By Dana A. Kuhn & Clorinda Walley
April 27, 2018 at 5:00 am ET
Some marketplace health insurance providers have effectively created a new way to deny coverage to patients with pre-existing conditions. Insurers in 42 states now kick people off their plans just because they receive charitable assistance to help cover their premium and out-of-pocket costs for health care.
Patients who receive premium and cost-sharing assistance are disproportionately likely to have rare or chronic diseases and need expensive treatments — which is why many receive nonprofit assistance in the first place. Regrettably, chronically ill patients remain an easy target, and those who are financially vulnerable are most at risk. Individuals living with costly conditions such as cancer, cystic fibrosis and hemophilia depend on nonprofit assistance to live independent lives without reliance on government programs.
For over 30 years, patient assistance organizations have acted as a safety net for people with rare and chronic illnesses — ensuring access to treatments and bridging gaps in care. But the safety net those nonprofits provide is being eroded by insurers that take advantage of a misguided 2014 Centers for Medicare and Medicaid Services rule that allows them to prohibit third-party payments by nonprofit organizations.
It makes no sense for federal policies to prevent charities from assisting Americans. Yet, the CMS regulation has given insurance providers a permission slip to discriminate against patients who use charitable assistance to access expensive care. If a patient receives copay or premium assistance from a charity, the government allows insurance companies to void coverage plans or even demand reimbursement.
In response, Congressman Kevin Cramer (R-N.D.) introduced a bill that now has more than 130 bipartisan co-sponsors who want to correct this harmful guidance. The Access to Marketplace Insurance Act seeks to remedy discriminatory insurance practices and protect charitable entities dedicated to helping rare and chronic disease patients who struggle to afford their care. It states that marketplace insurers must accept premium and cost-sharing assistance from nonprofit organizations, places of worship and local civic organizations.
This week, more than 20 leading patient advocacy and assistance organizations met with members of Congress to urge passage of this bill so that they can continue to assist patients in need.
Unsurprisingly, even though health insurers continue to reap record profits, they have come out strongly against this bill. In doing so, they conveniently group together specific types of patient assistance organizations and cite inappropriate coverage steering practices by some bad actors.
The fact is, the Access to Marketplace Insurance Act specifically addresses the potential for improper practices. For instance, it requires the Department of Health and Human Services to modify existing rules or create new regulations to ensure that patient assistance programs notify patients when they qualify for public assistance programs such as Medicaid or Medicare. With the passage of this bill, patient assistance programs could no longer steer patients to marketplace plans without their consent or understanding of their circumstances.
There are hundreds of thousands of patients living with various disorders who rely on premium and cost-sharing assistance programs offered by nonprofit organizations. By allowing insurers to deny charitable assistance, patients are left with few options: either become financially insolvent to qualify for federal assistance or receive uncompensated care via the local hospital emergency room.
Everyone needs access to care to address a given illness. But at its core, health care is about getting more time to experience special moments with family and friends that make life worth living. Patients have a right to choose the health plan that best meets their needs to do so. No one should lose this right because of disease-based discrimination.
The Affordable Care Act led to millions of newly insured Americans, though most still cannot afford their medical bills even with insurance. If the insurance industry prevails, Americans cannot be certain that charitable support will be made available in times of great need.
Our goal is to ensure that patients obtain the coverage they need without being forced into public programs through financial insolvency. If the federal government shares this goal, Congress should act on it and pass the Access to Marketplace Insurance Act.
Dana Kuhn is the founder and president of Patient Services Inc.
Clorinda Walley is the president of Good Days.
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