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6  MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH 

BENEFIT PLAN v. DAVITA INC. 
Opinion of the Court 

supplies  an  objective  benchmark  or  comparator  against 
which to measure a plan’s coverage for outpatient dialysis. 
Absent  some  benchmark  or  comparator,  courts  would 
have  great  difficulty  trying  to  make  an  apples-to-
apples comparison of a plan’s coverage for outpatient dialy-
sis  against  its  coverage  for  other  services.    Group  health
plans cover services for many different health issues at var-
ied rates.  Those rates may reflect negotiations with third
parties, the needs of a particular plan’s beneficiaries, and
other factors such as geography.  Courts would be entirely
at sea in trying to determine an appropriate benchmark or 
comparator  for  outpatient  dialysis.    Put  simply,  DaVita’s 
approach  is  a  prescription  for  judicial  and  administrative 
chaos,  and  further  demonstrates  that  DaVita’s  disparate-
impact theory is not a correct interpretation of the statute.2 
DaVita’s position would ultimately require group health
plans to maintain some (undefined) minimum level of ben-
efits  for  outpatient  dialysis.  But  this  statutory  provision
simply  coordinates  payments  between  group  health  plans 
and Medicare.  As the Government itself acknowledges, the 
statute does not dictate any particular level of dialysis cov-
erage by a group health plan.  See Brief for United States 
as Amicus Curiae 13.  If Congress wanted to mandate that 
group health plans provide particular benefits, or to require
that  group  health  plans  ensure  parity  between  different
kinds of benefits, Congress knew how to write such a law.
It did not do so in this statute.  To the extent that Congress 
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2 DaVita’s related proxy theory—that singling out outpatient dialysis
is simply a proxy for singling out individuals with end-stage renal dis-
ease because those individuals disproportionately receive outpatient di-
alysis—likewise finds no support in the statutory text.  The statute re-
quires  that  a  plan  provide  the  same  dialysis  benefits  regardless  of 
whether  an  individual  has  end-stage  renal  disease.    If  a plan  provides
the same benefits to all individuals, the plan does not “differentiate in 
the benefits it provides” to individuals with and without end-stage renal 
disease.  §1395y(b)(1)(C)(ii) (emphasis added).  This statute is a coordi-
nation-of-benefits statute, not a traditional antidiscrimination statute.