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2  MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH 

BENEFIT PLAN v. DAVITA INC. 
KAGAN, J., dissenting in part 

hardly  anyone  else—undergoes  outpatient  dialysis.
Ninety-seven percent of people diagnosed with end stage re-
nal disease—all those who do not obtain a preemptive kid-
ney transplant—undergo dialysis.  See National Institutes 
of  Health,  United  States  Renal  Data  System,  2021  Ann. 
Data  Rep.:  End  Stage  Renal  Disease,  ch.  1,  figure  1.2, 
https://adr.usrds.org/2021/end-stage-renal-disease. 
And 
99.5% of DaVita’s outpatient dialysis patients have or de-
velop end stage renal disease.  See Brief for Respondents 6. 
Because  that  is  so,  common  sense  suggests  that  we
should not care whether a health plan differentiates in ben-
efits  by  targeting  people  with  end  stage  renal  disease,  or 
instead by targeting the use of dialysis.  When “status and 
conduct”  are  proxies  for  each  other,  “[o]ur  decisions  have 
declined  to  distinguish”  between  them.  Christian  Legal 
Soc.  Chapter  of  Univ.  of  Cal.,  Hastings  College  of  Law  v. 
Martinez,  561  U. S.  661,  689  (2010).    So,  for  example,  we 
have explained that a penalty for “homosexual conduct” is
a penalty for “homosexual persons.”  Lawrence v. Texas, 539 
U. S. 558, 575 (2003).  And likewise, a “tax on wearing yar-
mulkes  is  a  tax  on  Jews.”  Bray  v.  Alexandria  Women’s 
Health  Clinic,  506  U. S.  263,  270  (1993).    The  same  goes
here: A reimbursement limit for outpatient dialysis is in re-
ality a reimbursement limit for people with end stage renal 
disease.  And so a plan singling out dialysis for disfavored
coverage  “differentiate[s]  in  the  benefits  it  provides  be-
tween individuals having end stage renal disease and other 
individuals.”  §1395y(b)(1)(C)(ii).  That is so even if, as pe-
titioner Marietta notes, dialysis is also a treatment for some
miniscule number of people with acute kidney injury.  See 
Reply Brief 13.  That a proxy is only 99.5% (not 100%) ac-
curate should make no difference.  A tax on yarmulkes re-
mains a tax on Jews, even if friends of other faiths might 
occasionally don one at a Bar Mitzvah. 

And  if  common  sense  were  not  enough,  statutory  text
would come to the rescue.  Congress was well aware of the