Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1641_3314.pdf
Page Number: 4.0

2  MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH 

BENEFIT PLAN v. DAVITA INC. 
Opinion of the Court 

$50 billion annually on treatments for those individuals. 

During the initial years of the Medicare program after its
enactment  in  1965,  Medicare  acted  as  the  first  payer  for 
many  medical  services,  regardless  of  whether  a  Medicare
beneficiary was also covered under another insurance plan,
such as an employer-sponsored group health plan.  In 1980 
and 1981, in part due to rising Medicare costs, Congress en-
acted and amended the Medicare Secondary Payer statute.
That  statute  as  amended  makes  Medicare  a  “secondary” 
payer to an individual’s existing insurance plan for certain
medical services, including dialysis, when that plan already 
covers  the  same  services.  See  Medicare  and  Medicaid 
Amendments  of  1980,  §953,  94  Stat.  2647;  Medicare  and 
Medicaid  Amendments  of  1981,  §2146,  95  Stat.  800;  42
U. S. C. §§1395y(b)(1)(C), (2), (4).

Given  the  significant  costs  of  healthcare  for  those  with 
end-stage  renal  disease,  Congress  recognized  that  a  plan
might try to circumvent the statute’s primary-payer obliga-
tion by denying or reducing coverage for an individual who 
has end-stage renal disease, thereby forcing Medicare to in-
cur more of those costs.  To prevent such circumvention, the 
statute  imposed  two  specific  constraints  on  group  health
plans.  First, a plan “may not differentiate in the benefits it 
provides  between  individuals  having  end  stage  renal  dis-
ease and other individuals covered by such plan on the ba-
sis of the existence of end stage renal disease, the need for 
renal dialysis, or in any other manner.”  §1395y(b)(1)(C)(ii). 
Second, as relevant here, a plan “may not take into account
that an individual is entitled to or eligible for” Medicare due
to end-stage renal disease.  §1395y(b)(1)(C)(i); see §426−1. 

B 

DaVita is one of the two major dialysis providers in the 
United  States.    DaVita  provides  dialysis  to  hundreds  of 
thousands  of  individuals  each  year,  including  individuals
insured by their employers’ group health plans.