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Expand chart
Note: Current through June 30, 2019; Data: United Network for Organ Sharing; Chart: Chris Canipe/Axios

President Trump signed an executive order yesterday modernizing kidney disease care for the first time in decades, a move that could reduce spending and improve treatment for one of the country's most pervasive illnesses.

Why it matters: This could be a big deal for the 37 million Americans suffering from chronic kidney disease, including 726,000 with kidney failure.

The big picture: The executive order requires Medicare to test different payment models encouraging preventive kidney care, home dialysis (versus facility-based dialysis) and kidney transplants.

  • The administration will also push for the development of artificial kidneys and speed up the kidney matching process so that more people can get transplants.
  • Almost 100,000 Americans are waiting for a kidney transplant, by far the most common organ transplant, and more than 100,000 begin dialysis each year.

The administration's goals are ambitious: It wants to reduce the number of patients with kidney failure by 25% by 2030, have 80% of patients who do develop it in 2025 either receive home dialysis or a kidney transplant, and double the number of kidneys available for transplant by 2030.

What they're saying: Encouraging home dialysis would obviously shake up the business models of dialysis clinic operators, namely the duopoly of DaVita and Fresenius. But they've already been moving in this direction, said Dan Mendelson, founder of Avalere Health.

  • "Home dialysis isn’t a full replacement for traditional dialysis, and the large chains have been preparing for this evolution for years," he said.

The bottom line: The focus on home dialysis and prevention are good for patients, and the executive order "could also reduce federal cost somewhat if implemented properly – but we need more detail to really assess that," Mendelson said.

Go deeper: The growing toll of kidney disease

Go deeper

The Exvangelicals

Illustration: Aïda Amer/Axios

Even as evangelicals maintain their position as the most popular religion in the U.S., a movement of self-described "exvangelicals" is breaking away, using social media to engage tens of thousands of former faithful.

The big picture: Donald Trump's presidency, as well as movements around LGBTQ rights, #MeToo and Black Lives Matter, drew more Americans into evangelical churches while also pushing some existing members away.

Updated 4 hours ago - Science

Huge wildfire reaches edge of Sequoia National Park

A plume of smoke and flames rise into the air as the fire burns towards Moro Rock during the KNP Complex fire in the Sequoia National Park near Three Rivers, California, on Saturday. Photo: Patrick T. Fallon/AFP via Getty Images

Firefighters in Sequoia National Park were working into the night after two wildfires merged to reach the Giant Forest Saturday.

Why it matters: This forest contains over 2,000 giant sequoias, including the General Sherman Tree — the world's largest tree by volume. Park officials wrapped the redwoods in foil last week as the Paradise and Colony Fires, now known as the KNP Complex Fire, neared. Protection efforts appeared to be working overnight.

5 hours ago - World

Hong Kong holds first "patriots only" elections

Hong Kong Chief Executive Carrie Lam during a news conference last Monday. Photo: Lui Siu Wai/Xinhua via Getty Images

Hong Kong's elections to choose the city's Election Committee members opened to a select group of voters on Sunday, under a new "patriots only" system imposed by China's government.

Why it matters: All candidates running to be members of the electoral college have been "vetted" by Beijing, per Reuters. They will go on to choose the Asian financial hub's next leader, approved by China's government, and some of its legislature.