question under