Since 1972, Public Law 92-603, particularly Section 299I, provides Medicare coverage to all victims of end-stage renal disease (irreversible deterioration of kidney function). Medicare covers the high costs of treatment by hemodialysis or renal transplantation. This paper examines the decision to enact Section 299I and the policy debate which preceded it. Four characteristics of that debate are significant: (1) The debate was lengthy, beginning in the early 1960s and resolved in 1972. (2) The critical importance of paying for the cost of therapy was always clearly understood. (3) Strong resistance to expanding the federal government's responsibility from health research to include financing of patient care was encountered at every major juncture in the debate. (4) The resolution of the debate in the enactment of Section 299I occurred after very limited discussion and was inconclusive with respect to any definitive interpretation. The various medical and political factors affecting the policy debate are analyzed, and the implications of the decision are explored.