The Medicare Secondary Payer Act (MSPA) aimed to protect individuals with end-stage kidney disease (ESKD) by ensuring that Medicare would not bear the cost of kidney care services that should instead be primarily covered by group health plans. However, the Supreme Court's 2022 decision in Marietta v. DaVita overturned this provision. Consequently, employer group health plans began excluding crucial kidney care services from coverage, forcing many ESKD patients off their private plans and onto Medicare.